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Minding the Gap

Written by on February 7, 2016

There are two critical time gaps in joint injuries. The first is the interval from when a joint is injured to when arthritis sets in.The second is from when arthritis sets in to when you are considered old enough for artificial joint replacement surgery. For the knee, shoulder and ankle injuries that I’ve treated, these gaps have ranged from years to decades. But as we move into the 21st century, those gaps are looking very different. Let’s first look at them historically, starting with gap number one. In the past, when a significant cartilage injury occurred, the damaged cartilage was either ignored or removed. Those removal procedures—called meniscectomy for removing the knee joint meniscus, and chondroplasty for shaving away the articular cartilage—left the joints with poor shock absorption. The remaining cartilage surfaces wore out quickly, deforming the underlying bone. This in turn stimulated the formation of osteophytes(bone spurs), leading to instability of the joint. This was especially true when key ligaments (such as the ACL in the knee joint) were also torn, leading to further degradation. Arthritis—the wearing away of the cartilage and the deformation of the underlying bone—occurred almost universally after cartilage was removed. The gap in time before arthritis set in was often silent. Many people, especially pro athletes, assumed they were healed, and returned to high levels of impact sports. Not until late in their careers did they realize they were faced with decades of joint pain. The second gap is the time between when the arthritis has become symptomatic—with pain and loss of range of motion of the joint—and the time at which joint replacement is recommended. Joint replacements are generally not advised before the age of 65 because (a) they only last a couple of decades, (b) they are nonreversible, and (c) up to 50% of Read More

Struggling with Self-Expression

Written by on February 7, 2016

Growing up with Systemic JA and in an abusive household, I learned that my opinion was not wanted, that my existence was only valued based on what I could do for others. My mother needed me as an emotional extension of herself. Other abusers needed me as a means to an end. As a result, I know that my communication skills aren’t the best. As one can imagine, that complicates many aspects of my life – nowhere is this more obvious than in my interpersonal relationships. Intimate relationships are predicated on the notion that we share our lives with one person (or more) in an open manner. Everyday interactions require sharing of things from how your day was to food ideas to fun things to do. Even sex depends on this basic idea of communicating. When I met my husband in college, it took a while to find a balance between our introvert styles. We both had to grow in order to really share and build a life together. By the time we got married, we were completing each other’s sentences and the like. We still do – even before we say them sometimes! After spending eight years together and going through more than some couples face in a lifetime, I still find myself holding things back. These things mostly relate to my wants, desires, or needs. When we have plans that need to alter due to my physical state, I’ve gotten better at speaking up but that’s a newer development. When we’re being intimate, I still have a hard time saying that I’d like to try a new position or a new toy. Hell, I even have a hard time speaking up when I have a cramp and we should take a break! And I’m not alone. There are a lot of Read More

How safe are joint implants? (Implant Device Safety Series Post #3 of 4)

Written by on January 22, 2016

In a four-part series, we will explore the safety of joint implant devices as well as how patients can have a stronger voice in ensuring the safety of these devices by participating in research.

In the Week 3 post, we focus on the importance of patients being well-informed on various devices’ safety and effectiveness during their selection process. Interested patients can participate in an upcoming webinar (conference call) to discuss their individual experience with joint replacement.

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