Chapter 6. Adult Reconstructive Surgery

Adult reconstructive surgery in orthopedics has changed rapidly over the past several decades. Prior to the successful development of so-called low-friction arthroplasty of the hip in the late 1960s, treatment options for severe joint disease were limited. Reconstructive procedures with high success rates are now available for a variety of disorders, from marked degenerative hip and knee disease to rotator cuff tears of the shoulder. Research has increased the understanding of joint function and contributed to the success of almost all reconstructive procedures, and there is now tremendous demand for these procedures. In 2010, total knee arthroplasty and total hip arthroplasty procedures were estimated to number 770,000 and 280,000, respectively, in the United States and are increasing by approximately 65,000/year and 15,000/year, respectively. This is the result of their great success in returning patients to active lifestyles and the increasing numbers of older patients. Millions of Americans are now benefiting from these procedures for extended periods. Because the cumulative procedure failure rate is approximately 1% per year, 10 years after the operation, patients have approximately a 90% chance of still having a successful, well-functioning joint replacement.

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 6–1). Evaluation of the history, physical examination, and laboratory data is helpful in arriving at a diagnosis.

History

The history is very important in defining the disease process. The mechanism of injury and timing and duration of symptoms since onset are key factors. The mechanism of injury is most often insidious. The individual is often unable to recall a specific event that elicited the symptoms. However, when there was a sudden traumatic event in the past and especially when there was prior surgery, this information is important. The timing and severity of pain are valuable pieces of information. Most often, symptoms are initially mild and gradually worsen. Constant pain, night and day, ...