当 to Get a 膝盖 or Hip Replacement-大发娱乐

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Dr. 米勒: 当's the best time to get that hip replacement? We're going to talk about that next on Scope Radio.

嗨，我是博士. Tom Miller, and I'm here with Dr. 克里斯•彼得斯. 克里斯•彼得斯 is a professor of 整形外科手术 here at the University of Utah.

Postponing a Joint Replacement

克里斯, 老锯是, 好吧, at least when I trained in medical school, if you had to have your hip replaced, 或者你的膝盖被替换了, you ought to wait as long as possible, maybe even until the time that you're crawling, because there was some concern that the surgery was a little risky. That's not the case now, is it?

Dr. 彼得斯: 不，你说得对，汤姆. 在过去，我可能会说在过去的二十年里，发生了非常深刻的变化. 当 hip and knee replacement was first begun in the late 1960s and 1970s, 那些最初的病例是在患有严重关节炎的人身上进行的, and they were folks who were predominately wheelchair-bound.

Dr. 米勒: They were the worst of the worst.

Dr. 彼得斯: Yeah, the worst of the worst. 随着时间的推移, what we have seen is that there's been a slow, 稳定的变化, 在很多情况下，等待可能对病人的整体健康有害, and so I think now we realize that, 例如, if a patient's in their early 60s and has some health problems, which is common these days, 糖尿病, 高血压, and their functional status is profoundly impaired, that is they can't go out and recreate, they can't go for a walk around the block, they can't go play with the grandkids comfortably, those patients are probably better off treated with surgery earlier, 而不是旧的传统智慧，尽可能地等待.

Advances in Joint Implant Technology

Dr. 米勒: 好吧, technology and techniques have improved, 我认为, remarkably since the first joint implants had been done, 正确的? So a lot has changed in terms of the functionality of the implants, 恢复的时间, 之后进行的物理治疗使人们可以更快地回到他们之前做的许多事情.

Dr. 彼得斯: 绝对, 一次又一次, back in the '70s and even into the early '80s and '90s, we had concerns about implant longevity. We used to tell patients, we hoped this would last, that a hip or a knee replacement would last ten years. 大发娱乐发现大发娱乐现在使用的这一代假肢的寿命大概是15到20年. 所以再一次, 那些60岁出头的病人很可能在他们的余生里都要做髋关节或膝关节置换术, 在他们生命的最后几十年里，他们的功能状态可能会很好.

Risks of Delaying Joint Replacement

Dr. 米勒: Now is it true the longer one waits, 关节周围的韧带和肌肉变得更弱? 我想，如果是这样的话，手术后修复那个区域会更加困难.

Dr. 彼得斯: 正确的, 大发娱乐发现，等待太久的病人来到大发娱乐大发娱乐时，大发娱乐称之为“去条件化状态”. So we start to see deterioration in other organs, and often what goes along with that is obesity and weight gain. And many of these things can be reversed. 当你恢复行走时，你就恢复了外出和锻炼的能力. 所以我认为现在的病人如果有髋关节或膝关节关节炎的话，越早越好.

当 is the 正确的 Time for a Joint Replacement?

Dr. 米勒: So 克里斯, when will the 正确的 time be? 我是说，这是因人而异的. 显然，这是个人决定，但你怎么建议病人?

Dr. 彼得斯: 最佳时间显然是因人而异的, 但如果病人来找大发娱乐，有关节炎的x光或x光片证据，并能向大发娱乐描述他们生活中的重大损害, 不管这种损害是指下班后不能出去打九洞高尔夫球, 或者这种缺陷是无法在周末和孙子孙女一起去动物园, and they're experiencing significant pain, 他们已经用了一段时间人们用来治疗疼痛的标准药物, such as anti-inflammatories, if they've gone through that process and they're in that position, they're probably ready for a joint replacement.

Non-Operative Therapy for Joint Pain

Dr. 米勒: 你有没有建议他们做一些其他的治疗比如关节注射润滑剂或者强的松龙, something to calm the joint down before you make that decision?

Dr. 彼得斯: 当然，大发娱乐称之为保守疗法或非手术疗法绝对是有作用的. 有证据表明, 例如 in the knee, corticosteroid injections can provide short-term symptomatic relief, 大发娱乐会在早期关节炎患者中使用这些药物. But once you get to significant bone-on-bone contact, and whether it's in the hip or the knee, 这些方式往往只是短期的缓解疼痛并不是治疗病人的长期策略.

Dr. 米勒: They just don't last, do they?

Dr. 彼得斯: 正确的.

Benefits of a Joint Replacement

Dr. 米勒: The primary reason to do a hip replacement, 据我所知, is to reduce pain and to increase function, but it's so much more than that, 不是吗，克里斯?

Dr. 彼得斯: 正确的, and it's really a fascinating thing. 作为整形外科医生，大发娱乐从这种狭窄的视野开始. You've got a patient who comes in with an 关节炎髋关节或者膝关节，大发娱乐对替换它感到很兴奋因为大发娱乐知道当大发娱乐做髋关节或膝关节替换时疼痛和功能会有相当可预测的改善, 但随着时间的推移，大发娱乐发现这对病人也有不可思议的额外好处. So their overall health tends to improve.

We see patients who come in to us as a diabetic, and who are significantly overweight, and now they can get back out and exercise, they can get on their bike, they get into a Zumba class, 他们会减肥. 通常他们会从胰岛素依赖型糖尿病变成口服药物控制型糖尿病. 大发娱乐看到大发娱乐看到整体健康状况的显著改善仅仅是因为髋关节或膝关节置换术后更活跃的能力.

Dr. 米勒: 所以它不仅仅是改善功能和减轻疼痛.

Dr. 彼得斯: 当然,是的. 我的意思是, 我认为这是关节置换外科医生没有意识到的事情之一，直到, 我会说, 过去十年左右, 但现在大发娱乐可以, 我认为非常可靠, with good literature support, 告诉病人，不仅他们的髋关节或膝关节关节炎会感觉好一些, but likely their overall 好吧-being will be better.

_{更新日期：2024年8月13日}
_{originally published: September 20, 2016}