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Fibromyalgia: Causes, Symptoms and Treatments

What Are the Symptoms of Fibromyalgia?

Symptoms of fibromyalgia include:

  • Chronic muscle pain, muscle spasms, or tightness
  • Moderate or severe fatigue and decreased energy
  • Insomnia or waking up feeling just as tired as when you went to sleep
  • Stiffness upon waking or after staying in one position for too long
  • Difficulty remembering, concentrating, and performing simple mental tasks (“fibro fog”)
  • Abdominal pain, bloating, nausea, and constipation alternating with diarrhea (irritable bowel syndrome)
  • Tension or migraine headaches
  • Jaw and facial tenderness
  • Sensitivity to one or more of the following: odors, noise, bright lights, medications, certain foods, and cold
  • Feeling anxious or depressed
  • Numbness or tingling in the face, arms, hands, legs, or feet
  • Increase in urinary urgency or frequency (irritable bladder)
  • Reduced tolerance for exercise and muscle pain after exercise
  • A feeling of swelling (without actual swelling) in the hands and feet

There are several theories about the causes of fibromyalgia, from hormonal disturbances to stress to genetics. While there is no clear consensus about what causes fibromyalgia, most researchers believe fibromyalgia results not from a single event but from a combination of many physical and emotional stressors.

Other Theories About Causes of Fibromyalgia

Some have speculated that lower levels of a brain neurotransmitter called serotonin leads to lowered pain thresholds or an increased sensitivity to pain. Serotonin is associated with a calming, anxiety-reducing reaction. The lowered pain thresholds in fibromyalgia patients may be caused by the reduced effectiveness of the body’s natural endorphin painkillers and the increased presence of a chemical called “substance P.” Substance P amplifies pain signals.

There have been some studies that link fibromyalgia to sudden trauma to the brain and spinal cord. Keep in mind, though, theories about what causes fibromyalgia are merely speculative.

Who Gets Fibromyalgia?

Fibromyalgia is far more common in women than in men. Some interesting studies show that men make serotonin at a much faster rate than women — about 50% faster. That may help explain why fibromyalgia syndrome, or FMS, is more common in women.

Another theory states that fibromyalgia is caused by biochemical changes in the body and may be related to hormonal changes or menopause. In addition, some (but not all) people with fibromyalgia have low levels of human growth hormone, which may contribute to the muscle pain.

Does Stress Cause Fibromyalgia?

Some researchers theorize that stress or poor physical conditioning are factors in the cause of fibromyalgia. Another theory suggests that muscle “microtrauma” (very slight damage) leads to an ongoing cycle of pain and fatigue. These mechanisms, like all the others, are still unproven for fibromyalgia.

Do Insomnia or Sleep Disorders Cause Fibromyalgia?

Most people with fibromyalgia experience insomnia or non-restorative sleep — sleep that is light and not refreshing. Disordered sleep might lead to lower levels of serotonin, which results in increased pain sensitivity. Researchers have created a lower pain threshold in women by depriving them of sleep, possibly simulating fibromyalgia.

How Is Fibromyalgia Fatigue Treated?

Along with deep muscle pain and painful tender points, fatigue is a key symptom of fibromyalgia and it can be debilitating. Not only do you feel exhausted and weak, but bed rest does not seem to help. Many people with fibromyalgia report sleeping eight to 10 hours at night and feeling as if they haven’t slept at all.

Some drugs may help ease the fatigue associated with fibromyalgia. In addition, aerobic exercise can help ease fatigue, minimize pain, improve quality of sleep, and improve mood.

How Does Exercise Help Fibromyalgia Symptoms?

Numerous studies show that exercise is one of the most important treatments for fibromyalgia. Many people with fibromyalgia are are not physically fit. They avoid exercise because they fear increased pain. Yet aerobic or conditioning exercise can actually help relieve pain and depression.

Regular exercise increases the body’s production of endorphins, natural painkillers that also boost mood. Starting slowly and gradually increasing the duration and intensity of exercise can help you enjoy the benefits of exercise without feeling more pain.

