Given the large number of people who have had successful joint replacements, why not go with the surgeon and have my right shoulder done immediately? Good question.
Unless it is an emergency, I think it always better to take the time to review options, get second (or more) opinions, and make an informed decision about any medical treatment. Remember, the person ultimately responsible for your health is you, and it is incumbent upon any responsible person to be informed and to make informed decisions.
In this case, there are several factors at work.
Back the second time I worked for NASA (as a contractor), I worked commercial space research and as part of that worked with the Center for Commercial Applications of Combustion in Space. The team there was working with partners on advanced bone replacement materials. The problem with the implants then (and it applies to current day as well) is that they are solid chunks of metal or other similar materials. Natural bone may be smooth on the outside, but inside they are quite porous. Thus, you have density and mass differences that can and do affect the system on a mechanical basis. The stem of a replacement has to be glued in place, and that has caused problems on occasion.
The work CCACS was involved with produced a metallic/metallic-ceramic replacement that was smooth where needed, and had a porosity effectively equivalent to natural human bone. The research was focused on how to get the same results on Earth so that custom replacements, as close to identical to what was being replaced as possible, could be produced on Earth in the OR. Since the reaction was exothermic, the replacement parts would be sterile.
The truly advanced work, however, was focused on developing materials that would serve as a scaffold for natural bone to grow. As the patient’s bone grew into it, the replacement would dissolve and pass out of the body until after a period of time the patient was left with natural healthy bone in place.
There is a good bit of research underway (see here for one example) on advanced materials. Such advanced materials are needed because of a different area of medical research: regenerative medicine.
Regenerative medicine uses things such as stem cells, the extra-cellular matrix, and even some genetic manipulation to heal. In fact, using regenerative medicine, it is possible to not simply heal, but to restore a site, organ, limb, etc. to what it was before. Ultimately, they are looking at being able to regenerate limbs, organs, and other structures. To call it an exciting field is an understatement.
While separate, regenerative medicine ties into a variety of anti-aging research. This research focuses on restoring the body to the cellular conditions of youth.
Now, having worked with such research at NASA, and having had the honor of working with the late Leslie A. Geddes at Purdue — who pioneered several fields of biomedical research including regenerative medicine — I’ve been keeping a bit of an eye on such things. As Glenn Reynolds the Instapundit often notes, “Faster, Please.”
And I do want to see it faster, much faster, please. Based on current research, and even allowing for the FDA approval system that seems designed to prevent advances and competition, I believe I have a good twenty to forty years of life ahead of me barring something catastrophic. Which gets back to the current state of joint replacement.
Current materials are not designed to take advantage of future advancements. Nor are they designed for the life of the patient. The sad fact is that for many types of replacement, you can count of having to have the replacement replaced about every fifteen to seventeen years. So, at least two if not three replacements.
I would also note that because of the issues connecting bone with replacement, I would be limited to picking up no more than 15 pounds at a time, not have full range-of-motion restored, and face other limitations on activities. This would include many things I enjoy doing. Add in that at least two people I’ve talked to who have gone this route would not do the replacement over again, well…
So, I could opt for immediate replacement with parts that are close/semi-close to the size of my bones and will limit my activities because of the mechanical and other differences. These parts also are not designed to work with near-term or long-term advances in medical treatment; but, the replacement would reduce (though not necessarily eliminate) the pain in the joint and prevent further damage.
Or, I can opt to wait and experiment. The experimentation is potentially two-fold.
The first part is to try a supplement regimen that could slow, or even stop, damage not just in my shoulders but my entire body. Such a regimen has reportedly resulted in healthy regeneration (to some extent) in some patients. The odds, as I understand them from medical research, are long. I’ve faced some long odds in life before, it’s worth a shot.
The second part is to research clinical trials in regenerative medicine and advanced bone replacement materials. If I qualify for one or more regenerative medicine trials and participate, then I have the potential for at least partial restoration if not full. Add to it the fact that by participating I can help drive things forward faster please, even if it does not help me, then it’s still a win.
If regenerative trials don’t work out for whatever reason, then I will look to advanced bone replacement materials trials. If I have to have a replacement, why not go for one designed to take advantage of advances in medical technology?
Meantime, I’ve lived with chronic pain for years, decades even. I don’t like it, am working on dealing with it, but can handle a bit more. So long as I minimize damage to the shoulders and other joints being attacked by arthritis, I can and will put up with the additional pain.
That’s it in a nutshell, and there are several areas that can, and may be, explored in greater detail later. However, for now, it lays out the base case for my decisions.
