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Orthopaedic Surgeon at Dreyer Medical Clinic - Fox Valley Villages and Mercy Campus
Each year, about a half million people in the United States have joint replacement surgery to regain physical function, with a goal of eliminating pain, cane, and limp. Hips and knees top the list of joints replaced but other joints, such as shoulders, elbows, ankles, toes, and fingers also can undergo replacement.
Joint problems are often the result of arthritis – osteoarthritis, rheumatic arthritis, or traumatic arthritis. Avascular necrosis (loss of blood supply) and bone tumors can also require total joint replacement. Childhood dysplasia in the hip can result in arthritic problems as an adult.
Arthritis can affect people in their early 30s and upwards. Arthritis is the main cause of disability in America, and joint pain is probably the best-known symptom of the disease. One in seven people has some type of arthritis.
Arthritis has many causes. Over the years, joints wear out and cause pain, a need for assistance such as a cane, and eventually a limp. In the worst cases, walking or moving the joint can be impossible because of pain or general restriction of motion. Anti-inflammatory medication, cortisone injections, hyaluronic acid (series of 3) injections, physical therapy, etc. can be used but eventually are of no avail. Activities of daily living are limited and the overall quality of life is diminished. At that time – when all conservative modalities have been tried and a person has realized that they can no longer live with such discomfort – joint replacement must be considered.
Fortunately, innovative procedures can get us moving again fast. The average candidate for a new knee or hip is between the ages of 65 and 67, but today, 1 in 3 surgeries are performed on someone younger than 60.
The surgical procedure replacing joints is termed as arthroplasty, which literally means “reforming of the joint,” and involves complete or partial replacement of the joint.
Various options are available. With total hips, different bearing surfaces such as metal on plastic, metal on metal, ceramic on plastic, or ceramic on ceramic are available. In the United States, new innovations of hip resurfacing are becoming popular. For total knees there are fixed bearing options versus rotating platform options. Unicompartment knee replacements also are available. For each of the options, the patient’s body type, disease process, and overall personality is critical in choosing the correct implant and surface interface.
Choice of implant, incision size, and final outcome is dependent on variables such as body mass index (a ratio of weight and height), prior surgeries, marked deformity, and retained hardware from prior surgery.
Emphasis on scar size (minimal versus minimizing incision) is a constant debate in the orthopaedic community. Some techniques use shorter incisions and avoid tendons, muscles, and other tissue. The claim is that there is a smaller scar, less pain, and a faster recovery, but this is not always the case. The handling of tissue with reduced tissue trauma and optimal pre-, peri- and post-operative pain management is the key to a faster recovery. Appropriate rehabilitation also is important, as is pre-surgical education of patients and their families.
Traditional hip surgery is done under general or regional anesthesia with an 8 to 10-inch incision. Generally, you can expect to spend 3 to 5 days in the hospital. Pain usually subsides within the first couple of weeks, but it can take up to 3 months to regain full strength and stamina. Outcomes are excellent, with over 95% of the procedures resulting in marked improvement in pain and joint function.
Total knee arthroplasty involves surgical replacement of all three of the knee’s compartments – inside (medial), outside (lateral), and kneecap (patellofemoral). In partial knee replacement, the diseased bone is removed from just one of the knee’s compartments, either medial or lateral, and replaced with an implant. Partial joint replacement usually involves a smaller incision, a shorter hospital stay, and a faster recovery.
Shoulder surgery techniques are advancing rapidly. Like hips and knees, some procedures previously done through large open incisions can now be accomplished using smaller incisions with the potential for less pain and faster recovery. The shoulder joint is quite complex and has the greatest range of motion of any joint in the body. This flexibility is why so many problems arise. Recovery from shoulder surgery can be lengthy and take as long as 6 months. Physical therapy is important as well as strengthening exercises for long-term shoulder care.
Ankle injuries, such as fractures, are the most common reason for development of arthritis in the ankle. With every step, the ankle joints absorb about 5 times your body weight per square inch, a greater force than is exerted on any other joint in your body. The ankle is a resilient joint but arthritis may cause major issues. Ankle replacement is an option, but only for the correct patient and should be evaluated by a surgeon with the expertise and skill to do a good surgical intervention.
Some of the risks associated with major surgery include infection, neurovascular injury, fracture, component failure, deep venous thrombosis (blood clot in legs), pulmonary embolism (blood clot to lungs), anesthesia risk, as well as death. Dislocation and leg length discrepancy are also valid risks.
Post-operative follow-up and dedicated physical therapy is critical to the success of joint replacement surgery and is best accomplished through a multi-team approach. The office and hospital nurses, surgical team, implant vendors, patient families, physical therapists, surgeons, and last but not least, patients must be committed to quality care and dedicated service.
The goal of joint replacement surgery is re-introduce patients to an acceptable and enjoyable quality of life. These are not necessarily patients who want to run marathons or become yoga gurus or incredible contortionists. Often, all they want is no pain, no cane, and no limp.
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