Arthritis Relief and Joint Replacement: January 2007

Humpty Dumpty sat on a wall,
Humpty Dumpty had a great fall;
All the King's horses and all the King's men,
Couldn't put Humpty together again.

Things have changed. Back in the days of knights, all those horses and men couldn't even put together a simple egg. Recently former President George Walker Bush had his second hip replacement. While he does not plan on falling off a wall, he probably does plan on skydiving. Eat your heart out, Humpty.

What has changed since Humpty's fall and failed surgery to the point where President Bush's hip replacement is expected to be extraordinarily successful?

The Top Ten Reasons Why Bush's Hip Replacement Will Succeed and Humpty Dumpty's Failed

10. Former President Bush probably had health insurance. While over 40 million Americans are uninsured and millions more have insurance but for a variety of reasons little access to appropriate healthcare, that still means that well over 250 million Americans are getting access to healthcare. Former President Bush has Medicare. Therefore he did not have any barriers access to a hip replacement. Humpty Dumpty didn't even have the coverage to get transported to a nearby medical facility. They tried to fix him on the spot. Poor choice.

9. Former President Bush is way healthier than Humpty ever was. Humpty was fat, out of shape- he was shaped like an egg for God's sake! His form of exercise was climbing up a wall and planting his fat butt on top. Bush is a former fighter pilot, takes care of his general health, and exercises on a regular basis.

8. Former President Bush has a supportive family network which helps in the healing process. Humpty was surrounded by a bunch of bad eggs.

7. Former President Bush had an operation that has a history of success. Humpty Dumpty basically had a bunch of horses and men trying to figure this stuff out. Hip replacement is an operation that has a successful multi-decade experience due to the work many dedicated surgeons and engineers, and device manufacturers. In the 1960's, Sir John Charnley from Writhing, England developed the most successful hip replacement of its day. Charnley's principles, based on his own work as well as work of other surgeons in the years prior to him, remain today as the foundation of hip replacement. His design of a plastic liner with a metal stem, fixed to the bone with a special type of cement ushered in the modern era of joint replacement.

6. Today we also have women involved in healthcare. I would suspect that the second stanza of the Humpty Dumpy Poem reads: Later in the day, the men decided not to be such pigs about it, took their horses, picked up some womenfolk (that is what they were called back then) returned and put him back together in no time flat.

5. There were no antibiotics in Humpty Dumpty's day. We sometimes forget that antibiotics were discovered and developed just last century. We don't really know the details of Humpty's surgery on that fateful day. Maybe he was put back together and developed an acute infection and it all fell apart. Today we use antibiotics before and after the surgery for a period of time to prevent infections.

4. Humpty Dumpty had a great fall, remember. Former President Bush had his problem isolated to the hip from arthritis. When injuries happen due to significant trauma, other parts of the body can be the cause of problems. With Humpty it could have been that his yolk ruptured or the egg whites leaked. Former President Bush did not have to worry about any injury to his spleen or liver. The surgeons were able to concentrate solely on his hip.

3. Former President Bush had anesthesia. The field of anesthesia was not in existence in Humpty's day. According to a summary of the history of anesthesia, modern anesthesia with the introduction of ether did not occur until 1946. The advances of anesthesia have been tremendous since that time to allow Former President Bush to have extremely safe anesthesia for the surgery. Also, without anesthesia, Humpty's injury must have really hurt and I am sure he was moving all over the place while the horses and men were trying to put things back together. Because of this, I am sure that not only were they not able to put him back together again. I am sure they were unable to put him back together again and again and again.

2. Former President Bush had his general medical conditions optimized by his primary care physician prior to the surgery. It is important for patients to understand the seriousness of this. Having a strong relationship with your primary care physician and optimizing any and all medical conditions prior to surgery can have significant impact of the success of the surgery. What what I can gather from Humpty's situation he was at a distinct disadvantage having Little Jack Horner, Little Bo Peep, and Jack Sprat on his preoperative medical team.

1. Doctors and teams of health professionals are now involved in the surgery and the care that follows. Don't get me wrong. I like horses but it is tough to tie sutures and hold a scalpel with those hoofs.