And hip problems when can joint replacement surgery help and how do implants work. Heres your host dr constantly. Hello welcome to in good shape today were going to talk about hip replacement and when i recall my days as a medical student i remember the patients were in the hospital after surgery for about fourteen days nowadays with all those new innovative techniques they can leave the clinic after just a few days but they have to show that they are able to walk on their own for approximately thirty meters so this is why here ill thirty meters on this hospital ward in the. Protestant hospital and im going to visit a surgery with professor. And the first five meters i just finished. Me. At our clinic patients can walk five hours after surgery me. First it hurts a bit then the pain doesnt go away and after that it gets worse when physiotherapy or medication dont help anymore its time to hit the you are about when is the right time to go for surgery. And it could happen first noticed something was wrong two years ago while out jogging for the first time she noticed a vague in her thought i and buttocks she thought it was. And i crossed it on i went to the hospital and had it x. Rayed there the doctor said it didnt look good oh yes he told me that in three to six years id be there again asking him for a hip replacement consists of scaling. Which it all happened much faster than that the pain in her side kept getting worse at just fifty one many ordinary activities had become painful by then it wasnt joking anymore that had been replaced by physical therapy along with the pain restricted my ability made her day to day life increasingly difficult. Getting into a car is painful its tough i need a wide parking spot for that i can open the door wide and back into the seat. The hip joints are constantly exposed to high impact as long as theres enough consulates between the rounded fin murrell head and the socket to buffer the blows the joint moves freely and without pain but with. The cartilage gets worn down the joint space. And in most patients describe pain in the groin which usually radiates out through the thought i dont to the knee. Feel hip pain on the outside of the outer side of the hip is wear and tear of the cartilage usually doesnt become a problem until later in life if its not treated properly patients can end up in a wheelchair but younger people can also be affected in the early stages of the condition doctors tend to recommend a conservative approach involving physiotherapy injections and medication. Often the symptoms creep up and theyre not always present all the time you often experience painful phases and less painful phases or even pain free periods at times you can go for weeks or months without any symptoms even though the arthrosclerosis visible in x. Rays. The deterioration cant be reversed so in the long run surgery is usually the only option. On this x. Ray for example changes in the bone structure itself are already visible severe pain is also a sign its rare that surgery is done too early more often its done too late. You dont want to wait until bone structures in the joint have degenerated is that requires more complex surgery and extensive repairs especially to the socket area i think shouldnt get to that stage. If you wait too long for surgery you may not be able to restore original mobility or the desired level of mobility. Could happen had hopes to delay her operation but her symptoms are becoming increasingly severe fifty one is still rather young for a hip replacement but she hopes that surgery will give her at least another twenty years or even longer without any symptoms. Its already apparent that the mobility in elko has hip joint is restricted the pain she feels matches what her doc to seize on the physical exam. An x. Ray will show if the time is right for surgery nobody goes under the knife here in less cartilage damage is visible on an x. Ray. Now because x. Ray is a textbook case. This joint space is basically in good shape. But this area here in the impact zone is very thin you know why it isnt the lead on a pencil so the cartilage is almost completely worn away. Because doctors have recommended that she stay mobile ahead of the surgery being fit will help her get back on her feet shes following their recommendations its best if she can with gentle exercise and weight training. The patient all report decided to get a full hip replacement and that kind of surgery we can visit here so this patient is getting a hip replacement so we started already doing the preparation we do the surgery minimally invasive meaning we dont go through the muscle we go between the muscles we trust separate term and implant the prosthesis through this minimal and base of approach. So youre using a very small approach a very small cut isnt it more difficult to operate through such minor cuts yes minimal invasive total help author of last is more demanding as it is the standard procedure but at the end for the patient who benefits from this that theres less trauma you can fast on his feet again so all together its a benefit for the patient. Has it taken until the patient can get out of bed after this kind of surgery so the implants