Paraplegia : Causes, Symptoms & Treatments

Definition

Paraplegia is a spinal cord injury that paralyses the lower limbs. It is a result of severe damage to the spinal cord and the nervous system. Paraplegia mainly affects the trunk, legs, and the pelvic region, resulting in loss of movement.

Causes of Paraplegia :

  • Accidents
  • Severe spinal cord injury
  • Motor neuron disease
  • Cancerous cell growth, tumors or blood clots within spinal cord
  • Spina bifida
  • Prolonged diseases
  • Alcohol addiction

Categorization

There are two main categories – complete and incomplete. Complete paraplegia is witnessed when the injury affects the patient at the neurological level and it hinders the movement of limbs, whereas in case of incomplete paraplegia, some of the limbs are still moving.

Symptoms of Paraplegia

  • Loss of ability to feel and move
  • No control over bowel and bladder activities
  • Intense pain or tingling sensation in the trunk, legs, and the pelvic region
  • Problems in breathing and coughing
  • Sexual function and fertility can be affected

There are no apparent symptoms that could be seen. Moreover, there may be delayed symptoms like numbness and paralyses.

Diagnosis of Paraplegia :

The doctors may diagnose paraplegia with the help of one of the following tests:

  • Computerized CT Scan for a better understanding of the severity of the injury
  • X-rays to examine any tumors or fractures in the spine
  • Magnetic Resonance Imaging (MRI) to test for blood clots or any mass formation that may compress the spinal cord

 

Treatment of Paraplegia:

In the early stage, treatment is possible through medication and traction for immobilization. Surgery or experimental treatments can also be conducted.

While the patient is undergoing a treatment, doctors focus on preventing secondary problems like bowel and bladder issues, blood clots, pressure ulcers and respiratory infections. Any hospitalization will depend on the patient’s condition.

In the case of complete paraplegia, there are new technologies that may restore movement.

Recovery may start from the first week or it may take up to six months to experience improvement. However, there may be no permanent treatment for this condition.

Strawberry Nevus: Causes, symptoms & Treatments

What Are the Symptoms of Strawberry Nevus?

A strawberry nevus, or hemangioma, is named for its color. This red tinge to your skin comes from a collection of blood vessels close to your skin’s surface. While the hemangioma can be anywhere, the most common locations are the face, scalp, back, and chest. If you look closely at the area, you may see small blood vessels closely packed together.

 

What Causes Strawberry Nevus?

Physicians do not know the cause of strawberry nevus. According to What to Expect, one in 10 babies are born with the marking. Most develop while your baby is in the uterus, when small veins and capillaries collect under the skin, creating a red patch.

What Are the Effects of Strawberry Nevus?

A strawberry nevus is rarely harmful, but it can affect a child’s self-esteem if the mark is in a highly visible place and does not fade as the child ages. Also, some strawberry nevi can leave behind a gray or white scar as they fade, leaving the area noticeably different from the surrounding skin.

In the severest cases, a large hemangioma can be life threatening. A large nevus pulls blood platelets in from your bloodstream, which can lead to heart failure. A physician can evaluate the size of the marking and perform tests to determine its depth, if necessary.

How Is Strawberry Nevus Diagnosed?

Physicians diagnose most strawberry marks by physical examination. In some instances, your child’s physician may recommend testing to ensure that the strawberry mark does not go deep into the skin. If your doctor suspects that the strawberry mark is deep, a cavernous hemangioma, or close to a major organ, he or she may need to remove it.

Tests to determine the birth mark’s depth may include a:

  • biopsy, or tissue removal
  • computed tomography (CT) scan
  • magnetic resonance imaging (MRI) scan

How Is Strawberry Nevus Treated?

Because most strawberry marks are not harmful and will fade with time, treatment is not necessarily recommended. However, if the mark is in a very visible area, such as the face, it can be a source of anxiety for a child. You can first try pressing on and kneading the mark to fade it more quickly.

