The Joint Replacement Center
Expertise in All Joint Replacement Conditions & Procedures
Total joint replacement is usually reserved for patients who have severe arthritic conditions.
Most patients who have artificial hip or knee joints are over 55 years of age, but the operation is being performed in greater numbers on younger patients thanks to new advances in artificial joint technology.
Circumstances vary, but generally patients are considered for total joint replacement if:
- Functional limitations restrict not only work and recreation, but also the ordinary activities of daily living
- Pain is not relieved by more conservative methods of treatment, such as those described above, by the use of a cane, and by restricting activities
- Stiffness in the joint is significant
- X-rays show advanced arthritis or other problems
WHAT IS TOTAL JOINT REPLACEMENT?
Total joint replacement is a surgical procedure in which certain parts of an arthritic or damaged joint, such as a hip, knee or shoulder, are removed and replaced with a ceramic, metal, and plastic device called a prosthesis. The prosthesis is designed to enable the artificial joint to move just like a normal, healthy joint.
Total joint replacements of the hip, knee, and shoulder have been performed since the 1960s. These procedures result in significant restoration of function and reduction of pain in 90% to 95% of patients. Advances in surgical technique and implant design continue to expand the lifespan of these devices.
OUTPATIENT JOINT REPLACEMENT
Many patients do not like the stress and chaos of the hospital environment. Through a streamlined process that places your patient experience and safety first, we offer outpatient partial knee, total knee, and total hip procedures at Boston Out Patient Surgical Suites (BOSS). Talk with us today to see if you are a candidate for this patient-centered option.
KNEE REPLACEMENT SURGERY
Knee Replacement is sometimes recommended for advanced stage arthritis that does not respond to nonoperative treatments. A Partial or Total Knee Replacement is a surgical procedure which involves the replacement of worn-out parts in the knee with an artificial joint. The replacement parts are made of metal and plastic. Most of the ligaments and all of the tendons remain intact, which allows the knee to function appropriately.
CAUSES OF ARTHRITIS
The most common cause of chronic knee pain and disability is arthritis. Although there are many types of arthritis, most knee pain is caused by just three types: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.
- Osteoarthritis. This is an age-related “wear and tear” type of arthritis. It usually occurs in people 50 years of age and older, but may occur in younger people, too. The cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness.
- Rheumatoid arthritis. This is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most common form of a group of disorders termed “inflammatory arthritis.”
- Post-traumatic arthritis. This can follow a serious knee injury. Fractures of the bones surrounding the knee or tears of the knee ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.
DESCRIPTION OF THE PROCEDURE
Knee replacement is more accurately described as knee “resurfacing” because only the surface of the bones are actually replaced. <1cm of bone is typically removed to allow the implant to “re-cap” the prepared bones surfaces.
There are four basic steps to a knee replacement procedure.
- Prepare the bone. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
- Position the metal implants. The removed cartilage and bone is replaced by metal components that recreate the surface of the joint. These metal parts may be cemented or “press-fit” into the bone.
- Resurface the patella. The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button.
- Insert a spacer. A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.
RECOVERY FROM KNEE REPLACEMENT
Knee replacement surgery generally takes 1½ to 3 hours in the operating room. Directly following the surgery, the patient is brought to a recovery room where vital signs are monitored. Once the patient has been stabilized, he/she can move out of the recovery room.
There are several components to the rehabilitation and recovery process. Each one is integral to the entire course of healing. These components include:
- Physical therapy. During the first several days/weeks of physical therapy, some degree of discomfort and stiffness is expected. As the therapy continues, your body will adjust to the new prosthetic, allowing it to operate as part of your leg. Even after physical therapy is concluded, the knee needs to continue being active. Walking or other mild activities are perfect to increase mobility over time. It may take 12-18 months for your muscles to fully strengthen.
- Incision care. A sterile dressing will be applied in the operating room. If dry, this dressing will often remain for 1 week. Afterwards, it can be removed and covered with a dry dressing. You must keep the incision dry for the first 10-14 days. Do not soak the knee for 4 weeks after surgery.
- DVT prophylaxis. Lower extremity surgery poses an increased risk for blood clots. In mobile patients, Aspirin 2x/day for 6 weeks will thin the blood enough to minimize this risk. In patients with a history of clotting, decreased mobility, or GI issues, alternatives such as Eliquis, Lovenox, Arixtra, or Coumadin will be prescribed.
