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Adult reconstructive surgery in orthopedics has rapidly evolved over the past 30 years. Prior to the successful development of so-called low-friction arthroplasty of the hip in the late 1960s, reconstructive options for the hip and the knee were limited. Reconstructive procedures with high success rates are now available for a variety of disorders, from marked degenerative hip disease to rotator cuff tears of the shoulder. Research done in the last 30 years has increased the understanding of major joint function and contributed to the success of reconstructive surgical procedures in almost all cases, and there is now a tremendous demand for these procedures. In 1997, total knee arthroplasty and total hip arthroplasty procedures numbered 338,000 and 289,000, respectively, the result of their great success in returning patients to active lifestyles. Millions of Americans are now benefiting from these procedures for extended periods. Because their cumulative procedure failure rate is approximately 1% per year, 10 years after their operation, patients have approximately a 90% chance of still having a successful, well-functioning joint replacement.

Statistics from American Academy of Orthopedic Surgeons: Arthroplasty and Total Joint Replacement Procedures in the United States 1990 to 1997.


Evaluation of Arthritis


To treat arthritic conditions of the joints appropriately, an understanding of the disease process is essential. This begins with accurate diagnosis and a history of the progression of the disease, so that the future progression can be predicted and appropriate decisions regarding treatment can be made. The physician must evaluate the possibility of traumatic, inflammatory, developmental, idiopathic, and metabolic causes of the arthritis (Table 7–1). Evaluation of the history, physical examination, and laboratory data is helpful in arriving at a diagnosis.

Table Graphic Jump Location
Table 7–1. Causes of Arthritic Conditions.



Clearly the history is important in defining the disease process. The time course, including duration and behavior of symptoms since onset, is a key factor. Gradual rather than acute onset implies a nontraumatic cause. Swelling in the joints is an important sign, as is the distribution of joints if more than one is involved. The degree of interference with activities indicates the seriousness of the disorder.


The presence and extent of pain are valuable pieces of information. Constant pain, night and day, implies infection, cancer, or a functional disorder. Pain only with activity such as walking, standing, or running suggests joint loading. Pain that awakens the patient is considered severe and requires evaluation. Location helps ...

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