Knee-joint replacement Health Dictionary

The joint formed by the FEMUR, TIBIA and patella (knee-cap). It belongs to the class of hinge-joints, although movements are much more complex than the simple motion of a hinge, the condyles of the femur partly rolling, partly sliding over the ?at surfaces on the upper end of the tibia, and the acts of straightening and of bending the limb being ?nished and begun, respectively, by a certain amount of rotation. The cavity of the joint is very intricate: it consists really of three joints fused into one, but separated in part by ligaments and folds of the synovial membrane. The ligaments which bind the bones together are extremely strong, and include the popliteal and the collateral ligaments, a very strong patellar ligament uniting the patella to the front of the tibia, two CRUCIATE LIGAMENTS in the interior of the joint, and two ?brocartilages which are interposed between the surfaces of tibia and femur at their edge. All these structures give to the knee-joint great strength, so that it is seldom dislocated. The cruciate ligaments, although strong, sometimes rupture or stretch under severe physical stress such as contact sports or athletics. Surgical repair may be required, followed by prolonged physiotherapy.

A troublesome condition often found in the knee – and common among athletes, footballers and other energetic sportspeople – consists of the loosening of one of the ?bro-cartilages lying at the head of the tibia, especially of that on the inner side of the joint. The cartilage may either be loosened from its attachment and tend to slip beyond the edges of the bones, or it may become folded on itself. In either case, it tends to cause locking of the joint when sudden movements are made. This causes temporary inability to use the joint until the cartilage is replaced by forcible straightening, and the accident is apt to be followed by an attack of synovitis, which may last some weeks, causing lameness with pain and tenderness especially felt at a point on the inner side of the knee. This condition can be relieved by an operation

– sometimes by keyhole surgery (see MINIMALLY INVASIVE SURGERY (MIS)) – to remove the loose portion of the cartilage. Patients whose knees are severely affected by osteoarthritis or rheumatoid arthritis which cause pain and sti?ness can now have the joint replaced with an arti?cial one. (See also ARTHROPLASTY; JOINTS, DISEASES OF.)... knee

Knock-knee, or genu valgum, is a deformity of the lower limbs in such a direction that when the limbs are straightened the legs diverge from one another. As a result, in walking the knees knock against each other. The amount of knock-knee is measured by the distance between the medial malleoli of the ankles, with the inner surfaces of the knee touching and the knee-caps facing forwards. The condition is so common in children between the ages of 2–6 years that it may almost be regarded as a normal phase in childhood. When marked, or persisting into later childhood, it can be corrected by surgery (osteotomy).... knock-knee

Within a few years medical scientists have introduced into the domestic scene a steroid which has changed the whole course of female history. HRT has solved some basic medical problems by making good the loss of oestrogen in a woman’s body when menstruation is finished and her body learns to adjust.

A lack of oestrogen induces hot flushes, night sweats, thinning of the bones (osteoporosis) with possible fractures, and a wide range of physical and emotional disorders.

HRT also prevents the increased frequency of coronary disease which may follow the menopause. With oestrogen only, HRT appears to increase the incidence of cancer of the uterine body. Use of oestrogen and progestogen avoids this.

HRT is available as a tablet, transdermal patch, implant or topical cream. Most women notice temporary improvement in their appearance and hot flushes as long as treatment is continued. HRT is not prescribed by the herbal practitioner. Soya and Hops are a mild alternative.

Side-effects of such treatment include blood pressure rise, weight gain and periods probably continue with a monthly bleed. Elderly women taking HRT for osteoporosis may develop bleeding problems, the risk of blood clot and gall bladder diseases.

Helonias has proved a useful alternative, effective in eliminating excess fluids, reducing hot flushes, and relieving that bloated feeling, thus helping the older woman to live a normal life.

Damiana. 1 heaped teaspoon leaves to each cup boiling water; infuse 5-10 minutes; strain. 1 cup 2-3 times daily for 3-6 weeks.

Sarsaparilla. 1oz (30g) root in 1 pint (500ml) water; simmer gently 20 minutes; strain. 1 cup 2-3 times daily for 3-6 weeks.