- Follow-up. For the first year following surgery, scheduled follow-up appointments will ensure that recovery is going as planned. We would like to see you at 2 weeks, 6 weeks, 3 months, and one year after your surgery. After that, annual visits may be expected to keep your knee in peak condition.
SCHEDULE AN APPOINTMENT
As with all surgical procedures, it is imperative to choose a surgeon with a proven track record in this specialty. Feeling comfortable with your surgeon will have a positive impact on your overall experience. Contact Boston Orthopaedic & Spine today, and let us help you get active again.
KNEE REPLACEMENT: COMPLICATIONS
Complications
The complication rate following total knee replacement is low. Serious complications, such as a knee joint infection, occur in fewer than 1-2% of patients. At Mount Auburn Hospital and New England Baptist, our rates are <1%. Major medical complications such as heart attack or stroke occur even less frequently. Chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur, they can prolong or limit full recovery.
Factors known to increase surgical risks include diabetes, obesity, peripheral vascular disease, prior joint infections, and major depression or mental health concerns. Please talk with your surgeon if you have concerns about your risk for surgery.
Complications associated with Knee Replacement procedures include:
Infection. Infection may occur in the wound or deep around the prosthesis. It may happen while in the hospital or after you go home. It may even occur years later. Minor infections in the wound area are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the prosthesis. Any infection in your body can spread to your joint replacement.
Blood clots. Blood clots in the leg veins are one of the most common complications of knee replacement surgery. These clots can be life-threatening if they break free and travel to your lungs. The best way to minimize your risk is to move and walk. While in the hospital, you will receive sequential compression devices (SCDs) and you may even go home with a portable pair. You will also receive medications to thin the blood. We typically use either Aspirin, Eliquis, Arixtra, Lovenox, or Coumadin. If you have any personal or family history of bleeding or clotting disorders, please alert your surgeon.
Implant problems. Although implant designs and materials, as well as surgical techniques, continue to advance, implant surfaces wear with time and the components may loosen. Additionally, although an average of 115° of motion is generally anticipated after surgery, scarring of the knee can occasionally occur, and motion may be more limited, particularly in patients with limited motion before surgery.
Instability. Knee replacement is really a recapping of the bones with careful attention and care for the soft tissues. In time, ligaments may stretch and cause the knee to feel “loose”. This often occurs in patients who have large weight shifts.
Continued pain. A small number of patients continue to have pain after a knee replacement. This complication is rare, however, and the vast majority of patients experience excellent pain relief following knee replacement.
Neurovascular injury. While rare, injury to the nerves or blood vessels around the knee can occur during surgery.
KNEE REPLACEMENT: WHAT TO EXPECT
Preparing for Knee Replacement Surgery – What Should You Expect?
Pre-admission Testing
Within 1 month of your surgery, you will be asked to undergo several laboratory tests, an electrocardiogram, and chest x-ray. This is called pre-admission testing. This will help us to tell whether there are any conditions which might increase the risk of surgery. A physical examination, performed by your primary care physician and cardiology/pulmonology (if necessary), is also a part of pre-admission testing.
Joint Class
All patients should attend joint class prior to their surgery. This will be arranged by your surgical coordinator and plays a very important role in your surgical preparation. Patients who attend this class have demonstrated a more predictable and successful recovery.
Just Before Surgery
You will be asked to arrive 1.5-2 hours prior to your scheduled surgery time.
You will not be allowed to drink or eat anything after midnight and on the day of your surgery. In some cases, you may be allowed to take a medication you normally take in the morning with a minimal amount of water. If instructed to do so, you will need to let the admitting nurse know that you have done this.
Anesthesia
You will be seen by the anesthesiologist on the day of surgery. The anesthesiologist can answer specific questions you might have. Most of our surgeries are performed under spinal anesthesia, though we will also use regional and general anesthesia when a spinal does not seem to be the best option.
You may receive some medications in the holding area prior to your surgery. These may include specific pain medications and antibiotics for your surgery.
The Surgery
As stated before, the surgery involves the removal of all of the damaged bone and cartilage. This is done with saws and drills much like a carpenter uses. The next step is to prepare the bone for the prosthesis. This involves using specialized tools to make precise cuts and to shape the bone so that the prosthesis will fit properly. The artificial joint is then placed into the bone with or without bone cement. The surgery itself takes between 2-3 hours, depending on the complexity of your case.