If this doesn’t work, your physician can use steroid injections, laser removal, or cryotherapy—using liquid nitrogen to freeze the tissue—to fade the abnormal areas of skin. However, these procedures are not without their side effects. Side effects can include scarring and pain as the removed tissue heals.

In severe cases, a plastic surgeon may be able to remove the entire red patch of skin. This is typically recommended only when the birthmark extends deep into the skin.

Hyperhidrosis: Causes, symptoms & Treatments

Causes

Sweating helps the body stay cool. In most cases, it is perfectly natural. People sweat more in warm temperatures, when they exercise, or in response to situations that make them nervous, angry, embarrassed, or afraid.

Excessive sweating occurs without such triggers. Persons with hyperhidrosis appear to have overactive sweat glands. The uncontrollable sweating can lead to significant discomfort, both physical and emotional.

When excessive sweating affects the hands, feet, and armpits, it is called primary or focal hyperhidrosis. In most cases, no cause can be found. It seems to run in families.

If the sweating occurs as a result of another medical condition, it is called secondary hyperhidrosis. The sweating may be all over the body or it may be in one area. Conditions that cause second hyperhidrosis include:

  • Acromegaly
  • Anxiety conditions
  • Cancer
  • Carcinoid syndrome
  • Certain medications and substances of abuse
  • Glucose control disorders
  • Heart disease
  • Hyperthyroidism
  • Lung disease
  • Menopause
  • Parkinson disease
  • Pheochromocytoma
  • Spinal cord injury
  • Stroke
  • Tuberculosis or other infections

Symptoms

The primary symptom of hyperhidrosis is wetness.

Treatment

Treatments may include:

  • Antiperspirants: Excessive sweating may be controlled with strong anti-perspirants, which plug the sweat ducts. Products containing 10% to 20% aluminum chloride hexahydrate are the first line of treatment for underarm sweating. Some patients may be be prescribed a product containing a higher dose of aluminum chloride, which is applied nightly onto the affected areas. Antiperspirants can cause skin irritation, and large doses of aluminum chloride can damage clothing. Note: Deodorants do not prevent sweating, but are helpful in reducing body odor.
  • Medication: Medicines may prevent stimulation of sweat glands. These are prescribed for certain types pf hyperhidrosis such as excessive sweating of the face. Medicines have side effects and are not right for everyone.
  • Iontophoresis: This procedure uses electricity to temporarily turn off the sweat gland. It is most effective for sweating of the hands and feet. The hands or feet are placed into water, and then a gentle current of electricity is passed through it. The electricity is gradually increased until the patient feels a light tingling sensation. The therapy lasts about 10 to 20 minutes and requires several sessions. Side effects include skin cracking and blisters, although rare.
  • Botox: Botulinum toxin type A (Botox) is used to treat severe underarm sweating. This condition is called primary axillary hyperhidrosis. Botulinum toxin injected into the underarm temporarily block the nerves that stimulate sweating. Side effects include injection-site pain and flu-like symptoms. Botox used for sweating of the palms can cause mild, but temporary weakness and intense pain.
  • Endoscopic thoracic sympathectomy (ETS) : In severe cases, a minimally-invasive surgical procedure called sympathectomy may be recommended when other treatments do not work. The procedure cuts a nerve, turning off the signal that tells the body to sweat excessively. It is usually done on patients whose palms sweat much more heavily than normal. It may also be used to treat extreme sweating of the face. ETS does not work as well for those with excessive armpit sweating.
  • Underarm surgery: This is surgery to remove the sweat glands in the armpits. Methods used include laser, curettage (scraping), excision (cutting), or liposuction. These procedures are done using local anesthesia.

 

 

Cerebral Palsy: Symptoms, Causes & Treatments

What Are the Symptoms of Cerebral Palsy?