Supplementation. Daily. Vitamin E, 400iu. Vitamin B-complex (high potency). Evening Primrose oil capsules, 500mg morning and evening. Dolomite, for Calcium and Magnesium, 2 tablets morning and evening.

Note: An extensive study of breast cancer risks with HRT revealed a positive link between the risk of cancer and length of use. Risk of the disease increased with all types of women using HRT with every year of use. Pre-menstrual women were more than twice at risk. It would appear that oestrogens cannot be taken without risk. (Centre for Disease Control, Atlanta, USA) See: OESTROGENS. ... hormone replacement therapy (hrt)

The joint formed by the head of the thigh bone and the deep, cup-shaped hollow on the side of the pelvis which receives it (acetabulum). The joint is of the ball-and-socket variety, is dislocated only by very great violence, and is correspondingly di?cult to reduce to its natural state after dislocation. It is enclosed by a capsule of ?brous tissue, strengthened by several bands, of which the principal is the ilio-femoral or Y-shaped ligament placed in front of the joint. A round ligament also unites the head of the thigh bone to the margin of the acetabulum.

For hip-joint disease, see under JOINTS, DISEASES OF.... hip-joint

See ARTHROPLASTY.... joint replacement

See REFLEX ACTION.... knee jerk

One of a pair of joints between each side of the SACRUM and each ILIUM. Strong ligaments between the ilium and the sacrum stabilise the joint, permitting little movement. Childbirth or strenuous sporting activities may strain the joint, causing pain in the lower part of the back and buttocks. Such strains may take a long time to mend; PHYSIOTHERAPY is the treatment. The joint(s) may become in?amed (see SACROILEITIS).... sacroiliac joint

A joint that is repeatedly damaged by injuries that have gone unnoticed because of loss of sensation in the joint (see neuropathic joint).... charcot’s joint

A surgical procedure to replace all or part of a diseased hip joint with an artificial substitute. The replacement is most often carried out in older people whose joints are stiff and painful as a result of osteoarthritis. It may also be needed if rheumatoid arthritis has spread to the hip joint or if the top end of the femur is badly fractured (see femur, fracture of).... hip replacement

The joint between the mandible (lower jaw bone) and the skull.... temporomandibular joint

Pain and other symptoms affecting the head, jaw, and face, thought to result when the temporomandibular joints and the muscles and ligaments attached to them do not work together correctly. Causes include spasm of the chewing muscles, an incorrect bite (see malocclusion), jaw, head, or neck injuries, or osteoarthritis. Common symptoms include headaches, tenderness of the jaw muscles, and aching facial pain. Treatment involves correction of any underlying abnormality, analgesic drugs, and, in some cases, injection of corticosteroid drugs into the joint.... temporomandibular joint syndrome

Named after a 19th-century French physician, this condition presents as a painless swelling and disorganisation of the joints resulting from damage to the pain ?bres that occurs in diabetic neuropathy (see DIABETES MELLITUS – Complications), LEPROSY, SYRINGOMYELIA and syphylitic infection of the spinal cord (see SYPHILIS).... charcot’s joint

See under MENOPAUSE.... hormone replacement therapy(hrt)

An in?ammation of the bursa in front of the knee-cap, often mistaken for some disease in the joint itself (see BURSITIS).... housemaid’s knee

A popular term for a loose body in a joint. It is found especially in the knee. (See JOINTS, DISEASES OF.)... joint-mouse

See PATELLAR TENDINITIS.... jumper’s knee

Synovitis. Treat as for gout.