Total knee prostheses can be attached to the bone using a material called methylmethacrylate or, more simply, bone cement. With proper technique,this gives an immediate fixation of the prosthesis to the bone. Another method is called biologic fixation. This method uses no cement and with time, bone grows into the pores of the prosthesis. This is similar to how most hip replacements are fixed to the bone. There are advantages and disadvantages to each type of “fixation.” The type recommended to you will depend on your age, weight, activity level, and surgeon preference.
Recovery Room
When your surgery is completed, you will go to the recovery room where you will be closely monitored until the effects of the anesthesia and intra-operative medicines are decreased and you are relatively awake and comfortable.
Orthopedic Unit
When you have completed your stay in the recovery room, you will be transferred to your hospital room in the orthopaedic nursing unit. As long as you feel well, you will be out of bed on your day of surgery, hopefully taking your first steps!. The therapists will instruct you in learning how to use crutches or a walker and being taught some of the precautions that are necessary in the immediate post-operative period. Our therapists are extremely good and will help you navigate these first challenging days.
Discharge
Most patients will be able to go home 1-2 days after surgery. Some will stay for a 3rd day and others may go to a short-term rehab facility to help improve strength and gait. In order to leave the hospital, you need to be safe moving out of your bed/chair, have pain controlled by medications you can take at home, and able to tolerate a diet.
HIP REPLACEMENT SURGERY
Hip Replacement is sometimes recommended for advanced stage arthritis that does not respond to nonoperative treatments. The worn-out parts are replaced by components made of ceramic, metal, and plastic. These parts function very well to restore function, improve motion, and decrease pain.
Causes of Hip Arthritis
The most common cause of chronic hip pain and disability is arthritis. The pain and lack of motion associated with hip arthritis can present as knee pain and worsen back pain due to altered body mechanics.
- Osteoarthritis. This is an age-related “wear and tear” type of arthritis. It usually occurs in people 50 years of age and older and often in individuals with a family history of arthritis. The cartilage cushioning the bones of the hip wears away. The bones then rub against each other, causing hip pain and stiffness. Osteoarthritis may also be caused or accelerated by subtle irregularities in how the hip developed in childhood.
- Rheumatoid arthritis. This is an autoimmune disease in which the synovial membrane becomes inflamed and thickened. This chronic inflammation can damage the cartilage, leading to pain and stiffness. Rheumatoid arthritis is the most common type of a group of disorders termed “inflammatory arthritis.”
- Post-traumatic arthritis. This can follow a serious hip injury or fracture. The cartilage may become damaged and lead to hip pain and stiffness over time.
- Avascular necrosis. An injury to the hip, such as a dislocation or fracture, may limit the blood supply to the femoral head. This is called avascular necrosis (also commonly referred to as “osteonecrosis”). The lack of blood may cause the surface of the bone to collapse, and arthritis will result. Some diseases can also cause avascular necrosis.
- Childhood hip disease. Some infants and children have hip problems. Even though the problems are successfully treated during childhood, they may still cause arthritis later on in life. This happens because the hip may not grow normally, and the joint surfaces are affected.
Description of the Procedure
In a total hip replacement (also called total hip arthroplasty), the damaged bone and cartilage is removed and replaced with prosthetic components.
- The damaged femoral head is removed and replaced with a metal stem that is placed into the hollow center of the femur. The femoral stem may be either cemented or “press fit” into the bone.
- A metal or ceramic ball is placed on the upper part of the stem. This ball replaces the damaged femoral head that was removed.
- The damaged cartilage surface of the socket (acetabulum) is removed and replaced with a metal socket. Screws or cement are sometimes used to hold the socket in place.
- A plastic spacer is inserted between the new ball and the socket to allow for a smooth gliding surface.
Recovery from Hip Replacement
Hip replacement surgery generally takes 1½ to 3 hours in the operating room. Directly following the surgery, the patient is brought to a recovery room where vital signs are monitored. Once the patient has been stabilized, he/she can move out of the recovery room.
There are several components to the rehabilitation and recovery process. Each one is integral to the entire course of healing. These components include:
- Physical therapy. During the first several days/weeks of physical therapy, some degree of discomfort and stiffness is expected. As the therapy continues, your body will adjust to the new prosthetic, allowing it to operate as part of your leg. Even after physical therapy is concluded, the knee needs to continue being active. Walking or other mild activities are perfect to increase mobility over time. It may take 12-18 months for your muscles to fully strengthen.