for the pelvis of the cup and the stem for the tight is pressed for implanted the patient can immediately or immediately put forward bearing on the leg. Doesnt matter whether its cemented or samantha less so how do you fix the cup into the belly do you have to use some screws or Something Like that no this is a press fit cup be removed into the pelvis and the cup the saudis sign for that. Automatically gets enough crept into the bone and you can do it very. Its a hole do you determine the right angle so this is almost. Automatically positioned in my hand which is experience this position stand under the table and where the patient is and this is the most difficult thing and experience how to position the cup so the cup is in sight right now so whats the next step in the impact or so now we open the femur this is the second part of the surgery. And after that to be bring in the stem which is the second component of the total hip author plastic. Whats the material this piece is made of for the cup its almost titanium for the stem if it is cemented it is stainless steel and cement if it is cement free on the stem its also titanium because titanium can grow into the bone. So how do you fix the stem into the bill or do same and yes there are two options you can do it cement less or you can do it with cement it depends depends on the bone quality so this lady is eighty eight years old so the board quality is not the best c. She has osteoporotic bone so its better to cement the stem. One place he wanted to last as long as it can if something goes wrong. Might be able to repair it. Bends stretches work so muscles matilda klyde eyes it is determined to keep fit even with two artificial hips. Patients expect a lot more. Mobility is now the goal Patients Want to return to their former activity levels before the hip replacement and hip pain began. These days patients tend to expect an artificial joint to function just as well as a Natural Healthy joint. Matilda had one hip replaced thirteen years ago and the other five years ago even so a fitness and agility levels remain good but then she began experiencing acute pain it was clear something was up. I started having terrible pain when i was lying down at night. Id lie awake for hours. The doctor told me my new hip joint had simply worn out. But what happens when after thirteen years of where an artificial hip begins to cause problems is another major operation the only solution. As soon as the patient notices pain they should have the artificial joint x. Ray we may be able to just replace the inlay or the artificial from oral had. An artificial joint is anchored deep in bone where only occurs where the artificial surfaces rub together a little wear and tear occurs with every step. Over the years those worn areas grow larger and. The hip grows loose eventually it has to be replaced. A lot depends on what materials those surfaces are made of they can be steel ceramic or polyethylene plastic every doctor has their own opinion about what works best the cheapest combination is steel and polyethylene. Because thats how endo prosthetics were first made but where is common you can predict when it will wear out pretty accurately and when it will need to be replaced. Currently a combination of ceramic and polyethylene is a popular choice the plastic helps cushion the joints a little. As mine on my own id say its the most effective pairing. That doesnt wear down very quickly while at the same time its very forgiving if its find some doctors recommend a ceramic ball in a ceramic socket. Thats a stick i thought oh thats my favorite paring it wears out slower than any other so i like it best on the best that. I dont like it much myself because ive seen cases where the ceramic gets chipped away at the edges and that can cause a whole new set of problems. Matilda klyde it was right joint a ceramic and its not caused any problems yet but her left hip joint made of plastic and metal is causing pain. It started to sound like metal was rubbing i metal and then it started to crunch and crack like there was standin there. Are these and im a creep. That and thinking i dont suggest repairing the joint rather than replacing the entire artificial joint which is major surgery he wants to renu the small plastic socket the socalled inlay on the ball then theres no need to drill into bone. That takes just twenty minutes and matildas bones on touched. Us. But are there ways to help replacement joints last longer matilda wonders if it would help to exercise less but doctors say thats not a good idea. Because an artificial hip joint is only as good as the environment the surrounding muscles bone structure and so on so its a bad idea to think you know just sit around and if i dont move it wont wear out itll last forever that doesnt work. Weak muscles cant hold the joint properly in place which ultimately causes faster wear and tear it can even cause ceramic joints to break but when the surrounding muscles are strong they support the joint and improve its longevity so exercise is very important. And fitness improves quality of life too which also helps the hip joint Matilda Clyde i said can continue to enjoy plenty of exercise knowing