Potato Poultice. 1 part potato juice to 3-4 parts hot water, applied on suitable material. Cover with protective. ... big toe joint, inflammation

The joint that lies between the outer end of the clavicle (collarbone) and the acromion (the bony prominence at the top of the scapula (shoulderblade).... acromioclavicular joint

Inflammation of the bursa that cushions the pressure point over the tibial tubercle (the bony prominence just below the knee) caused by prolonged kneeling (see bursitis).... clergyman’s knee

Athroplasty. Success rate: high. Commonest indication: osteo- arthritis of hip. A lesser risk of sepsis occurs in first operation than in subsequent ones. Infection is suspected when acetabular loosening is present in conjunction with femoral loosening. Echinacea is the key remedy for combatting infection and for enhancing the patient’s resistance. Comfrey root promotes healing of bone tissue. St John’s Wort gives partial relief in post-operative pain. Horsetail is a source of readily absorbable iron and calcium. For slow healing, a liver agent (Fringe Tree) may be indicated. Alternatives. Teas. Comfrey leaves, Calendula, St John’s Wort, Gotu Kola, Plantain.

Tablets/capsules. St John’s Wort.

Formula. Comfrey root 2; St John’s Wort 1; Echinacea 2; trace of Cayenne (Capsicum). Dose – Powders: 750mg (three 00 capsules or half a teaspoon). Liquid Extracts: 1-2 teaspoons. Tinctures: 1-3 teaspoons. Effect is enhanced when doses are taken in cup of Comfrey herb tea. Other agents to promote renewal of tissue. Slippery Elm bark, Fenugreek seeds, Wild Yam, Carragheen Moss.

Discomfort from a scar. Aloe Vera gel, Calendula, Comfrey or Chickweed cream or ointment. See: CASTOR OIL PACK.

Diet. High protein, oily fish or fish oils.

Supplements. Vitamin C: 3-6g daily. Calcium ascorbate, Zinc. Magnesium. Cod Liver oil for Vitamins A and D; 2 teaspoons daily.

Note: Where titanium alloy implants are used for this operation serum levels of the metal are likely to show up higher than normal. Raised serum titanium has been linked with lung cancer, osteoporosis, and platelet suppression. A New Zealand study has found deaths from cancer were significantly higher in patients having had a metal hip replacement. See: CHELATION.

Comfrey. Potential benefit far outweighs possible risk. ... hip replacement operation

Complete displacement of the 2 bones in a joint so that they are no longer in contact, usually as a result of injury. (Displacement that leaves the bones in partial contact is called subluxation.) It is usually accompanied by tearing of the joint ligaments and damage to the membrane that encases the joint. Injury severe enough to cause dislocation often also causes bone to fracture. Dislocation restricts or prevents the movement of the joint; it is usually very painful. The joint looks misshapen and swells. In some cases, dislocation is followed by complications, for example, paralysis.A dislocated joint should only be manipulated by medical personnel. First- aid treatment consists of applying a splint or, in the case of a dislocated shoulder, a sling. Sometimes, an operation is necessary to reset the bones.... dislocation, joint

A type of joint found in the spine, formed by the bony knob (called a process) of one vertebra fitting into a hollow in the vertebra above. Facet joints allow a degree of movement between individual vertebrae, which gives the spine its flexibility.... facet joint

A surgical procedure in which one or more artificial joints made of metal, plastic, or silicone rubber are used to replace finger joints destroyed by disease, usually rheumatoid arthritis or osteoarthritis.

The procedure is usually successful in relieving arthritic pain and enabling the patient to use his or her hands again, but it rarely restores normal movement.... finger-joint replacement

A temporary inability to move the knee joint. A locked knee may be caused by a torn cartilage or by loose bodies in the joint.... locked knee

The joint between each metatarsal bone and its adjoining toe bone (see phalanges). The metatarsophalangeal joint at the base of the big toe is commonly affected by gout and by hallux rigidus.... metatarsophalangeal joint

The accumulation of fluid in a joint space, causing swelling, limitation of movement, and usually pain and tenderness. A joint is enclosed by a capsule lined with a membrane called the synovium. The synovium normally secretes small amounts of fluid to lubricate the joint, but if it is damaged or inflamed (for example, by arthritis) it produces excessive fluid.

Pain and inflammation may be relieved by analgesic drugs, nonsteroidal anti-inflammatory drugs, and injections of corticosteroid drugs.

Swelling usually reduces with rest, firm bandaging, icepacks, and keeping the affected joint raised.