- Incision care. A sterile dressing will be applied in the operating room. If dry, this dressing will often remain for 1 week. Afterwards, it can be removed and covered with a dry dressing. You must keep the incision dry for the first 10-14 days. Do not soak the knee for 4 weeks after surgery.
- DVT prophylaxis. Lower extremity surgery poses an increased risk for blood clots. In mobile patients, Aspirin 2x/day for 6 weeks will thin the blood enough to minimize this risk. In patients with a history of clotting, decreased mobility, or GI issues, alternatives such as Eliquis, Lovenox, Arixtra, or Coumadin will be prescribed.
- Follow-up. For the first year following surgery, scheduled follow-up appointments will ensure that recovery is going as planned. We would like to see you at 2 weeks, 6 weeks, 3 months, and one year after your surgery. After that, annual visits may be expected to keep your knee in peak condition.
HIP REPLACEMENT: ANTERIOR APPROACH
There are several approaches to the hip that can provide an excellent outcome, but over the past several years, popularity of the anterior approach to the hip has grown. Improved equipment designed for the smaller working space has made the approach safer and more reproducible.
Benefits of Direct Anterior Total Hip Replacement
- Provides opportunity for direct comparison of leg lengths.
- Allows for use of Xray as part of the surgical workflow to confirm component position.
- Less muscle trauma and pain, which has a direct effect on early mobility and pain medication in the first 6 weeks after surgery,
- No motion or position-related restrictions after surgery.
- Very low rate of dislocation compared to the classic posterior approach
Unique Complications Associated with Anterior Hip Replacement
- Numbness along the thigh associated with injury to the lateral femoral cutaneous nerve.
- Increased risk of fracture of the femur during surgery as exposure is more challenging.
- Extension of the approach may be more challenging and unfamiliar.
- More wound healing issues often caused by irritation of the skin at the top of the incision.
HIP REPLACEMENT: WHAT TO EXPECT
Preparing for Hip Replacement Surgery – What Should You Expect?
Pre-admission Testing
Within 1 month of your surgery, you will be asked to undergo several laboratory tests, an electrocardiogram, and chest x-ray. This is called pre-admission testing. This will help us to tell whether there are any conditions which might increase the risk of surgery. A physical examination, performed by your primary care physician and cardiology/pulmonology (if necessary), is also a part of pre-admission testing.
You may also be asked to obtain additional imaging with a sizing marker which allows us to plan which size of implants are best likely to match your anatomy.
Joint Class
All patients should attend joint class prior to their surgery. This will be arranged by your surgical coordinator and plays a very important role in your surgical preparation. Patients who attend this class have demonstrated a more predictable and successful recovery.
Just Before Surgery
You will be asked to arrive 1.5-2 hours prior to your scheduled surgery time.
You will not be allowed to drink or eat anything after midnight and on the day of your surgery. In some cases, you may be allowed to take a medication you normally take in the morning with a minimal amount of water. If instructed to do so, you will need to let the admitting nurse know that you have done this.
Anesthesia
You will be seen by the anesthesiologist on the day of surgery. The anesthesiologist can answer specific questions you might have. Most of our surgeries are performed under spinal anesthesia, though we will also use general anesthesia when a spinal does not seem to be the best option.
You may receive some medications in the holding area prior to your surgery. These may include specific pain medications and antibiotics for your surgery.
The Surgery
As stated before, the surgery involves the removal of all of the damaged bone and cartilage. This is done with saws and drills much like a carpenter uses. The next step is to prepare the bone for the prosthesis. This involves using specialized tools to make precise cuts and to shape the bone so that the prosthesis will fit properly. The artificial joint is then placed into the bone, most often without bone cement. The surgery itself takes between 2-3 hours, depending on the complexity of your case.
The surgical approach is a topic of frequent discussion. When bone quality allows, we generally perform anterior hip replacement using muscle-sparing techniques. This allows for a faster early recovery and does not require strict mobility precautions. Alternative approaches, such as direct lateral or posterior, are utilized on a case specific basis.
Recovery Room
When your surgery is completed, you will go to the recovery room where you will be closely monitored until the effects of the anesthesia and intra-operative medicines are decreased and you are relatively awake and comfortable.
