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OA and joint replacement

Bite-sized advice for busy GPs

1

Pain in the hip may herald loosening and impending failure of a total hip replacement, with the need for revision.

2

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.

3

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.

4

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.

5

Primary care management of obesity in those awaiting hip surgery may improve outcome and reduce postoperative morbidity.

6

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.

7

Patient education can help to reduce pain and disability in patients with knee osteoarthritis.1

8

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

9

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

10

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

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