In some cases, the fluid is drawn out with a needle and syringe.... effusion, joint

A joint that has been damaged by inflammation and a series of injuries, which pass unnoticed due to loss of sensation in the joint resulting from neuropathy (nerve damage caused by disease). Neuropathic joints develop in a number of conditions, including diabetes mellitus and untreated syphilis.

When sensation to pain is lost, abnormal stress and strain on a joint do not stimulate the protective reflex spasm of the surrounding muscles; this failure of the protective reflex allows exaggerated movement that can damage the joint. Osteoarthritis, swelling, and deformity are features of a neuropathic joint.An orthopaedic brace or caliper splint may be necessary to restrict any abnormal movement of the joint.

Occasionally, an arthrodesis (a surgical operation to fuse a joint) is performed.

The nerve damage is irreversible.... neuropathic joint

Preparations containing nicotine that are used in place of cigarettes as an aid to stopping smoking.

Nicotine products are available in the form of sublingual tablets, chewing gum, skin patches, nasal spray, or inhaler.

Side effects may include nausea, headache, palpitations, cold or flu-like symptoms, hiccups, and vivid dreaming.

Nicotine replacement therapy should be used as part of a complete package of measures, including the determination to succeed.... nicotine replacement therapy

A surgical operation to replace a defective or diseased heart valve. (See also heart-valve surgery.)... valve replacement

A popular term for accumulation of fluid within or around the knee joint. The most common cause is bursitis. (See also effusion, joint).... water on the knee

a surgical technique used to replace a diseased length of aorta, most often the abdominal aorta. It usually involves inserting into the aorta a flexible tube of artificial material, which functions as a substitute for the diseased section.... aortic replacement

(gliding joint) a form of *diarthrosis (freely movable joint) in which the bony surfaces slide over each other without angular or rotational movement. Examples are the joints of the carpus and tarsus.... arthrodic joint

see enarthrosis.... ball-and-socket joint

see cystectomy.... bladder replacement

a painless joint effusion in a child, usually in the knee, caused by inflammation of the synovial membranes due to congenital syphilis. [H. H. Clutton (1850–1909), British surgeon]... clutton’s joint

see arthrodic joint.... gliding joint

see ginglymus.... hinge joint

(prepatellar bursitis) inflammation and resultant swelling of the bursa in front of the kneecap, usually due to repetitive friction and pressure over the kneecap, as from frequent episodes of prolonged kneeling. Treatment includes pressure bandaging, *NSAIDs, and avoidance of kneeling. See bursitis.... housemaid’s knee

n. the point at which two or more bones are connected. The opposing surfaces of the two bones are lined with cartilaginous, fibrous, or soft (synovial) tissue. The three main classes of joint are *diarthrosis (freely movable), *amphiarthrosis (slightly movable), and *synarthrosis (immovable).... joint

(patellar tendinitis) a form of *tendinitis that is common in athletes and dancers. Repeated sudden contracture of the quadriceps muscle at take-off causes inflammation of the attachment of the patellar tendon to the lower end of the patella. Treatment includes rest, physiotherapy, and anti-inflammatory medication.... jumper’s knee

the buttocks-up position assumed by patients undergoing anorectal examinations, now commonly performed in the left lateral position. It is useful for helping patients dispel excess flatus following colonoscopy.... knee-elbow position

(PERT) a therapeutic approach using supplements of the digestive enzymes lipase, amylase, and protease (Creon, Pancrex), which are given when there is insufficient endogenous production of pancreatic enzymes: for example, to patients with pancreatic cancer or cystic fibrosis. The capsules must be taken with all meals and snacks to be effective. PERT treats the symptoms of *steatorrhoea.... pancreatic enzyme replacement therapy

see trochoid joint.... pivot joint

a bone that is formed by replacing cartilage with bony material.... replacement bone

a form of *diarthrosis (freely movable joint) in which the articulating surfaces of the bones are reciprocally saddle-shaped. It occurs at the carpometacarpal joint of the thumb.... saddle joint

see diarthrosis.... synovial joint

(pivot joint) a form of *diarthrosis (freely movable joint) in which a bone moves round a central axis, allowing rotational movement. An example is the joint between the atlas and axis vertebrae.... trochoid joint