January - April 2008 Issue
Hip and Knee Replacements Eliminate Pain, Increase Mobility
James Ninomiya, MDMedical College of Wisconsin Orthopaedic Surgeon
Each year, more than 500,000 Americans undergo total hip or knee replacement surgery, restoring their ability to walk and relieving their pain. Dr. James Ninomiya explains advances in joint replacements and the team approach to care provided at Froedtert & the Medical College of Wisconsin.
Q. Who is a candidate for hip and knee replacements? Anyone who has severe arthritis of the knee or of the hip, regardless of age, may be a candidate for hip or knee replacement surgery. Joint replacement — the surgical replacement of a natural joint with an artificial joint — is done only after other methods of pain relief (e.g., injections, physical therapy and medications) have been used, but have not fully relieved the patient’s pain. If pain is significant and other treatments have not provided relief, surgical replacement of the hip or knee should be considered.
Q. What advancements have been made in total hip and knee replacements? One of the greatest recent advances in hip replacements is the minimally invasive approach. This involves using a 3-inch incision or less, rather than an 8- to 12-inch incision to remove the old hip joint and implant the new one. A smaller incision generally results in less pain and bleeding, a shorter hospital stay (about two days vs. five) and faster recovery. While not every patient is a candidate for this approach, we start with the smallest incision possible for each case.
Another newer technique for treating an arthritic hip is hip resurfacing, which involves replacing only the arthritic surface of the hip joint. Hip resurfacing removes less bone than a total hip replacement. To date, there are no data to indicate that this approach is better than a total hip replacement. Some patients are candidates for hip resurfacing, while others require a total hip replacement.
The materials used in hip and knee replacements have also evolved over the years, enabling people to benefit from their new joint for longer periods. In most cases, a hip or knee replacement should last for up to 20 years or even longer.
Q. What is a partial vs. total knee replacement?There are three compartments in the knee, and if arthritis is limited to only one compartment, a person may be a candidate for a partial knee replacement. A surgeon will determine if all or part of a knee needs to be replaced, based on a person’s condition and the extent to which the knee is affected by arthritis. A partial knee replacement can be done using a minimally invasive approach, which uses a smaller incision.
Q. What is the recovery period typically like? With our team approach to pre- and post-operative pain management, the recovery time for patients receiving a new joint is greatly reduced. Team members include orthopaedic surgeons, orthopaedic anesthesiologists, pharmacists, physical therapists and nurses who staff the inpatient orthopaedic unit. Patients who have knee replacement stay in the hospital for only three days, while patients who receive a new hip have an even shorter stay. To help patients prepare for surgery, we conduct a “joint class,” and we’re developing a new joint replacement education guide for patients as well.
Q. What are the short- and long-term outcomes of hip and knee replacements? The majority of patients can expect a 95 percent or greater reduction in pain and greatly improved ability to walk following hip or knee replacement. Today’s mechanical hips and knees are expected to last about 20 years. Patients may require a revision of a hip or knee replacement once their new joint has worn out.
Q. How should a person choose an orthopaedic surgeon?Ask an orthopaedic surgeon about the number of hip or knee replacements he or she has performed and complication rates. It’s also important to discuss the risks associated with joint replacement surgery.
While we do a higher percentage of complex joint replacement surgeries at Froedtert & the Medical College of Wisconsin, our complication rate is very low because of our team approach. Research supports that surgeons who do more surgeries see fewer complications among their patients. We do joint implants here all the time, and I do about 350 joint replacement surgeries a year.
Unlike other healthcare facilities, we also have many types of joint implants readily available to use as a backup, in the event a selected joint isn’t an ideal fit for a certain patient.
Source: Every Day
Date: Jan - April 2008 Issue