Ask The Doctors: August 2012
Q. I have arthritis in both my thumbs, and my doctor wants to operate. What is the surgery’s success rate, and what other options do I have?
A. Many people with mild symptoms of thumb arthritis improve with a limited period of anti-inflammatory medication and avoidance of painful activities, with or without some type of splint.
A cortisone injection into the sore area usually is helpful, at least temporarily. Relief usually lasts about two months. One or two injections provide permanent relief for about 50 percent of people with this problem.
When conservative treatment is no longer effective, surgery may be your only option. The most commonly performed surgery for thumb arthritis involves removal of the arthritic surfaces and insertion of a material—your own tendon or a synthetic substance—between the two ends of the bones. The success rate for this procedure is about 90 percent.
Another surgical procedure is fusion of the two bones that make up the joint. This generally eliminates the painful symptoms but produces some loss of motion and joint stiffness.
Total joint replacement for the thumbs has not been as successful as replacement of large joints, such as the hip and knee.
Q. I’ve been reading about pulsed-signal therapy and how it can help patients with fibromyalgia. How does it work? Is it expensive?
A. Pulsed-signal therapy (PST) involves the use of a low-power electromagnetic field through which a pulsed signal is directed to the affected area to stimulate the healing process. The painful area, such as the knee or neck, is placed inside a magnetic coil, through which electric current is sent in pulses. At this time, the entire body cannot be accommodated, as might be necessary for treating fibromyalgia, and I am unaware of any studies evaluating the use of PST in the treatment of fibromyalgia.
Most published reports on the effectiveness of PST in treating osteoarthritis have been written by its developers. Although the procedure is used extensively in Europe and Canada (where it is even included in many hotel-spa packages), there are few studies and little evidence to support its use in most musculoskeletal disorders.
Q I recently had a hip replacement. I’ve read that revision surgery is sometimes necessary. Why, and what are the symptoms or signs that further surgery is needed?
A Hip replacement is one of the most successful orthopaedic surgeries—more than 90 percent of people who have hip replacement surgery will never need revision surgery.
Hip replacements wear out very slowly, but the problem does progress over the years. Ten years after a hip replacement, there is a 90 percent chance that the implant will be functioning well; 20 years after surgery, the chances decrease to about 80 percent; and by 25-30 years after surgery, about 50 percent of hip replacements will still be working well.
The most common problem with hip replacements is that they begin to loosen over time because of wear of the implant surfaces and weakening of surrounding bone. Loosening of the implant causes pain and difficulty when walking. If you experience these symptoms after your initial recuperation, let your doctor know. Follow-up visits with X-rays will allow your doctor to determine whether the implants are in the proper position. If you follow the recommendations of your doctor and physical therapist, your hip replacement should function well for many years.