OA and joint replacement
Bite-sized advice for busy GPs
Pain in the hip may herald loosening and impending failure of a total hip replacement, with the need for revision.
If this is needed, NICE recommends metal-on-metal resurfacing (MoM), a new technique that involves replacing the damaged surfaces of the hip joint with metal surfaces for young and active patients, removing less bone than with the conventional surgery.
Women of child-bearing capacity may not be suitable for MoM prostheses as higher levels of cobalt and chromium have been found after MoM and their effect on the fetus is unknown.
Good predictors of pain relief and functional restoration following hip replacement include: patients aged 45-75; weight less than 70kg; good social support; less preoperative morbidity.
Primary care management of obesity in those awaiting hip surgery may improve outcome and reduce postoperative morbidity.
One of the poor prognostic indicators for revision of a hip replacement is heavy work such as labouring, gardening and foundry work. Liaise with the occupational health department to identify opportunities for rehabilitation and a phased return to modified work.
Patient education can help to reduce pain and disability in patients with knee osteoarthritis.1
Strength and aerobic exercise programmes, either singly or combined, have been reported to lead to a small to moderate benefit in pain reduction and improve function in patients with osteoarthritis of the knee.2
Some studies suggest there is no benefit to injecting steroids into an osteoarthritic knee. Steroids did no better than placebo, which in itself showed a major effect, possibly due to the benefits of aspirating the knee.3
Return to driving depends on which side has been operated on; advice from the surgeon is needed. Patients need to be able to comfortably perform an emergency stop and drive without discomfort.
1. Mazzuca SA et al. Effects of self-care education on the health status of inner-city patients with osteoarthritis of the knee. Arthritis Rheum 1997;40:1466-1474
2. Baker K, McAlindon TE. Exercise for knee osteoarthritis. Curr Opin Rheumatol 2000;12:456-463
3. Kirwan JRR. Intra-articular therapy in osteoarthritis. Baillieres Clin Rheumatol 1997; 1: 69-794
Nerys Williams is clinical assistant in orthopaedics, Birmingham