that its also doing hip joints a world of good. Thing the patient in the reports started to have problems with her hip after thirteen years. Time range. Its the total. Blast long. Problem of the life. Which can have. As usual it might depend on the. How the proteins was implanted a poor. Procedures today should last fifteen twenty or even more years so its all about the rentier of the procedures weve got a viewer question from mexico from colors materials such as he rides that hes sixty five years old and has been running marathons for years and now his hip is damaged and he needs a hip replacement and hes very concerned that he has to give up his sport this is a big problem people who are used to the sport they want to do that immediately again and in the same intensity. In general we dont recall mant sport with impact on the try and because then we have more wear saw the recommendation would be. To switch to swimming maybe only a little charging but running a marathon is not good for this artificial hip. What impressed me most during the surgery was that you said that this eleven year old lady is going to get on her own feet right hours after surgery so you call this program rep it Recovery Program whats that all about so this is fast track surgery which is. Which is the. Abdominal surgery since twenty years and now its coming to charmingly also for total hip and total Knee Replacement so the program is that the patient is informed before the surgery what happens he goes to a special seminar bird learns what he has to eat before the surgery how to walk with the crutches and all this is in the program step by step by step by step and its all about information of the patient and then its possible for him to start walking five hours after surgery and i remember my days as a medical student at university when needed a hip replacement the patient where in hospital for say two weeks or fourteen days so what about your patients here in your hospital so with this Fast Track Program its no problem that we can discharge the patient after for maximum five states this is in this Fast Track Program thank you so much but i see you later in the show after your patients starts walking again and if youve got any questions you like me to ask the experts be sure to write to me in email. On an upcoming show well be looking at a debilitating condition Cystic Fibrosis what can people who are born with a genetic disorder do to cope more easily with daily life or new therapies for the insurable disease send your questions to in good shape f. T. W. Dot com just put Cystic Fibrosis in the subject line we look forward to hearing from you. Only one thing women can rely on its their menstrual cycle unless of course they suffer from polycystic ovaries syndrome and thats a problem if they want to have children. Mary is two years old and full of beans a mother elisa wagner enjoys every moment for a long time she thought she would never be able to have a child. We tried for five years so we went to my gynecologist to find out why i wasnt getting pregnant he kept saying its because im overweight and then we went to a fertility clinic weve been trying so long it was clear we needed more help from. Lisa was diagnosed with polycystic ovary syndrome p. C. O. S. It wasnt wrong as its a hormonal disorder in women that often involves raised levels of male hormones typical symptoms of menstrual irregularities or an absence of ovulation. But on this many patients are overweight and have a thyroid disorder. In forty percent of the cases it can lead to difficulty conceiving that. The diagnostic work up usually includes blood tests with p. C. O. S. Various blood hormone levels are generally out of the normal range. Lisa wagner and her husband had never heard of the syndrome. As you drive north of the diagnosis with quite a shock but once they knew what the problem was we could work on getting pregnant one out of them in p. C. O. S. The ovaries contain numerous cysts clusters of small fluid filled sacks visible on an ultrasound exam the cysts arise when homo nevels prevent of you lation when p. C. O. S. Causes infertility there are various treatment options. He can be used to make the menstrual cycle more regular and stimulate of elation another option is to have intercourse with the best time or use Artificial Insemination if none of that works there is in vitro fertilization for. Women who arent trying to get pregnant are usually treated with oral contraceptive pills that helps regulate hormone levels lisa wagner first got oral medication to stimulate of elation and then daily shots of hormones after a few months she became pregnant p. C. O. S. Affects glucose metabolism and can lead to insulin resistance patients are sometimes prescribed metformin a drug primarily used to treat type two diabetes there can be further problems p. C. O. S. Patients who become pregnant can expect complications such as just ational diabetes high Blood Pressure and preterm labor so they need to be closely monitored is a part. Of the whole lisa wagner was lucky her pregnancy went smoothly and mary was born full term life with a lively taut may sometimes be hard work but liza and her husband and loving it. Me