Set Yourself Up For Success
If you and your doctor think joint replacement is reasonable, give yourself time beforehand to deal with health issues that may interfere, such as obesity or uncontrolled diabetes. And take these steps:
Pick an experienced surgeon. Choose one who frequently performs joint replacement and has a low complication rate: At least 50 surgeries a year and a 3 percent or lower complication rate are good benchmarks. The medical facility you choose should do at least 400 joint replacements annually.
Because a key risk of surgery is infection, ask about the facilitys overall infection rate . Or check Consumer Reports hospital ratings.
Find out about recalls. Ask your surgeon whether the device he or she is planning to use has ever been recalled. And request the unique device identifier for your implant in case it is recalled in the future.
In addition, make sure that you dont have an allergy or a sensitivity to any of the materials in your device and that your surgeon isnt planning to use a metal-on-metal implant.
When it comes to techniques, dont be dazzled by robotic or minimally invasive surgeries, which use shorter incisions, says Matthew Kraay, a professor of orthopedic surgery at Case Western Reserve University School of Medicine. They havent been shown to be more effective than standard methods, and surgeons may be less familiar with them.
Troubled By Knee Arthritis But Not Ready For Knee Replacement Here Are 5 Alternatives
Millions of Americans suffer from knee arthritis, which can cause pain, stiffness and a decrease in activity level and quality of life. Eventually, this often leads to knee replacement surgery, which remains the most effective treatment for permanent pain relief. However, knee replacement should be reserved as a last resort. There are several minimally invasive options you and your surgeon can try before committing to knee replacement surgery:
MAKING THE DECISION
The Ligaments Need To Be Saved To Save Your Hip
Remarkable in their observations are recent studies that look at people who still had hip pain after hip replacement surgery. Since the bone-on-bone was alleviated by the hip replacement what could be causing the patients continued pain?
Doctors at Washington University in St. Louis School of Medicine suggest that it must be the hip ligaments. They write: surgical management for hip disorders should preserve the soft tissue constraints in the hip when possible to maintain normal hip biomechanics.
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Why Might I Need A Total Knee Replacement
You might need a total knee replacement if you have significant damage to your knee joint. Different types of medical conditions can damage this joint, such as:
Injury or fracture of the knee joint
Bone tumor in the knee joint
This damage might be very painful and limit your normal activities. The procedure may help decrease your pain, improve your joint mobility, and quality of life. Usually, healthcare providers only recommend total knee replacement when you still have significant problems after trying more conservative treatments, like pain medicines and corticosteroid shots .
Talk with your doctor about the benefits and risks of having minimally invasive total knee replacement instead of traditional total knee replacement. Minimally invasive total knee replacement uses a smaller incision than a traditional knee replacement, so it may lead to less pain and decreased recovery time. It is not yet clear whether the procedure leads to an increased risk of certain complications, though.
In some cases, you may have other surgical options, like shortening the bone or a partial knee replacement. Talk with your doctor about the risks and benefits of all your options.
Which Method Of Hip Replacement Is The Best
The different hip replacement surgery methods have pros and cons and unique applications:
- Anterior hip replacement surgery: This approach enters the hip joint through the front of the upper thigh. The main benefit of this approach is that it works between muscles. With this approach, surgeons can access the hip joint without separating muscle from bone, which helps patients recover faster. That said, the anterior approach has a higher risk of causing nerve damage.
- Posterior hip replacement surgery: The posterior approach provides surgeons with more precise views of the hip joint. Yet, this approach also involves cuts through several muscles to access the joint. Since the posterior approach causes increased trauma to the surrounding tissues, this approach involves lengthier recovery times. That said, it may be necessary for complicated hip replacement surgeries. The posterior approach causes trauma to the top of the outer thigh muscles, the gluteus maximus and external hip rotators.
- Lateral hip replacement surgery: Like the posterior approach, lateral hip replacement surgery provides clearer views of the hip joint but has to cut through muscles to get there. The lateral approach affects the gluteus medius and minimus muscles. A surgeon would opt for this approach instead of the posterior if the damage mainly exists at the side of the hip joint.
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How Long Does It Take To Recover From A Hip Replacement
Recovery length from a hip replacement surgery depends on various factors and can take anywhere from six months to one year. Some factors that influence how long it takes to recover from hip replacement surgery include:
- Your age, nutrition and physical condition.
- The type of procedure whether it was partial or total hip replacement surgery.
- How closely you adhere to pre- and post-procedural instructions.
- Whether any complications occur during or after surgery.
- The strength of your bones and their ability to adhere to the prosthesis.
- Whether you qualify for minimally invasive hip replacement surgery.
The classic hip replacement recovery timeline is as follows:
Research: We Know The Hip Ligaments Are Important They May Be More Important Than We Think
As mentioned above, when you first go to a doctor with hip pain, it is rare for the doctor to acknowledge that your problem may be from the ligaments. The reason? Ligaments are not cartilage and they are not bone. It is easier to describe to someone that they have bone on bone than joint instability causing a premature arthritis condition.
