There goes the universe again–humbling man; showing him that, while his attempts to control nature may be noble, he still can’t do better when it comes to running living organisms. Take joint replacements, for example, long seen as modern orthopedic miracles (and in some ways they are), they are now being implicated in creating a painful inflammatory condition that could destroy bone and loosen the new joint.

According to new research, the titanium used to make artificial joints can lead the body to enter into an autoimmune inflammatory response, called Th2, that activates “alternatively activated macrophages,” a group of immune cells thought to be responsible for the bone destruction in the inflammatory condition.

The researchers believe that titanium chips slough-off the artificial joint surfaces, causing an allergic-type reaction, the type of inflammation associated with allergens and parasitic worm infections. The study was carried out in mice and results were published in the Journal of Immunology.

These new findings bring up two important points for me. One: I still believe joint replacements are too quickly recommended. Although joint degeneration is a real phenomenon, what causes it is of some misunderstanding by the medical profession. Joints don’t just break down. Often other biomechanical dysfunctions predispose to joint wear-and-tear, and by correcting them, the joint can readily be saved. In other words, too many replacements are happening instead of rehabilitating, and allowing self-healing. This is another paradigm problem, whereby orthopedic medicine believes joint breakdown to be random and arbitrary, and joint reconstruction a common necessity.

Two: I think that the researchers are somewhat off-base with their analysis, particularly that “alternatively activated macrophages” are responsible for bone breakdown. It is my understanding that alternatively activated macrophages are involved in the “resolution of inflammation and promotion of wound repair due to their anti-inflammatory, fibrotic, proliferative, and angiogenic activities,” which would make sense to me, as I would think the body would attempt to heal the area. The body sees titanium as foreign, and develops an allergic response to it. Classic macrophages, not alternatively activated macrophages, likely breakdown bone and promote the inflammatory response. The presence of alternatively activated macrophages is the organisms attempt to heal, the natural response of a living organism.

To my mind, why not just look to correct the underlying causes of joint breakdown? Chronically tight muscles, excess weight, foot dysfunction, chronic subluxations–all can lead to increased joint breakdown. But each one of these causes is ignored by some in the orthopedic profession. Why? Part of the reason has to do with everything looking like a nail to the hammer-wielder. In other words, professionals rely on what’s in their arsenal first and foremost. Unfortunately for you and me that means the cultural health authority always having scalpel ready for business.

The other reason is that–in the short term, at least–surgery is much easier than hard work required in rehab (About 773,000 Americans have a hip or knee replaced each year). For doctors and patients alike, easier is more attractive; and when the other causes are ignored (or denied), what better way to explain failure than the “no guarantee” nature of all surgical procedures.

My philosophy is simple and valuable in the long term. Always try conservative first, get the body back into operable biomechanical condition, and let the body do it’s own self-healing. The presence of alternatively activated macrophages should be proof enough that the body will always attempt healing, even in severely challenging situations (like having a foreign metal put into your body). If after a good-old-college-try at conservative care and self-healing doesn’t do the trick, then get the surgery. Conservative first, surgery last. Simple.

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