Some common diseases associated with degeneration of a joint that may require joint replacement include the most common, which is degenerative osteoarthritis or just normal wear and tear. In this process, the cartilage itself is denuded off of the cap of the joint. That causes this underlying subchondral bone to be exposed, which has many nerve endings in there. That leads to a process people commonly refer to as bone on bone arthritis. That subchondral bone is very sensitive and it becomes very painful. Another type of arthritis is called rheumatoid arthritis or really any other type of inflammatory condition that is actually more of a disease of the synovium or the lining of the joint itself rather than the cartilage surface. The lining is inflamed causing a degenerative process that takes away the cartilage in an inflammatory type of way. This condition, inflammatory arthritis is another common reason to undergo joint replacement surgery. Another common condition that can cause patients to require joint replacement surgery is a process called avascular necrosis. What happens in this condition is that the blood vessels that go to the bone itself become impeded for a variety of reasons. The most common are alcoholism and steroid use, either through the use of asthmatics or another different inflammatory condition. All of these processes lead to destruction of the joint that ultimately your body cannot respond or restore and may require joint replacement surgery. I typically do not tell patients that they need or require a joint replacement. That is that, those words don't usually come out of my mouth because most of the time it's a lifestyle decision. This is an elective surgery. Typically, we're not dealing with a tumor situation, requiring the replacement of a joint and therefore we're not saving this person's life necessarily. Instead, we're giving back their quality of life. And so it really becomes more to the patient's overall ability to respond to the anti-inflammatory medicines and different conservative treatments. And then how willing they are to continue with that path until they do want to proceed with hip replacement or knee replacement surgery.
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