Is Our Modern Lifestyle Fuelling the Need for Joint Specialists?
There is little doubt that, since the industrial revolution and the advent of labour-saving machinery, successive generations have become increasingly less active. With the growth of automation and its application to many of the most basic household tasks, it has become apparent, for example, that today’s male children possess significantly less upper body strength than their fathers. While today’s generation may have less need for physical strength in the workplace or the home, it is a prerequisite for joint stability, so orthopaedic specialists are now being confronted with the evidence of this on a daily basis.
The simple act of walking involves the articulation of groups of bones in the hip, the knee, and the ankle, and when one walks regularly, this can serve to strengthen the muscles, tendons, and ligaments required to stabilise these regions, and to maintain their integrity throughout one’s lifetime. The problem is that we now tend to do much more riding and sitting than walking, which tends to weaken those soft tissues and thus makes bones and cartilage more susceptible to traumatic injury. Much the same is true of the shoulders in that when exercised infrequently, they are more prone to sprains, strains, and dislocation.
Joint specialists will often be called upon to repair damage arising from accidents and sports injuries – contingencies that are unavoidable, in most cases. In addition, a major area of their responsibility has always been to rectify the results of the wear and tear, typically seen in the hips and knees, and that is the almost inevitable consequence of getting older. In the past, candidates for a hip or knee replacement were generally aged 65 or older. More recently, however, orthopaedic surgeons are increasingly required to consider performing arthroplasty on patients in their fifties and even younger.
Some authorities are now convinced that this increasing pressure on the services of joint specialists can be attributed to one other consequence of the more sedentary modern lifestyle – the growing incidence of obesity, particularly in younger individuals. Given the growing tendency of modern living to combine diminished physicality with the additional burden of extra weight, often the legacy of too much junk food, and it is not too surprising that this combination should result in a marked speeding up of the normally protracted process of natural wear and tear.
In health, the articulating surfaces of bones are protected by a layer of specialised connective tissue known as cartilage, creating a near friction-free bearing between them. Further lubrication is provided by an encapsulating membrane filled with viscous synovial fluid. Where an injury or disease is suspected, joint specialists are able to supplement information from X-ray images with a real-time, illuminated view of the internal structures within a hip or knee by inserting an instrument known as an arthroscope through a tiny incision.
Consisting of a narrow tube, its fibre optic core transmits light to the examination area and imagery to a miniature TV camera for display on a monitor or in an eyepiece. Since its introduction, however, the arthroscope has become far more than a powerful diagnostic tool for the convenience of the orthopaedic surgeon. The development of new surgical techniques has made it possible to perform a number of interventions arthroscopically. Joint specialists simply need to make one or two additional keyhole incisions through which to insert their instruments whilst referring to the view shown on the monitor screen in order to manipulate them.
Used first for relatively minor procedures such as repairs to a torn meniscus or lavage of bone and cartilage fragments, arthroscopic procedures have since been developed for use in arthroplasty. Markedly less invasive than the alternative of exposing an entire joint, it serves to limit the risk of bleeding and infection, whilst also reducing post-operative recovery times, and represents one of the greatest advances by joint specialists to date.