i also considered the windows to your soul and i think thats really true because you can read emotions of other people in there but whether the iris reveals also diseases is debatable. Marketa lawful money is convinced that her eyes saved her twelve years ago she was diagnosed with Breast Cancer but wasnt found during a routine checkup or mammogram bought after her doctor on a stickler looked into her eyes stickler is also an alternative health practitioner. Any it is. She looked at my irises and said there was something wrong with me. And that i should be alert to any changes. After a while it turned out that i had Breast Cancer didnt the scripts. She underwent surgery and Radiation Therapy and her cancer appears to be gone. Cammy eyes really shed light on the state of a persons health. Its a well established fact that many conditions such as high Blood Pressure diabetes and metabolic syndrome are associated with changes to the eyes. But alternative Health Practitioners go further. The iris diagnosis allows us to look into somebodies genetic disposition to get an idea of what that particular person came into the world with. As even and. There is no Scientific Research showing the validity of iris diagnosis those who practice it evaluate the color and condition of the iris iris maps are used to interpret the condition of organs such as the heart lung or intestines. But cannot iris really reveal any illnesses i know there is one illness marfan syndrome a connective tissue disorder that clearly affects the iris the structure of the connective tissue there is looser. To it so when conventional medicine the state of the iris does not reveal a whole range of other diseases iris diagnosis says the left in the right eye reveal Different Things is that plausible. Basically symmetrical but the two sides are never exact matches thats why diagnosticians in the field of alternative medicine look for differences between the left and right. Iris diagnosticians to see precise correspondences for example a particular zone of the left iris is linked to the left lung conventional medicine rejects this kind of thing. You cant assume that individual zones of the iris represent an organ. Theres no connection has been known when a certain iris pattern is believed to be unique to each individual like a fingerprint iris ologists incest illness causes changes some changes are also recognised by conventional now. Dissin it could come up the iris can get thinner muscular mobility can decline and pupils can respond to a symmetrical. And its not uncommon for the color of the iris to change slightly. But does that have anything to do with diagnosing disease in other organs. Diagnostics more a matter of guesswork right now to try to skip carter is no Scientific Evidence that it has any validity as a method of diagnosis for. Such criticism doesnt deter. She says she uses iris diagnosis to supplement other diagnostic procedures. It can also hints that further examinations and tests are definitely needed. So even those who believe iris diagnostics can be useful acknowledge certain limitations further tests are needed to establish a proper diagnosis. Me so thats it for today and after just three and a half hours after surgery our patient can walk on her own with eighty eight years thats really in mazing so thats it for today see you next week and try to stay in good shape. Why do elephants need. A plastic model turn into a paving stone why do algae make it clear. Good idea kill working anywhere and there are people developing Smart Solutions everywhere. Lets inspire each other to the environment magazine to go at africa in thirty minutes on t. W. Meet the germans new and surprising aspects of choice and culture in germany. Us american keep music take a look at germany get missing chrissys at their traditions every day lives and language can just come out of. The day on the good ship the big guy im going to be w. Dot com the german. They live to surf but. Danger lurks in the water we were there all year long surfing waste anything and. Polluted water not only being the witness but the time being victims i mean was it you troubles or gastric troubles. Basically it is this a sort of always moment in backup of the nation flow i was on today show. Fumin sewage completely untreated and stone walls are coming out of these great consider river and out into want to call moles most premier so. Hes going to decide to go somewhere every day and sees more and more probably sheets tiniest missing gives me everything i suppose waves the wind i have to give Something Back i feel obliged to move it was to miss him too many on the first. Point waves surfers fighting against unseen pollution in the city starting in january seventh on w. S. P t twenty the dont think it. Tells them to and i make this list a few of them tell of the famous potato. This is d w news live from berlin the United Nations gets sad away and that is after the United States threatens to cut funding to countries that support a motion condemning its decision to recognize to reduce the level as israels capital the emergency session is underway at the u. N. We have got an axe
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