Orthopedic Unit
When you have completed your stay in the recovery room, you will be transferred to your hospital room in the orthopaedic nursing unit. As long as you feel well, you will be out of bed on your day of surgery, hopefully taking your first steps!. The therapists will instruct you in learning how to use crutches or a walker and being taught some of the precautions that are necessary in the immediate post-operative period. Our therapists are extremely good and will help you navigate these first challenging days.
Discharge
Most patients will be able to go home 1-2 days after surgery. Some will stay for a 3rd day and others may go to a short-term rehab facility to help improve strength and gait. In order to leave the hospital, you need to be safe moving out of your bed/chair, have pain controlled by medications you can take at home, and able to tolerate a diet.
HIP REPLACEMENT: COMPLICATIONS
Complications
The complication rate following total hip replacement is low. Serious complications, such as a hip infection, occur in fewer than 1-2% of patients. At Mount Auburn Hospital and New England Baptist, our rates are <1%. Major medical complications such as heart attack or stroke occur even less frequently. Chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur, they can prolong or limit full recovery.
Factors known to increase surgical risks include diabetes, obesity, peripheral vascular disease, prior joint infections, and major depression or mental health concerns. Please talk with your surgeon if you have concerns about your risk for surgery.
Complications associated with Hip Replacement procedures include:
Infection. Infection may occur in the wound or deep around the prosthesis. It may happen while in the hospital or after you go home. It may even occur years later. Minor infections in the wound area are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the prosthesis. Any infection in your body can spread to your joint replacement.
Hip dislocation. The rate of hip dislocation after a posterior approach is 3%. This rate is much lower with the anterior approach, approaching 0.1%
Blood clots. Blood clots in the leg veins are one of the most common complications of knee replacement surgery. These clots can be life-threatening if they break free and travel to your lungs. The best way to minimize your risk is to move and walk. While in the hospital, you will receive sequential compression devices (SCDs) and you may even go home with a portable pair. You will also receive medications to thin the blood. We typically use either Aspirin, Eliquis, Arixtra, Lovenox, or Coumadin. If you have any personal or family history of bleeding or clotting disorders, please alert your surgeon.
Implant problems. Although implant designs and materials, as well as surgical techniques, continue to advance, implant surfaces wear with time and the components may loosen. The rates of wear have improved considerably with newer implant designs.
Continued pain. A small number of patients continue to have pain after a hip replacement. When present, it is often associated with spine pathology or inflammation of the tissues around the hip.
Neurovascular injury. While rare, injury to the nerves or blood vessels around the knee can occur during surgery.
DID YOU KNOW?
Joint replacement is usually reserved for patients who have severe arthritic conditions.
Circumstances vary, but generally patients are considered for total joint replacement if:
- Functional limitations restrict not only work and recreation, but also the ordinary activities of daily living.
- Pain is not relieved by more conservative methods of treatment — such as medications, physical therapy, the use of a cane, and/or by restricting activities.
- Stiffness in the joint is significant.
- X-rays show advanced arthritis or other problems
INTERESTINGLY…
- With every step you take, your moving body puts pressure roughly equal to three times your weight on your hips and knees.
- More than 24 million Americans currently suffer from limitations associated with arthritis.
- More than half of the population 65 or older show X-ray evidence in at least one joint.
FACTS ABOUT ARTHRITIS
- Arthritis is the leading cause of disability among adults in the U.S.
- An estimated 1 in 6 people in the US have some form of arthritis
- Around 44% of adults with doctor-diagnosed arthritis also had arthritis-attributable activity limitations in 2013-2015.
- Adults with arthritis are 2.5 times more likely to sustain a fall-related injury compared with adults without arthritis.
- Knees are the most commonly injured part of the body as a result of sporting activities. Individuals with knee injuries have a 6-fold greater risk of developing osteoarthritis, which is the leading cause of joint replacement
- Rheumatoid arthritis, the most crippling form of arthritis, affects approximately 2.1 million Americans and 2-3x more women than men. The average onset for rheumatoid arthritis is between the ages of 20 and 45 years old.
- 90% of joint replacements are done because of osteoarthritis.
JOINT REPLACEMENTS
- More than 7 million Americans are living with an artificial (prosthetic) knee (4.7 million) or hip (2.5 million)
- Joint replacement has been found to result in significant restoration of function and reduction in pain in over 90% of patients
- 95% of hip replacements last >15-20 years
- 85% of knee replacements last >20 years
- A study released in 2002 showed that patients who opted to postpone joint replacement surgery the longest had more pain and less mobility than patients who didn’t wait.