Doctors not knowing or understanding the hip ligaments and their role in hip stability are slowly recognizing ligaments as a major problem in the treatment of hip pain. Listen to what a team of German surgeons at the Department of Orthopedics at the University of Leipzig has recently published in the health journal PLusOne.
- We know that hip ligaments contribute to hip stability.
- We do not know how ligament damage affects men and women differently or how ligaments affect inside, outside, front, or back hip pain.
- We do not know clearly know how ligaments interact with other tissues stabilizing the pelvis and hip joint, as research is scant.
Here is the concluding statement of the paper abstract:
- Comparison of the mechanical data of the hip joint ligaments indicates that their role may likely exceed a function as a mechanical stabilizer.
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Hip And Knee Resource Centre
Your education regarding Hip and Knee Replacement Surgery can start before you meet with your surgeon. The Hip and Knee Resource Center offers an education class, Considering Joint Replacement Surgery, which provides information on the non-surgical treatment options for arthritis as well as helps you prepare for your consult visit with the surgeon. Once you decide to proceed with surgery and have been placed on the waitlist, there are more classes available to ensure your specific education needs are met before surgery. These classes include: The Knee Replacement Class, The Hip Replacement Class, Nutrition and Exercise Classes, Pain Management Class, and Before Your Surgery Preparation Class. You should receive a pamphlet outlining these classes and available dates when you are provided with your assigned surgeon. All classes provided through the Hip and Knee Resource Center are free of charge.
Understanding Your Health Can Help If Youre Wondering If You Need A Hip Or Knee Replacement
If youve been living with joint pain due to arthritis, you may be wondering if you need a knee or hip replacement. When considering joint replacement surgery, there are a few ways you can determine if youre ready to discuss it with your orthopedic provider.
Chad E. Smith, M.D., orthopedic surgeon with Norton Orthopedic Institute, suggests thinking about the following three factors:
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Stem Cells In Combination With Prolotherapy
In our published research in Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders, we showed that not only do stem cells regenerate tissue damage within the osteoarthritic joint, but used in combination with Prolotherapy injections, we were able to document repair and hip stability.
In this case series, we describe our experience with a simple, cost-effective regenerative treatment using the direct injection of whole bone marrow into osteoarthritic jointsin combination with hyperosmotic dextrose.
- Seven patients with hip, knee, or ankle osteoarthritis received two to seven treatments over a period of two to twelve months. Patient-reported assessments were collected in interviews and by questionnaire. All patients reported improvements with respect to pain, as well as gains in functionality and quality of life.
- Three patients, including two whose progress under other therapy, had plateaued or reversed, achieved complete or near-complete symptomatic relief, and two additional patients achieved resumption of vigorous exercise.
As far back as 2006, an article in Pain Physician Journal featured a case study of successful cartilage regeneration using stem cell therapy. This case involved a 64-year-old man with a 20-year history of hip pain. He was a candidate for a hip replacement as his MRI showed severe degeneration, decreased joint space, bone spurs, and cysts.
The Evidence For Alternatives To Hip Replacement Addressing Hip Instability With Regenerative Medicine Injections
- Note: Hip replacement may be the only option for people with advanced degenerative hip disease. This is where degeneration is so advanced that it has deformed the hip ball and socket and caused a frozen or locked hip situation, a lot of pain, and loss of quality of life. In our opinion, this is the only time hip replacement should be considered the number 1 option but it should also be the number 1 option when regenerative medicine injections are not considered a realistic option.
Whether you choose to have surgery or you are seeking not to have the surgery by using regenerative medicine injections, you need to function quickly and pain-free. There is a degree of urgency here because your hip will get worse and worse and at an accelerated rate. One of the first things that will happen if it has not already is that your hip will start causing you much more pain than your doctor or MRI shows. This is a critical time and we cover this patient problem in our article: Your hip hurts worse than your MRI is saying it should and your doctor doesnt believe you. When you have more hip pain than an MRI is showing you should, your hip is sending signals to the brain that it is sinking.
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Progress Toward Pain Relief Without Opioids
Research from the University of Massachusetts, presented at the annual American Society of Anesthesiologists meeting, found one in four hip or knee replacement patients were prescribed opioids in 2006. But by 2014, only one in 12 received opioid drugs after surgery and the numbers show a steady decline.
“Opioids are powerful pain medications but have many unwanted side effects, including the risk of addiction. This has prompted more interest in offering patients multimodal therapies to manage pain while also reducing the amount of opioids prescribed,” said University of Massachusetts medical student Philipp Gerner, who participated in the study. “Our research reflects that there has been steady progress over time toward achieving that goal.”
Are Any Of These Non
You might be tempted to grit your teeth and continue to tough out your knee pain. But before you resign yourself to missing out on your favorite sport, jogs around the neighborhood or dancing at your grandkids wedding, ask an orthopedist how they can help.
