SAFETY AND YOUR TOTAL JOINT REPLACEMENT
SURGERY EXPERIENCE
Replacing the worn out joint has become integral to our lives as we age. So much so, that meeting people with not just one but two, three and four artificial joints has become commonplace. Who would have known that? These people look and walk so normally. In fact nothing about their behavior would suggest that they had an artificial joint(s).
Joint replacement surgery has progressed so much and has advanced so far that today we consider total joint replacement surgery one of the safest procedures being performed in the history of medicine. Several factors contribute to this fact.
First, this is elective surgery. It is not performed in an emergent fashion generally speaking (although there are indications for this). So you, the patient, have a chance to prepare for the procedure physically, psychologically and logistically. Elective total joint replacement helps you arrange a suitable day for your surgery and plan your rehabilitation, even if it is to a short stay rehab center after surgery.
Your home should be prepared for the initial return from the hospital. Remove loose mats and throw rugs and make way for easy access around the house to the bedroom, toilet, shower, closets and drawers, dining room, easy chair and so on. A place inside the house to do simple exercises facilitates your rehabilitation. Physical therapists will visit you at home to guide you through your initial rehabilitation until you can visit a therapy office location where more aggressive therapy can be instituted.
Before surgery, your regular physician, primary care doctor, will evaluate you and "clear" you to undergo the procedure. Your internist or family physician may check your blood sugar levels and ensure that diabetics have adequate control of their blood sugar levels before surgery. This is important for proper healing and recovery. You may also require evaluation by a cardiologist to insure there are no cardiac related issues which might create a risk in undergoing the surgical procedure. A visit to your dentist is also highly recommended so that loose teeth, carious or infected teeth and gums may be addressed. All this planning is what helps ensure a good outcome.
Following surgery, I will see you in the office for routine checks to insure that the surgical site is healing and the functional use of your joint(s) are progressing. These visits may be every few weeks initially and taper off to annually or longer. Our team approach - working together with health care professionals and the patient - is how as an orthopedic surgeon, I ensure a long term good result and a joint that will function well for the rest of your life.
KNEE REPLACEMENT SURGERY
Knee Replacement Surgery is considered an option when all other measures to preserve your own natural knee joint have been exhausted. While this is a major procedure, advances in medicine, surgery and technology have made it one of the safest procedures to undergo.
In a knee replacement operation, the worn out cartilage which has covered the knee joint is shaved away and replaced with a metal prosthesis. It may be only part of the knee which is replaced, although commonly the entire knee joint needs replacement. When only a part of the knee is replaced, it is called a unicompartment or bicompartment replacement. When the entire knee and all three compartments are replaced it is called a total knee replacement or TKA.
As described above, the knee has three compartments, the medial or inside of the knee, the lateral or outside of the knee and the patellofemoral compartment under the knee cap. There are various reasons to replace one or more compartments and depending on the extent of wear in your knee, we can determine what needs to be done. It is important to determine the extent of wear and need for replacement to avoid the need for repeat surgeries. My goal is to have you go through only one operation that will last you your lifetime. However, there are special conditions and indications where doing less is as good as doing more.
For the procedure I make an incision which is called by many a "mini incision." As a surgeon I need to balance the benefits of a small incision against the requirements of fitting the new prosthesis through that opening. I do not cut the quadriceps muscle, which is the thigh muscle or its tendon at all. I believe that this is an important muscle to preserve and that preserving it eases rehabilitation. I operate through a subvastus approach, even in revision cases, which means I operate under the muscle, preserving its strength and function whether I am replacing only one or all compartments.
With a team approach and dedicated rehabilitation following surgery, the majority of my patients are discharged from hospital within 48 hours. Following our established protocols, we have been successful in avoiding blood transfusions in 90% of our patients. And the best part - in most instances, you can look forward to ambulating without assistive devices, no cane and no walker within a couple of weeks of your surgery.
HIP REPLACEMENT SURGERY
Hip replacement surgery involves replacing the worn out ball and socket of the hip joint and replacing it with artificial surfaces. There has been much innovation in orthopedic surgery. We have moved through cycles of replacing only the surface of the ball (surface replacement) to replacing the ball with an attached stem and mating it with a socket to complete the artificial joint and back again to replace only the surface in some selected young patients.
Hip joints are commonly approached by an incision on the side of the femur or thigh bone. I often use an anterior intermuscular approach between muscles, or occasionally antero lateral approach which has been shown to have a lesser incidence of dislocations of the artificial hip joint in the early post-operative period. The posterior approach, the approach used by most surgeons in the US, is one I favor for revision hip surgery. The hip joint is approached from the back although the actual skin incision remains on the side of the upper thigh.
Recently, media attention has been directed toward mini incision surgical procedures, double incision hip replacement and surface replacement hip procedures. Long term studies have shown varying benefits to the above. While I have performed all of these procedures, I do not use any particular one as a routine for every patient. Rather, I select the implant and approach on an individualized basis to maximize surgical outcomes for my patients.
As with any major procedure, the long term results of hip replacement surgery do carry certain risks including infection, loosening with or without infection and dislocation. Infection of the hip joint after surgery is usually less than 1 % in most patients. Dislocation of the artificial hip is also uncommon but can occur, often a result of wearing out of the joint surface. This is also known as polyethylene wear. Over the course of time, wearing out of the articulating surface, which was commonly made of very dense plastic or polyethylene, occurs. Just as a linoleum floor wears a tread path, or the tires on your car wear their tread out, the plastic liner of the hip joint can also wear out. To counter this, researchers developed ultra high molecular weight plastic and then irradiated this to make it even less likely to wear. Another prosthetic option was ceramic liners, but these, like your crockery, have a tendency to fracture, so much so that it is impossible to remove all the pieces from the body after a shattering fracture of a ceramic implant. Finally we come full circle again, to using highly polished metal (chrome surfaced) balls in a chrome liner. Initially they were not smooth enough but with technological advancements, there has been a resurgence in these metal on metal joints. Now we can use larger sized metal balls which in turn have a reduced tendency to dislocate. I still prefer to use high molecular weight polyethylene liners and either ceramic or metal balls/heads.
I tailor my approach and choice of implant according to my patient's individual needs and requirements, hence minimizing the risk and chances of dislocation and wear. I have followed the latest techniques and joined in discussions at different stages and levels of research. I am a member of the American Association of Hip and Knee Surgeons, who meet every year to discuss procedure and technology advancements and avoidance of complications. The surgical outcomes of my patients speak to the benefits of this individualized, state-of-the-art approach to their care. |