The symptoms of CP range from mild to severe. They also vary depending on the part of the brain that was affected. Some of the more common symptoms include:
  • delays in reaching motor skill milestones, such as rolling over, sitting up alone, or crawling
  • delays in speech development and difficulty speaking
  • stiff muscles
  • abnormal muscle tone
  • a lack of muscle coordination
  • tremors or involuntary movements
  • excessive drooling and problems with swallowing
  • difficulty walking
  • favoring one side of the body, such as reaching with one hand
  • neurological problems, such as seizures, intellectual disabilities, and blindness

Call your doctor immediately if you suspect your child has CP. Early diagnosis and treatment is very important

What Causes Cerebral Palsy?

CP is caused by an abnormality in brain development or by damage to the developing brain. The brain damage usually occurs before birth, but it can also happen during birth or the first years of life. In most cases, the exact cause of CP isn’t known. Some of the possible causes include:
  • a lack of oxygen to the brain during labor and delivery
  • severe jaundice in the infant
  • maternal infections, such German measles and herpes simplex
  • brain infections, such as encephalitis and meningitis
  • bleeding into the brain
  • head injuries as a result of a car accident, a fall, or child abuse

How Is Cerebral Palsy Treated?

The goal of treatment is to improve limitations and prevent complications. Treatment may include assistive aids, medications, and surgery.

Assistive Aids

Assistive aids include:

  • eyeglasses
  • hearing aids
  • walking aids
  • body braces
  • wheelchairs

Medications

Anticonvulsants and muscle relaxants, such as diazepam and dantrolene, are often used to treat CP. These medications can help reduce spasticity and drooling.

Surgery

Surgery may be used to relieve pain and improve mobility. It may also be needed to release tight muscles or to correct bone abnormalities caused by spasticity.

Other Treatment

Other types of treatment for CP include:

  • speech therapy
  • physical therapy
  • occupational therapy
  • counseling or psychotherapy
  • social services consultations

How Can Cerebral Palsy Be Prevented?

The majority of problems that cause CP can’t always be prevented. However, if you’re pregnant or planning on becoming pregnant, you can take certain preventive measures to minimize complications. It’s important to get vaccinated against diseases that can cause fetal brain damage, such as rubella. It’s also crucial to receive adequate prenatal care. Attending regular appointments with your doctor during pregnancy can help prevent premature birth, low birth weight, and infections.

Minimally Conscious State: Causes, symptoms & Treatments

A minimally conscious state is severe but not complete impairment of awareness that results from widespread damage to the cerebrum (the part of the brain that controls thought and behavior).

A minimally conscious state may result directly from brain damage, or it may follow a vegetative state as people recover some function.

People in a minimally conscious state, unlike those in a vegetative state, do some things that indicate some awareness of self and of their environment. They may do the following:

  • Make eye contact

 

  • Follow objects with their eyes
  • Reach for objects
  • Respond to questions (although often with the same word whether it is appropriate or not)
  • React to all commands in a usual but usually inappropriate way (for example, by blinking).

 

Most people in a minimally conscious state tend to improve continuously, but improvement is limited. A few people regain the ability to communicate and understand, sometimes after many years. However, very few recover enough to live and function independently. The longer a minimally conscious state lasts, the less function people are likely to regain. However, with skilled nursing care, people can live for years. Recovery may be better when the cause is a head injury.

There have been reports of people awakening after spending years in what appears to be a coma. These reports often involve people who had been in a minimally conscious state after a head injury.

Diagnosis

  • A doctor’s evaluation

  • Imaging tests such as magnetic resonance imaging

Doctors suspect the diagnosis based on symptoms. But before a minimally conscious state can be diagnosed, people should be observed for a period of time and on more than one occasion.

An imaging test, such as magnetic resonance imaging (MRI) or computed tomography (CT), is done to check for disorders that may be causing the problem, especially those that can be treated.

Treatment

  •  Preventive measures for problems due to immobilization
  •  Good nutrition
  •  Possibly certain drugs

Long-term care

Like people in a coma, people in a minimally conscious state require comprehensive care.

Providing good nutrition ( nutritional support) is important. People are fed through a tube inserted through the nose and into the stomach. Sometimes they are fed through a tube (called a percutaneous endoscopic gastrostomy tube, or PEG tube) inserted directly into the stomach through an incision in the abdomen. Drugs may also be given through this tube.