I have the pleasure of working with experienced orthopedists and orthopedic surgeons who are among the best in the Midwest. At TRIA, non-surgical treatments are always the starting point.
Well work with you to create a tailored treatment plan to help reduce and heal knee pain. If or when the time comes to consider knee replacement surgery, well talk you through the process.
Ready to talk with an orthopedist? Were here for you.
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Assessing The Patients Realistic Success Of Treatment
When we receive hip x-rays on discs or film from prospective patients, they provide an estimated prognosis, which is their best assessment of how many treatments might be needed to achieve the patients goals. This is more difficult to assess when we do not have the opportunity to examine the patient in person.
- Rating a hip Prolotherapy Candidate: We will rate the potential hip pain patient on a sliding scale of being a very good Prolotherapy candidate to a very poor one.
- In a very good candidates x-ray, the ball of the femur will be round, fitting nicely into the socket in the pelvis, with good spacing between these two bones. This space is the cartilage that cushions and allows the femur to rotate freely within the socket.
- The prognosis ranking is lowered from:
- very good to good,
Based on the following criterion:
- Amount of joint space or cartilage the patient shows.
- The presence or absence of bone spurs , and their locations
- The shape of the femoral head itself
Questions You May Like To Ask Your Anaesthetist
- Who will give my anaesthetic?
- What type of anaesthetic do you recommend?
- Have you often used this type of anaesthetic?
- What are the risks of this type of anaesthetic?
- Do I have any special risks?
- How will I feel afterwards?
Content used with permission from the Royal College of Anaesthetists website: Anaesthetic Choices for Hip or Knee Replacement . Copyright for this leaflet is with the Royal College of Anaesthetists.
Can I Do Martial Arts After Hip Replacement Surgery
Q) Im 57, not overweight and dont smoke. I need a total hip replacement and have been told its my choice when to have it.
Can I ask what your opinion is on people having a replacement hip then continuing to do martial arts, specifically karate? Any kicks I do are to a maximum of waist height. Ive put off the surgery for the last three years as I have been advised not to train ever again afterwards. Although, apparently its OK to play tennis and badminton, which I would have thought involve significantly greater impact than karate. Id be interested in your opinion.
A) The main risk of doing karate or other martial arts that involve kicking after a hip replacement would be dislocation of the joint, rather than the impact. Its the twisting movements involved in martial arts kicks that are different from racquet sports.
That said, it seems like quite a sweeping statement to be advised to never train again. Youre clearly someone who will demand a high level of function from any joint replacement, so it might help to see an orthopaedic surgeon with expertise in surgical management of hip osteoarthritis in sportspeople. Theyd be able to advise you on the specifics of treatment and rehabilitation, and on what the full range of options are available to you, not just a total hip replacement.
Its worth doing some research online about your local surgeons and their areas of expertise. Your GP should then be able to refer you.
A Knee Or Hip Replacement Without Surgery Its On The Horizon
The Wall Street Journal discusses the future of joint replacement and research evaluating new approaches to protect, repair and regrow articular cartilage, in the journals monthly series The Future of Everything. Experts including Scott A. Rodeo, MD, sports medicine surgeon, Vice Chair of Orthopaedic Research and Co-director of the Orthopaedic Soft Tissue Research Program at HSS, provided comments on the matter.
Dr. Rodeo explained the exploration to make joint replacements more effective. HSS laboratories are testing whether injecting cells derived from human umbilical veins into the muscle and tendon of an injured rotator cuff will stimulate stem cell activity and promote better repair after surgery. He affirmed the aim is to conduct a similar trial with the stem cells for cartilage repair.
According to Dr. Rodeo, If we can modulate that basic immune and inflammatory response, it may have a profound effect on tissue repair and tissue healing.
This article appeared in print on September 10 and online at WSJ.com. A subscription is required to access.
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What Happens During Joint Replacement Surgery
Hip and knee replacement are two of the most commonly performed operations in orthopedic surgery. Both procedures are very successful at eliminating pain, correcting deformity and improving patient mobility so patients can regain quality of life and get back to the activities they enjoy.
During hip replacement, the damaged ball of the hip ball and socket joint is removed and replaced with a metal or ceramic ball that attaches to a stem that fits into the femur. The prosthesis is usually coated with a special material into which the bone will grow over time. In some instances, however, the prosthesis is cemented into the bone. The socket portion of the ball and socket joint is also replaced with a metal cup that is placed into the pelvis. A plastic liner is then snapped into the metal cup and rotates with the new ball on the end of the femoral stem. The prostheses and implants come in a variety of shapes and sizes that can be tailored to the individual.
Total joint replacement surgery usually takes one to two hours and is typically performed in a hospital setting with a one- to two-day hospital stay. The procedure is usually performed under spinal anesthesia in combination with a nerve block. This prevents the need for general anesthesia and intubation during the surgery and can help patients avoid many of the side effects of general anesthesia such as post-operative nausea. This allows for better pain control and quicker recovery.