Knee joint replacement surgery, or known by the name of Total Knee Arthroplasty, could help eliminate pain and restore function in the joints that have suffered damage. At the time of replacement joints, the bones and cartilage that is damaged will be removed and replaced with an artificial joint (prosthesis) made of metal alloy, a very strong plastic and polymer.

For knee joint replacement surgery performed by a specialist orthopedics. Before the surgical procedure performed, usually the doctor will ask medical history and perform examination of the knee. Not only that, the doctor also will perform X-ray investigation, to see how severe joint damage that has occurred. Other complete examination such as blood tests, electrocardiography (ECG) and urine tests also required.

What was the procedure or process of this surgery?
Surgery performed by making incisions in length between 15-20 cm at the knee so that the joints can be opened and the bone or cartilage that is damaged can be discarded.
Then the medical team will do some measurements process in order to make sure that the prosthesis fitted properly. Before the wound was closed again, they will re-do tests to assess whether the new joint that is functioning properly.
In order for recovery to take place properly, you should follow doctor’s instructions about diet, wound care and exercise.

Routine or daily activities could help the patients recover more quickly, current technology applied in medical equipment able to reduce disorder and diagnose disease more quickly and efficient.

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Jacques Calve (1975-1954) of Berck, France, Arthur T. Legg (1874-1939) of Boston, U.S.A. and George Perthes of Tubingen, Germany, are all said to have described Perthes’ disease in 1910. Hence this disease is sometimes referred to as Calve-Legg-Perthes disease. With the help of radiography, Calve realised that some cases of tuberculous hips in children were actually cases of coxa plana. He saw that these rare cases of hip irritability had X-ray evidence of coxa vara, hypertrophy of the femoral head, increased density, fragmentation and flattening of the epiphysis. He noted that the disease was of short clinical duration, had good recovery, did not relapse and was not associated with adenopathy or abscess. Calve also described vertebral osteochondritis with collapse, which he attributed to vascular changes subsequent to trauma (although we now know that eosinophil granuloma is the common cause). Legg had wide interests, but is best known for the eight papers that he published on coxa plana. He included a treatment of traction hip splint and noted the limited degrees of movement.

The early 1900’s was also a time of improvement for spinal surgery. Russell A. Hibbs (1869-1932), was from the New York Orthopaedic Hospital and in 1911, published a report on a technique of spinal fusion that he had developed. Hibbs performed the first spinal fusion for tuberculosis and later performed a similar procedure for scoliosis. Joel Goldthwait (1867-1961) was another of the great Boston orthopaedists. He had a major interest in posture and in 1911, published a laminectomy from L1 to S3 performed on a man who developed bilateral sciatica followed by paraplegia after a lifting strain.

Enough for the history, lets move on the future.
The immediate challenges facing the modern orthopaedic surgeon are : The Human genome Project (sequencing the 23 human chromosomes; due for completion 2003) with the promise of gene therapy, human cloning and bovine prosthetic implants; corporate control of the practice of medicine with surgeons answering to corporate bosses rather than their patients and colleagues; the rise of the Internet with a more efficient interchange of information and the Global Burden of Disease where motor vehicle accidents are going to be the third greatest burden of morbidity by the year 2020. These challenges are there and are somewhat daunting but certainly less frightening than many that faced our proud forebears and teachers. If alive, John Hunter would be in the forefront of these scientific developments and I suspect, chide us for our tardiness in embracing such challenges. In some ways, Orthopaedics has lost its way by producing surgical technicians (surgeons merely content to operate) with not enough commitment to fundamental biomedical research and the protection of their craft.

DMPA is given by injection about once every three months, and is generally considered an effective, convenient and low-cost form of birth control. The contraceptive can, however, lead to significant bone loss.
While research has shown that this lost bone mass is often regained after women stop using DMPA, there are still concerns about whether substantial bone loss is completely reversible. So limiting the decline in the first place would be ideal.

In the new study, researchers found that among 95 women who used DMPA for two years, those who smoked or had a low calcium intake were at particular risk of significant bone density loss — defined as a decline of at least 5 percent in the spine or hip.
Current smokers were nearly four times more likely to lose that much bone mass as non-smokers were. On the other hand, the risk declined by 19 percent for every 100 milligrams (mg) of calcium a woman got each day.

Drs. Mahbubur Rahman and Abbey B. Berenson, of the University of Texas Medical Branch in Galveston, report the findings in the journal Obstetrics and Gynecology.
The study included 95 black, white and Hispanic women who were 24 years old, on average, at the outset. Their bone density was measured when they began using DMPA and two years later.

Overall, 47 percent of the women showed at least a 5 percent decline in bone density in the spine or hip.
Of those women, 44 percent were current smokers, versus 32 percent of women who lost less bone mass. The average calcium intake in the former group was 484 mg per day — less than half of the recommended 1,000 mg for women their age.

According to Rahman and Berenson, the findings suggest that not smoking can go a long way toward limiting the bone loss associated with DMPA. The same appears true of even moderate calcium intake; women who got more than 600 mg of calcium per day had lesser bone loss — about 2 percent or less over two years.
In other findings, women who had ever had a child were also at lower risk of significant bone loss. They were half as likely as childless women to see their bone density decline by 5 percent or more.

The results suggest that for DMPA users who have had children, do not smoke and get at least 600 mg of calcium day, “concerns about bone health are minimal,” write Rahman and Berenson.
But when women do smoke or get little calcium, they add, doctors should offer them help with smoking cessation and counsel them on eating calcium-rich foods and taking supplements if needed.

Leg Length Discrepancy
Exactly how the hip replacement implants are placed, and the size of the implants, will determine the length of the leg after surgery. If the hip is felt to be too loose, or unstable and prone to hip dislocation, your surgeon may elect to place larger or longer implants in the joint. The downside of placing these larger implants is lengthening of the limb. Ideally, your surgeon wants the leg lengths to end up being symmetric, but that is not always the final result.

To prevent a post-operative leg length discrepancy, your surgeon will template x-rays of your hip with overlay schematics of the hip replacement prosthesis. By doing so, your surgeon can determine the expected size of implant needed at the time of surgery, and how much bone to remove during the procedure. In addition, some doctors are now using computer-guided systems to help confirm position and size of the hip replacement implants. Computer-guided surgery is the operating room equivalent to a GPS system, showing your anatomy on a screen to help guide positioning of the implants.

When leg lengths are unequal, patients may experience increased pain and muscle fatigue. When the leg length is increased by more than a few centimeters, the nerves of the leg may become stretched to the point that patients experiences numbness or pain further down the limb.

What To Do When Leg Lengths Are Different
Your surgeon can help you understand why your leg lengths are different. In some cases, a leg length difference may have been anticipated, and in others, unexpected. The usual treatment of a small leg length discrepancy is with a lift in the shoe of the shorter leg. If the discrepancy is more than about 2 centimeters, then a build-up of the sole of the shoe may be necessary.

In larger leg length discrepancies, surgery may be considered to re-size the implants or remove additional bone, but that is usually undertaken only in individuals severely affected. It is important to note that differences in leg length have not been shown to affect how long the hip replacement will last.