Many problems result from being unable to move, and measures to prevent them are essential (see Problems Due to Bed Rest). For example, the following can happen:

  • Pressures sores: Lying in one position can cut off the blood supply to some areas of the body, causing skin to break down and pressure sores to form. Caregivers must turn people very frequently.
  • Contractures: Lack of movement can also lead to permanent stiffening of muscles (contractures) causing joints to become permanently bent.
  • Blood clots: Lack of movement makes blood clots more likely to form in leg veins.

To prevent these problems, physical therapists gently move the person’s joints in all directions (passive range-of-motion exercises). Therapists may splint joints in certain positions to help prevent contractures. People are also given drugs to prevent blood clots from developing.

If people are incontinent, care should be taken to keep the skin clean and dry. If the bladder is not functioning and urine is being retained, a tube (catheter) may be placed in the bladder to drain urine.

Other treatments

A very few people have improved after treatments such as zolpidem (a sleep aid) or amantadine (a drug used to treat viral infections). However, no treatment has been proved effective.

Sebaceous Cysts : Causes, Symptoms & Treatments

Sebaceous cysts form out of your sebaceous gland. The sebaceous gland produces the oil called sebum that coats your hair and skin. Cysts can develop if the gland or its duct, the passage where oil is able to leave, becomes damaged or blocked. This usually occurs due to a trauma to the area.

The trauma may be a scratch, a surgical wound, or a skin condition, such as acne. Sebaceous cysts grow slowly, so the trauma may have occurred months or weeks before you notice the cyst.

Other causes of a sebaceous cyst may include:

  • a misshapen or deformed duct
  • damage to the cells during a surgery
  • genetic conditions, such as Gardner’s syndrome or basal cell nevus syndrome

Symptoms of sebaceous cyst :

Small cysts are typically not painful. Large cysts can range from uncomfortable to considerably painful. Large cysts on the face and neck may cause pressure and pain.

This type of cyst is typically filled with white flakes of keratin, which is also a key element that makes up your skin and nails. Most cysts are soft to the touch.

Areas on the body where cysts are usually found include:

  • scalp
  • face
  • neck
  • back

A sebaceous cyst is considered unusual — and possibly cancerous — if it has the following characteristics:

  • a diameter that is larger than five centimeters
  • a fast rate of reoccurrence after being removed
  • signs of infection, such as redness, pain, or pus drainage

Diagnosis of a sebaceous cyst

Doctors often diagnose a sebaceous cyst after a simple physical examination. If your cyst is unusual, your doctor may order additional tests to rule out possible cancers. You may also need these tests if you wish to have the cyst surgically removed.

Common tests used for a sebaceous cyst include:

  • CT scans, which help your doctor find the best route for surgery and spot abnormalities
  • ultrasounds, which identify the contents inside the cyst
  • punch biopsy, which involves removal of a small amount of tissue from the cyst to be examined in a laboratory for signs of cancer

Treatment of sebaceous cyst:

Your doctor can treat a cyst by draining it or by surgically removing it. Normally, cysts are removed. This is not because they are dangerous but rather for cosmetic reasons. Since most cysts are not harmful to your health, your doctor will allow you to pick the treatment option that works for you.

It is important to remember that without surgical removal, your cyst will usually come back. The best treatment is to ensure complete removal through surgery. Some people do decide against surgery, however, because it can cause scarring.

Your doctor may use one of the following methods to remove your cyst:

  • conventional wide excision: completely removes a cyst but can leave a long scar
  • minimal excision: causes minimal scarring but carries a risk that the cyst will return
  • laser with punch biopsy excision: the laser is used to make a small hole to drain cyst contents and the outer walls of the cyst are removed about a month later

After your cyst is removed, your doctor may give you an antibiotic ointment to prevent infection. You should use this until the healing process is complete. You may also be given a scar cream to reduce the appearance of any surgical scars.

