Health Leader, Straight from the Hip

STORY BY

Meredith Raine

Kathryn Nowlin-Castellese grinned as she slowly made her way to the stage. She didn’t care that she was holding up the line. This was her moment.

The fact that she was walking on her own was as much of a milestone as the high school diploma she was about to receive. The soon-to-be graduates behind her would just have to wait their turns.

Kathryn thought she may not be able to walk across the stage at graduation or dance at her senior prom. Her juvenile rheumatoid arthritis was causing so much pain in her hips and her back that she had to rely on a scooter to transport her to class.

Improved joint replacement parts and surgery helped her stand up straight again and walk a painless path to recovery.

Long-lasting bio-materials

Terry Clyburn, M.D., assistant professor and director of research in the Department of Orthopaedic Surgery at The University of Texas Medical School at Houston, says joint replacement parts, once designed for older patients, are now made to last longer. With the development of metal-on-metal and ceramic replacement parts, there is a reasonable chance that the benefits of a joint replacement performed on a teenager could last the life of the patient.

“Once the joint is replaced, the arthritis in that joint is alleviated, and the arthritis does not come back,” Clyburn says. “Patients with juvenile rheumatoid arthritis (JRA) often have severe joint pain from almost the time they are born, so to be able to offer them the opportunity to live without some of that pain is quite significant.”

Nearly 300,000 children in American have some form of arthritis or rheumatic disease. JRA is the most common, according to the Arthritis Foundation.

The disease contributes to smaller, brittle bones and medication can soften the bones, so there are more risks associated with joint replacement in JRA patients. However, Clyburn says, minimally-invasive techniques often can be performed, and screws and clips can be used, if necessary, to anchor and reinforce the joint replacement.

For successful rehabilitation in patients with severe rheumatoid arthritis in their hips, Clyburn recommends a bilateral hip replacement. Otherwise, the untreated joint may be too stiff to do physical therapy after surgery.

Nowlin-Castellese, now 19, was 18 months old when a physician diagnosed her with juvenile rheumatoid arthritis. Throughout the years, she has taken methotrexate, Enbrel and other medications to help her maintain mobility. Even still, the pain in her hips and back progressed, and during her senior year, it became debilitating.

“I wanted to be able to dance at my prom,” Nowlin-Castellese recalls. “I wanted to walk with my class at graduation and get my diploma like everyone else.”

Clyburn replaced her hips with metal stems and sockets and ceramic balls five months before graduation. Today she walks with no pain. “I’m even a little taller,” Nowlin-Castellese says. “I used to be in so much pain that I was crying and I couldn’t concentrate on my work at school. Now that I have the new hips, I can do the things I want to do with my life.”

Last Updated: 6-24-2005

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About Dr. Clyburn:

Dr. Terry Clyburn is an assistant professor and director of research in the Department of Orthopaedic Surgery at the UT Medical School.

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Health Tip:

Packing Bag Lunches Safely

If you pack lunches for your child to take to school, be careful that you do not accidentally expose them to foodborne illness.

Bagged lunches, especially those containing perishable foods, need to be packed and handled properly in order to keep the food safe. In general, perishable foods should not be left at room temperature for more than two hours. If left out too long, the temperature of the food can enter the danger zone where bacteria grow most rapidly, which is between 40 and 140 degrees Fahrenheit.

Below are some tips to help families pack bagged lunches safely:

Pack foods that are nonperishable and won't require refrigeration.
If you do pack perishable foods such as luncheon meats or prepackaged cheese and crackers, include a frozen gel pack or a frozen juice carton with the food in an insulated lunch bag or box.
Pack only the amount of perishable food that your child can eat at lunch.
Preparing lunches the night before and storing them in the refrigerator until you pack your child's lunchbox in the morning can help keep food cold longer the next day.
Don't reuse packaging materials such as paper or plastic bags, aluminum foil, etc. as they can contaminate other foods and cause foodborne illness. Have your child discard all used food packaging and paper bags after lunch.

Before eating lunch or snacks at school, make sure your child washes his or her hands with soap and warm water for at least 20 seconds. If your child's school does not have a handwashing program in place, encourage them to adopt a such a program, as handwashing is one of the best ways kids and parents can protect health and stop the spread of germs.