HIP REPLACEMENT
- Over 325,000 hip replacements are performed in the U.S. each year
- 64% of hip replacement patients are women
- 33% of hip replacement patients are between the ages of 45 and 64
KNEE REPLACEMENT
- Approximately 700,000 knee replacement procedures are performed annually in the US. This number is projected to increase to 3.48 million procedures per year by 2030
- 63% of knee replacement patients are women.
- 50% of the patients now receiving knee replacements are younger than 65 years of age.
COMPUTER ASSISTED SURGERY
A GIANT STEP FORWARD IN JOINT REPLACEMENT
Computer-assisted surgery is a giant step forward in joint replacement. Advanced computer-assisted surgical monitoring with the Stryker Navigation System helps your surgeon precisely align your hip or knee implant with computer imaging. The Stryker Navigation System gives your surgeon 3-D imaging of your leg during surgery, which may result in more exact placement of the implants.1
Your joints are involved in almost every activity you do. Simple movements such as walking, bending, and turning require the use of your hip and knee joints. Normally, all parts of these joints work together and the joints move easily and without pain. But when a joint becomes diseased or injured, the resulting pain can severely limit your ability to move and work.
Gaining as much knowledge as possible will help you choose the best course of treatment to help relieve your joint pain — and get you back into the swing of things.
You’ll learn more about how computer-assisted surgery works in this website. As you read, make a note of anything you don’t understand. Your doctor will be happy to answer your questions so that you’ll feel comfortable and confident with your chosen treatment plan.
CUTTING EDGE TECHNOLOGY FOR JOINT REPLACEMENTS
Computer-assisted total joint replacement is a surgical procedure that offers the ability to accurately align your new joint. Accurate alignment is important to the overall function of your new joint. This surgical navigation technology requires tracking devices that collect and send information to provide a comprehensive understanding of your joint mechanics before finalizing the joint procedure. Armed with this information, the surgeon can make intraoperative adjustments within a fraction of a degree, helping to ensure your new joint has the strength, stability, and range of motion needed for a successful replacement.
While the medical and computer science behind the Stryker Navigation System is extremely complex, the system is relatively easy for your surgeon to use. Minimally invasive wireless “trackers” send data about your joint movement to the system’s computer. It presents your surgeon with multiple views of your body and allows the review of your leg’s range of motion with the implant installed in its final position. Armed with this information, the surgeon can make adjustments within a fraction of a degree, helping to ensure the best outcome.
WHAT GENERALLY HAPPENS DURING THE SURGERY
During computer-assisted total joint replacement surgery, the navigation system aids the surgeon in showing him or her where to remove the diseased bone tissue and cartilage from the joint. The healthy parts of the joint are left intact. Then, the surgeon replaces the diseased bone with new, artificial parts. The new joint is positioned and placed in alignment to your true anatomy with information received from the infrared instruments and camera.
Orthopaedic navigation technology is similar to directional tracking systems used in cars and ships — it is, in effect, a global positioning system (GPS) for the surgeon. Infrared sensors placed in the operating room act like satellites constantly monitoring the location of markers and instruments placed along a patient’s anatomy. Precise alignment is an important factor that may reduce joint wear and extend the life of the implant.2,3
COMPUTER-ASSISTED KNEE REPLACEMENT
As with any moving part, alignment is key to smooth movement and long-term wear, just as wheel alignment affects the life of automobile tires. This is also the case with knee replacement. For years, surgeons have used X-rays, specialized instrumentation, surgical techniques, and experience to ensure a proper fit and alignment of the knee implant.
While these technologies have served surgeons and their patients well, research has shown that accuracy to within one to two degrees and one to two millimeters is extremely important to the long-term outcome of your knee replacement. The Stryker Knee Navigation System was designed to assist the surgeon in achieving this degree of precision routinely and consistently.
COMPUTER-ASSISTED HIP REPLACEMENT
Similar to “global positioning systems,” the Stryker Computer-Assisted “navigator” helps the surgeon align and orient the hip implant with more precision than ever before. The surgeon is able to view an interactive display of the lines, angles, and measurements needed to position your hip implant. This combination of computers with wireless cameras and infrared technology is significantly improving medical technology for orthopaedic surgery.
HOW DOES COMPUTER NAVIGATION WORK?