BAHA Devices: Causes and uses

Conductive and mixed conductive/sensory hearing loss

A bone conduction implant (BCI) is used to treat 2 basic problems: conductive and/or mixed hearing loss and deafness in one ear (single-sided deafness). These devices are considered when use of a conventional (air-conduction hearing aid) is not possible. For the case of conductive or mixed hearing loss, they are used most commonly in patients with chronic ear infections, cholesteatoma, and chronic otorrhea in which the diseased eardrum and/or middle ear ossicles are not able to conduct sound to the cochlea and use of a conventional hearing device often is not possible. The other common situation is congenital aural atresia in which absence of the ear canal and eardrum causes conductive hearing loss and a conventional hearing aid cannot be used.

Before Baha, the only device available to treat these situations was a conventional bone conduction hearing aid. This device consists of a bone conduction hearing aid (vibrator) attached to a headband (see the image below). These devices, while very helpful over the years, have several inherent disadvantages that limit their benefit and their acceptance, including the following:

  • Discomfort caused by the constant pressure of the vibrator against the scalp
  • Poor sound quality and volume caused by the indirect and variable coupling of the vibrator to the skull due to intervening hair and scalp tissues
  • Variable and unstable positioning affecting the quality of transduction
  • Bilateral use is not possible
  • Poor aesthetics

Audiometric Testing

Basic audiometry including pure-tone audiogram and speech audiometry should be performed. A trial of the Baha using an external headband is useful. Several questionnaires are also available in order to obtain the participating patient’s subjective view of different aspects of Baha fitting, and these include the study-specific questionnaire, the International Outcome Inventory for Hearing Aids, the Meaningful Auditory Integration Scale, the Meaningful Use of Speech Scale, and the H70.

Polycystic Ovary Syndrome: Causes, Symptoms & Treatments

Polycystic Ovary Syndrome :

13321768_sWhat is Polycystic Ovary Syndrome?

Polycystic ovary syndrome, or PCOS, is a complex hormone disorder that causes such symptoms as irregular menstrual cycles, infertility, excessive body hair, acne, and obesity.  The syndrome is named for the cysts that may form in the ovaries when the hormone imbalance interrupts the ovulation process.  The term polycystic means “composed of many cysts”.  If the hormone imbalance is left untreated, the syndrome may lead to life-threatening illnesses such as diabetes, heart disease, stroke, and uterine and endometrial cancers.

Symptoms of Polycystic Ovary Syndrome

Because it is a syndrome, PCOS includes a set of symptoms.  Women with PCOS can suffer from any combination of the symptoms listed here.  Some women experience only one of these symptoms, while other women experience all of them.  The severity of PCOS symptoms can vary widely from woman to woman.  Talk to your physician if you suffer from one or more of these symptoms.•

  • Chronically irregular menstrual cycles or absent periods
  • Infertility or difficulty conceiving (due to not ovulating)
  • Obesity (greater than 20 percent over “ideal” weight)
  • Sudden, unexplained weight gain (even if you are still of “normal” weight)
  • Adult acne
  • Excessive hair growth (especially dark hair on the face, chest, or abdomen)
  • Male-pattern hair loss or thinning hair
  • Type II diabetes or insulin resistance

It is possible to have the above symptoms and not have PCOS.  However, most women with these symptoms, especially irregular menstrual cycles, do have PCOS.  In fact, 80 percent of women with six or fewer periods per year have PCOS.

Researchers have found some variations in the symptoms among different races.  For example, while excessive body hair is found among 70 percent of American women with PCOS, it only occurs in about 10 to 20 percent of Asian women.  Unfortunately, there is not enough evidence to explain why these variations in symptoms occur.

Because the symptoms of PCOS can vary widely, it can be difficult to exclude or include symptoms as a part of the diagnosis.  In face, the World Health Organization tried to determine a comprehensive list of symptoms and couldn’t agree on more than four of them.  Further research is being done at a dozen facilities in the United States alone.  There may be more common symptoms discovered as new studies are completed and women continue reporting their experiences.

Who Is Affected by Polycystic Ovary Syndrome, PCOS?

