Do You Need a 臀部 or Knee Revision?

Dr. 米勒: You've had a hip or 膝关节置换 and need a revision, we're going to talk about that next on Scope Radio.

播音员: 向大发娱乐的专家大发娱乐提供有关您今天面临的最大健康问题的深入信息. “专家”，与博士. 汤姆米勒在范围上报道.

New Technology for More Durable Joint Replacements

Dr. 米勒: 大家好，今天我和 Dr. 克里斯皮. He's an orthopedic surgeon here at the University of Utah in the 骨科. Chris, talk a little bit about how long a hip or 膝关节置换 lasts. Obviously, that's pretty variable. But when that begins to wear out, and I'm sure in a certain percent of people it does, 下一步是什么?

Dr. 皮: 从历史上看,一个 髋关节置换手术 会持续10-15年吗. Newer technologies have been developed, which allows the 髋关节置换手术s to be lasting closer to the 30-year time point, when we look at these on wear simulators, we haven't had the technology 30 years now, 但当大发娱乐查看现有的信息和文献时，它似乎比历史上持续的时间长得多.

Common Sources of Wear on Replaced Joints

Dr. 米勒: 所以当它们磨损时，真正的假体设备是磨损了还是松动了? 实际发生了什么? 什么更常见？?

Dr. 皮: There are three main wear mechanisms or failure mechanisms. 一个是轴承会磨损，所以塑料衬垫可以磨损，你可以更换塑料衬垫. 更常见的, 然而, 大发娱乐发现，植入物可能会从骨头上松动，或者最糟糕的并发症是植入物感染. 大发娱乐看到的很多转诊都来自社区医院以外的地方, they refer to us for complications related to infections.

这是早期关节置换术失败时最常见的失败之一, but it can happen later in life as well, 当细菌进入大发娱乐的血液并找到途径进入人工关节时，就会发生这种情况. 金属和塑料没有免疫系统所以当细菌进入大发娱乐的血液, whether it's from an infection in our mouth, 牙科工作, an infection of a toe or any other type of infection in our body, 细菌感染, it can find its way to our 髋关节置换手术s. 当病人在接受其他医疗问题的治疗时，大发娱乐要小心这一点.

Revising Previous Joint Replacements

Dr. 米勒: 好吧, based on how patients present with either one of those three things, I guess you craft the repair or surgery to meet that problem. 我可以想象 修订手术 与初次髋关节置换术相比，这可能是一个微妙或复杂的手术吗 膝关节置换.

Dr. 皮: It's quite a bit more complex. 这需要更多的专业知识和技巧因为做整容手术很容易出错.

Dr. 米勒: How long, then, does that revise tip last? 它的使用寿命和最初的植入一样长吗？或者人们认为髋关节或膝关节的使用寿命会短一点?

Dr. 皮: 这取决于. 这取决于大发娱乐要治疗的是什么问题以及大发娱乐要用什么植入物来重建. 但是，平均而言，它们应该持续与初始索引操作相似的时间框架. 有些手术可能是病人一生中最后一次需要做的手术.

Preventing Joint Replacement Infections

Dr. 米勒: 现在, patients who present with the infected hips, 我认为你可能会取出旧的设备，然后放入一个新的设备，或者等到感染得到治疗. But I imagine that treatment goes on for several weeks with antibiotics. 是这样吗？?

Dr. 皮: 没错，是的. We've taken a lot of pride and created a significant team around the treatment of joint replacement infections here at the University of Utah. We have infection disease specialists, our internal medicine colleagues, ourselves as orthopedic surgeons, 大发娱乐的护士, 物理治疗师, 医师助理和其他一些大发娱乐大发娱乐照顾病人的人. 但是,是的, 首先需要进行手术，取出设备并清除关节内的所有细菌.

大发娱乐放置一个临时的含有抗生素的或含有抗生素的垫片，上面有一些临时的部件，可以让髋关节或膝盖在大约三个月的抗生素治疗和药物假期后仍然像往常一样运动, 大发娱乐通常可以把临时装置拿出来，再换上一个永久性装置.

从手术中恢复

在典型的关节置换翻修手术中大发娱乐不能让刚做过手术的肢体承受重量. 经常, after a primary hip or 膝关节置换, we have the patients up and walking, 全重量承载, 手术那天. 通过翻修手术, depending on what it is we are doing, but with most 修订手术, 这通常是延迟的. 所以大发娱乐不会让他们得逞 . . .

Dr. 米勒: 膝盖和臀部?

Dr. 皮: 膝盖和臀部. Typically for about six weeks. 原因就像大发娱乐提到的，当大发娱乐处理骨质流失的时候必须适应或考虑越来越大的植入物, 有时, we need biology to be on our side.

Dr. 米勒: It's almost like a fracture that needs treatment so you can put weight on it.

Dr. 皮: It's almost like treating a fracture. 完全. 所以大发娱乐在等待植入物的骨骼生长在大发娱乐开始增加太多的重量之前开始做微运动或者其他可能损害稳定性或固定的事情. 所以通常, 他们至少要比原先的关节置换手术晚六个星期.

After which time, we start ramping up some more of their 物理治疗, 开始在上面走, 开始让他们用一些重量和阻力的方式来加强他们的肌肉, where they probably have not been doing those in the first six weeks. 所以他们可以期待一段很长的时间，直到他们回到他们的最大改进点.

Dr. 米勒: Initial replacements, they are out of the hospital pretty quickly these days. How long would they expect, on average, to be in the hospital after a revision?

Dr. 皮: Our typical primary joint replacements will go home the next day, 有时 the latest two days after surgery. A 修订手术 has an average length of stay of around three days. Some patients will go home around day two, 其他人在第三天左右, 有时甚至是第四天, but about a day or two longer in the hospital. 这主要是因为他们试图解释承重限制, the mobility needs that they have to get used to after having the 修订手术. So our 物理治疗师 are going to be working with them in the hospital, 试着让他们做一些他们出院后需要做的事情

Getting Proper Physical Therapy Post-Op

Dr. 米勒: 现在, you have patients coming from cities distant to Salt Lake. So, 有趣的是, once they leave the hospital, 你如何确保他们在家乡接受的治疗是充分的?

Dr. 皮: So we have patients that fly in from northern Montana, 怀俄明, 爱达荷州, 内华达, 科罗拉多州, 亚利桑那州, New Mexico all to have their surgeries done here with us. 这很难. 大发娱乐确实有, 就像我之前说的, 大发娱乐确实有一个大团队, 包括大发娱乐的一些护理协调员和护士协调员他们大发娱乐大发娱乐接触并确保大发娱乐的病人在手术后恢复良好. We call our patients pretty frequently.

大发娱乐写了非常严格和标准化的协议和说明，当病人离开医院时，大发娱乐会把这些协议和说明发给他们，这样物理治疗师就能非常严格地遵循这些指示. 这样, 大发娱乐不会因为他们对待事物的方式与大发娱乐对待事物的方式不同而做出任何妥协. 大发娱乐试图给他们这些指示，所以当他们离开医院时，大发娱乐的期望是非常明确的. 然后大发娱乐的护理协调员和护士团队会打电话来，确保随着时间的推移一切顺利.

Dr. 米勒: 所以他们的治疗师, no matter where they would be, 能不能联系你的护理团队看看他们在治疗方面是否有需要修改的地方?

Dr. 皮: 绝对.

播音员: Thescoperadio.com is The University of Utah Health Sciences Radio. 如果你喜欢听到的内容，请在Facebook上关注大发娱乐，获取最新内容. Just click on the Facebook icon at thescoperadio.com