- In the operating room infrared optics and tracking software continually monitor the position and mechanical alignment of the joint replacement components relative to your specific anatomy.
- Minimally invasive smart wireless instruments send data about to the joint movements (kinematics) to a computer.
- The computer analyzes and displays the kinematic data on the screen in the form of charts and graphs.
- These images provide your surgeon with the angles, lines, and measurement needed to best align your hip or knee implant.
WHAT ARE THE POTENTIAL BENEFITS?
- It allows your surgeon to make adjustments to within a fraction of a degree, helping to ensure optimal “fit” for your joint.
- It provides your surgeon with a comprehensive view of your joint mechanics.
- It helps your surgeon correctly position your joint in situations where it is otherwise difficult to get a good view of your anatomy.
- It may lead to improved stability for your joint and optimal range of motion for you.*
* Widmer KH, Grutzner PA. Joint replacement total hip replacement with CT-based navigation. Injury. 2004 Jun; 35 Suppl 1:S-A8-9.
YOU DON’T HAVE TO LIVE WITH SEVERE JOINT PAIN
You don’t have to live with severe joint pain and the limitations it puts on your activities. If you haven’t experienced adequate relief with medication and other conservative treatments, joint replacement may provide the pain relief you long for and enable you to return to your favorite activities. Remember, even if your doctor recommends knee replacement for you, it is still up to you to make the final decision.
For more information visit www.aboutStryker.com and contact your doctor.
REFERENCES
- Sparmann, M., et al., “Positioning of Total Knee Arthroplasty with and without Navigation Support,” JBJS, August 2003.
- Sikorski, J.M., Chauhan, S., “Computer-Assisted Orthopaedic Surgery: Do We Need CAOS?” JBJS, 2003; 85-B:319-23.
- Noble, P.C., Sugano, N., Johnston, J.D., Thompson, M.T., Conditt, M.A., Engh, C.A. Sr, Mathis, K.B., “Computer Simulation: How Can It Help the Surgeon Optimize Implant Position?” CORR, 2003 Dec; (417):242-52
PREPARING FOR JOINT REPLACEMENT
PAIN CONTROL AFTER JOINT REPLACEMENT
Joint replacement surgery, such as knee and hip replacement, is often done to reduce the pain caused by arthritis. However, in the days following surgery, some patients’ pain is just as bad or even worse than their original arthritic pain. While we understand that surgery without any pain is the exception and not the rule, we take pain very seriously and take a multidisciplinary approach to limiting pain to maximize recovery.
What is Pain?
Pain is complex interaction between specialized nerves, your spinal cord and your brain. It is a complicated traffic system, with on-ramps, different speeds, traffic lights, varying weather and road conditions, a traffic control center, an emergency response system, and more. And the vehicle you’re in also makes a difference, because the experience of pain varies from one person to another.
Pain is both physical and emotional. It involves learning and memory. It is altered by mood and physical and emotional stress. How you feel and react to pain depends on what’s causing it, and its expression varies from patient-to-patient.
Benefits of Effective Pain Control
- Increased patient comfort. Every joint replacement patient has some degree of post-operative pain, and effectively managing that pain can significantly affect patient comfort.
- Earlier rehabilitation. A patient whose pain is under control is more likely to get out of bed and perform rehabilitation exercises. When done under the guidance and supervision of a surgeon and physical therapist, post-surgical exercise can help reduce the development of scar tissue, increase range of motion, and increase the likelihood a successful recovery.
- Decreased risk of deep vein thrombosis (DVT). Patients who have undergone a joint replacement are at greater risk for developing a blood clot in a deep vein. When a patient’s pain is under control, he or she can move about and perform rehabilitation exercises, which improve blood flow and therefore decrease the risk of DVT.
- Earlier hospital discharge. The sooner a patient’s pain is under control, the sooner he or she can return home.
- Increased patient satisfaction. Patients who are able to be self-sufficient and return to their normal routine on schedule or ahead of schedule tend to be more satisfied with their joint replacement surgery.
Multimodal Analgesia – Less is More
We use combination of pain relief methods that complement each other and minimize side effects, an approach that is called multimodal analgesia. The goal is to target various parts of the Pain Pathway, so that you experience less pain and medication side-effects are minimized.
