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jOIn ruTh wErnEr, jAMES wASlASKI, And lyndA SOlIEn-wOlFE FOr ThE SEMInAr AT SEA, jAnuAry 23–30, 2011, And EArn CEuS. FOr MOrE InFOrMATIOn, VISIT www.OrThOMASSAgE.nET. cartilage injury has accrued to a certain level, it is for all intents and purposes stable and irreversible. Joint replacements restore a new, smooth surface to rough cartilage, but they usually have a proscribed lifespan. That is to say, a replaced knee or hip is expected to last about 10–15 years, depending on the weight and physical activity of the recipient. For this reason, younger patients are often counseled to delay a joint replacement surgery as long as possible, especially because each successive surgery has a greater chance for a poor outcome. At this point, massage may be particularly useful: skillfully administered massage can address osteoarthritis symptoms and help in the strategy to prolong the time a person can get along without undergoing surgery. "A business acquaintance shredded his anterior cruciate ligament, medial collateral ligament, lateral collateral ligament, and meniscus in a series of falls and accidents. They've cleaned out his knee and told him to live with it for five more years and then get the knee replacement surgery. Ugh." Other reasons for joint replacement surgery include rheumatoid arthritis, avascular necrosis, or serious trauma. Older people who have osteoporosis may be candidates for hip repair (to insert a stabilizing rod into the femur) simultaneously with a hip replacement. No matter what the underlying condition is, surgery is only conducted when all other options, including exercise, braces, anti-inflammatory medication, cortisone and synovial fluid replacement injections, and less invasive surgeries are no longer adequate interventions. The X-rays of a good candidate for joint replacement surgery typically show a loss of space in the joint cavity, bony remodeling, bone spurs, and the possibility of debris inside the joint cavity. TYPES OF JOINT REPLACEMENTS The implants used in arthroplastic surgery are called prostheses. Historically, these have been made of various materials ranging from ceramic to titanium, but today they are most likely to include a highly polished ball made of cobalt chrome on one surface and a polyethylene cup or socket on the other. ShOuldErS Arthroplasty of the glenohumeral joint is a relatively new surgical procedure, but it is becoming increasingly common. This is done when the joint is no longer competent: trauma, ongoing and irreversible damage to the rotator cuff, or bone spurs have made the head of the humerus and the glenoid fossa incompatible in shape. Shoulder joint repairs can take two forms. The most common version replaces the ball of the humerus and the cup of the glenoid. Some patients are candidates for a "reverse" shoulder replacement, in which a ball is attached to the scapula, and the head of the humerus is replaced with a shallow cup, thus reversing the typical relationship between the bones. hIPS Hip joints are frequently replaced, either as a consequence of arthritis that wears away at this huge weight- bearing joint, or as a result of femoral trauma with osteoporosis or avascular necrosis (a condition in which the blood supply to the femoral head is impaired and the bone degenerates). KnEES Knees are unique in that they combine a large range of motion with strict limitation in direction—that is, they only flex and extend (unless the knee is bent, in which position it can slightly rotate). Consequently, knees are vulnerable to shearing forces that can injure their stabilizing ligaments and put the internal cartilage at risk for permanent damage. Small repairs can be made with arthroscopic surgery, but eventually the joint may be reduced to bone-on-bone contact. Knee joint replacements can sometimes involve resurfacing only one part of the joint, or they can involve replacing the ends of the tibia, femur, and the contacting surface of the patella. Cruciate ligaments may be replaced with polyethylene posts to help stabilize the new mechanism. "My client tore her ACL by jumping off the back of a truck. She had it repaired and did fine. Then, about two years later, she tore her meniscus and had it scraped out. She knew she'd have to have a replacement eventually. She got massage regularly, specifically, on her knee, which helped her live with it for two years before her surgery. Now, she's very active—bikes and walks. She has stiffness and some pain at the end of the day. A hot tub helps the aches." OThEr jOInTS Arthroplasty can be conducted on ankles, various carpal-metacarpal and interphalangeal joints, the saddle joint of the thumb, and the temporomandibular joint. These procedures are relatively rare compared to replacements of knees, hips, and shoulders. WILL IT BE SUCCESSFUL? Several variables influence exactly how an arthroplasty is conducted. Older and less physically active patients may have their implants simply glued or cemented to their existing bone: this allows for a speedier recovery, but the joints tend to be less stable (they may loosen or dislocate easily). Younger or more active patients are better candidates for prostheses that have tiny pores where new bone tissue can grow to blend with the synthetic material. This takes a longer time, but the strength of the joint tends to be much better than with the cemented type. connect with your colleagues on massageprofessionals.com 99