The most common endocrine disorder, PCOS is estimated to affect anywhere from 5 to 10 percent of all women. That means at least 5 million and as many as 10 million women in the United States suffer from PCOS. The syndrome does not discriminate and can be found in women of all races and ethnic groups throughout the world, although it tends to be more common in women of Mediterranean descent.  PCOS affects women of all ages, from adolescence to menopause.  Once a woman is diagnosed, she will need to manage the symptoms for the rest of her life.

What is the Cementless Total Hip Replacement

What is Uncemented / Cementless Total Hip Replacement

Total hip replacement is a surgical procedure for replacing the hip joint. This joint is composed of two parts – the hip socket (acetabulum, a cup-shaped bone in the pelvis) and the “ball” or head of the thighbone (femur). During the surgical procedure, these two parts of the hip joint are removed and replaced with smooth artificial surfaces. The artificial socket is made of high-density plastic, while the artificial ball with its stem is made of a strong stainless metal. These artificial pieces are implanted into healthy portions of the pelvis and thighbones and affixed with a bone cement (methyl methacrylate).

An alternative hip prosthesis called a “cementless” total hip replacement has the potential to allow bone to grow into it, and therefore may last longer than the cemented hip. This is an important consideration for the younger patient. In some cases, only one of the two components (socket or stem) may be fixed with cement and the other is cementless and would be called a “hybrid” hip prosthesis.

When is total hip replacement considered ?

Total hip replacements are usually performed for severe arthritic conditions. The operation is sometimes performed for other problems such as hip fractures or avascular necrosis (a condition in which the bone of the hip ball dies). Most patients who have artificial hips are over 55 years of age, but the operation is occasionally performed on younger persons.

Circumstances vary, but generally, patients are considered for total hip replacements if : –

Your pain is severe enough to restrict work, recreation, and the ordinary activities of daily living.
Your pain is not relieved by anti-inflammatory medicine, the use of a cane or walker and restricting activities.
You have significant stiffness of the hip.
Your x-rays show advanced arthritis, or other problems.

The orthopaedic surgeon must be very precise in preparing the femur for a cementless impact. The implant channel must match the shape of the implant itself very closely. New bone growth cannot bridge gaps larger than 1 mm to 2 mm. Your surgeon may recommend a period of protected weight-bearing (using crutches or a walker) to give the bone time to attach itself to the implant. This protected weight bearing helps to ensure there is no movement between the implant and bone so a durable connection can be established.

Cementless femoral components tend to be much larger at the top, with more of a wedge shape. This design enables the strong surface (cortex) of the bone and the dense, hard spongy (cancellous) bone just below it to provide support.

The acetabular component of a cementless total hip replacement also has a coated or textured surface to encourage bone growth into the surface. Depending on the design, these components may also use screws through the cup or spikes, pegs, or fins around the rim to help hold the implant in place until the new bone forms. Usually these components have a metal outer shell and a polyethylene liner.

The pelvis is prepared for a cementless acetabular component using a process similar to that used in a cemented total hip replacement procedure. The intimate contact between the component and bone is crucial to permit bone ingrowth.

Initially, it was hoped that cementless total hip replacement would eliminate the problem of bone resorption or stem loosening caused by cement failure. Although certain cementless stem designs have excellent long-term outcomes, cementless stems can loosen if a strong bond between bone and stem is not achieved.

Patients with large cementless stems may also experience a higher incidence of mild thigh pain. Likewise, polyethylene wear, particulate debris, and the resulting osteolysis (dissolution of bone) remain problems in both cemented and uncemented designs. Improvements in the wear characteristics of newer polyethylene and the advent of hard bearings (metal-on-metal or ceramic) may help resolve some of these problems in the future.

Although some orthopaedic surgeons are now using cementless devices for all patients, cementless total hip replacement is most often recommended for younger, more active patients and patients with good bone quality where bone ingrowth into the components can be predictably achieved. Individuals with juvenile inflammatory arthritis may also be candidates, even though the disease may restrict their activities.

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