Total Joint Arthroplasty
Below are some frequently asked questions that have come from patients regarding arthritis and total joint arthroplasty or replacement (TJR). These mainly focus on the knee and hip; however other joints can be replaced also.
Is all knee/hip pain arthritis?
No, after a careful history, physical exam, and radiographic studies, your doctor can tell you if your pain is from arthritis or other problems such as meniscal tears, bursitis, tendonitis, referred pain from your back, etc.
What is arthritis?
Arthritis means inflammation of a joint. We most commonly see osteoarthritis or "wear and tear" but there is also rheumatoid arthritis, psoriatic arthritis, gout, septic, post-traumatic, and others.
What other treatments are there before TJR?
Arthritis and its severity fall on a spectrum from very mild pain with minimal joint changes to very severe pain with bone on bone contact and deformity. Likewise, the spectrum of treatment options varies depending on the patient’s symptoms. Non-operative treatment includes modalities such as heat and/or ice, limited rest of the joint, and medications such as Tylenol, anti-inflammatories, and glucosamine chondroitin sulfate. Sometimes neoprene sleeves or unloader braces help the knee joint especially people with deformity. Physical therapy for a comprehensive stretching and strengthening program and aquatic exercises can alleviate some pain by building strength and increasing flexibility. A low to non-impact exercise program can help maintain these gains. Surgical treatment with arthroscopy has a limited role in treating arthritis, mainly in patients with early stages and mechanical symptoms.
How long is the surgery?
Actual surgery time is from 1 to 2 hours but there is also time pre-op and with anesthesia and then time in the recovery room post-op.
How long do I stay in the hospital?
This varies greatly among patients and is affected by factors such as age, strength, balance, motivation, social setting, and family support. Usually patients are in the hospital from 1 to 5 days. If patients need more time to rehab or get back on their feet, we can transfer them to a rehabilitation unit or skilled nursing facility based on their needs.
What kind of therapy do I need after surgery?
Therapy can start before surgery by learning the exercises to build strength and improve motion. A continuous passive motion machine is started right after surgery. This is a machine that moves your leg passively for you and decreases pain and stiffness. In the hospital and /or rehab unit, you will work with a physical therapist to regain motion, begin weight-bearing ambulation and transfers, and start building strength. The occupational therapist works with you on activities of daily living such as bathing, getting dressed, and other personal care. After discharge and going home, therapy is continued either as an outpatient where you go to the facility to work with the therapist or with home health where the therapist comes to your home. This is based on your functional status at discharge.
When can I drive a car?
If we operate on your left leg and you have good control of your right leg, you can generally return to driving fairly quickly. If we operate on your right leg, it can be at least 2 to 4 weeks before you gain good muscle control to drive and be able to stop in an emergency.
How long will the joint last?
We tell patients that the joint will last about 15 years or a range of 10 to 20 years. There are patients who have joints that have lasted over 25 to 30 years and there are patients that need revision of there joint because it wore out sooner. The durability is affected by the patient’s age, amount of use, obesity, and correct placement. Modern joint replacement has only been around since the late 60’s to early 70’s, so our true long term experience is limited. In addition there have been many advances in design changes, material improvements and surgical techniques that should continue to increase the longevity of these joints.
What are the risks?
The risks include but are not limited to early loosening, infection, joint stiffness, fracture around the implant, blood clot or deep vein thrombosis, pulmonary embolism, and other medical problems such as heart attack, stroke, pneumonia, or urinary tract infection. Although this sounds very scary, these major complications occur infrequently and 90 to 95% of the patients are extremely pleased with their outcome.
Am I too old? Am I too young for joint replacement?
Ideally the best age is a patient in their 60’s or 70’s with severe arthritis that is limiting their activities, waking them up at night, and they have failed conservative management.
Which implant or joint is the best?
There are many total joint prostheses or implants for both the knee and hip joint that your surgeon can choose for your replacement. No particular type has been shown to be heads and tails better than all the rest. Your surgeon will work with you to determine your age and life expectancy as well as functional status and expected activity level to choose the best implant for you as an individual. There are newer technologies and surfaces such as metal on metal and ceramic for hips and cross-linked polyethylene for knees and hips that have shown to last longer in lab testing and may be better suited for younger, more active patients.
What is minimally invasive?
Minimally invasive surgery uses smaller incisions, less soft tissue damage, and some different instruments to hopefully decrease hospital stay and decrease the time to full recovery. The early results are promising however the surgery is technically more difficult and may have a higher risk of malposition of the implants. Also, initial marketing of this type of procedure has been misleading to the general population because it compares itself to older techniques with a very large incision and slower rehab. Most surgeons have gradually been progressing to a less invasive type of procedure.
These are a portion of the questions asked about total joint replacement by patients we see in the office. Talk to your surgeon about your joint pain and find out what the best treatment is for you.