These techniques involve limiting narcotic medications during surgery to decrease postoperative complications with breathing, thinking, and using the bathroom. During surgery, we prefer spinal and regional anesthesia, which numbs the surgical area and allows you to be completely comfortable for the surgery with light sedation. Don’t worry, you will not be awake to hear the surgery!
Medications that are commonly used include:
Tylenol
NSAIDs (Celebrex/Naprosyn)
Toradol
Tramadol
Gabapentin
Opioids (oxycodone/dilaudid/morphine)
Medications at Home
Once you leave the hospital, you will still have some discomfort, especially with activity. It is not uncommon to have difficulty sleeping for 6-8 weeks after surgery. Your joint often feels uncomfortable when you try to fully relax to sleep. This feeling improves more quickly in patients who have better motion and and earlier return of muscle tone.
Your surgeon will prescribe a combination of medications when you go home. The ultimate goal is to progressively decrease medication usage, and we generally recommend discontinuing narcotic pain medications first. Most patients are off their narcotics within 4 weeks of surgery.
Medications you may receive at home include:
Tylenol – in higher doses (>650mg), Tylenol is a very good pain reliever and works well with other medications to increase their effect. Patients with liver issues should consult their physician for dose recommendations. Patients should take no more that 3000mg of Tylenol daily.
Celecoxib (Celebrex) – selective anti-inflammatory medication which has fewer stomach and bone side effects when compared with more classic anti-inflammatories such as ibuprofen and naproxen. We often use Aspirin after surgery to limit blood clots, and Celebrex is safer in these patients for the stomach than ibuprofen (Motrin). It should be limited in patients with a sulfa allergy, renal insufficiency, or severe heart disease.
Tramadol (Ultram) – strong pain reliever that is not a narcotic and is thought to have less addictive properties and fewer GI side effects than opioids. 1/3 patients do experience some nausea.
Oxycodone or Hydromorphone – narcotic medications that are very powerful pain relievers. The do have addictive properties, both physically and mentally. They work very well for post-surgical pain, but the goal is to wean these medications to limit their side effects. They are strongly associated with constipation, urinary retention, and diminished reaction time.
SURGERY FAQ
What kinds of tests will I need before surgery?
The testing and clearances that we request are an attempt to minimize the risks of surgery. In preparation for surgery, you will need:
- Complete Blood Count (CBC)
- Basic Metabolic Panel (BMP)
- Staph nasal swab
- Urinanalysis
- Hemoglobin A1c (if diabetic) – must be below 7.5
- Serum albumin and total lymphocyte count (history of bariatric surgery or malnutrition)
- Chest Xray
- EKG
- Medical Clearance – primary care and cardiology/pulmonology (if applicable)
You may also be asked to obtain additional imaging in preparation for your surgery. This may include additional X-rays with sizing markers or a specialized MRI.
Will I need to donate blood before surgery?
The risk of needing a blood transfusion after hip/knee replacement is approximately 20% nationwide. While we used to recommend donating your own blood before surgery, we no longer do this as it actually has a higher rate of requiring a transfusion. If needed, you will receive highly tested blood. Hospitals follow universal guidelines in screening blood and blood products to optimize the patient’s safety.
How long will I be in the hospital?
For joint replacement surgery, most patients are hospitalized for 1-3 days, including the day of surgery. Hospital stays vary, but our improvements in pain control over the past decade has led to more patients returning home much sooner after surgery.
What is the typical recovery time?
Everyone heals from surgery at a different pace. It is difficult to compare yourself with others, as individual situations lead some patients to recover faster than others; however, in general, patients will use a walker or crutches while in the hospital. These devices are typically for balance, and patients may weight-bear as their comfort allows.
It is our experience that as patients comfort, confidence, and strength allows, they may progress to a cane. Typically, patients may progress to a cane at 2-3 weeks. By 4-6 weeks’ time, many patients are not requiring any external supports. It may take 6-9 months to return to normal function and patients continue to improve, as far as their comfort, mobility, and function for 12-18 months after their surgery.
Will I go home or to rehab?
Most patients are able to go home after their operation; however, you may go to a rehabilitation facility in order to gain the skills you need to safely return home. Many factors will be considered in this decision, including the availability of friends or family to assist you at home, a safe home environment, postoperative functional status as determined by a physical therapist in the hospital, and overall evaluation by your hospital team.
When can I drive?
This varies from patient to patient depending upon one’s comfort and confidence. Typically, patients may drive when they are using a cane comfortably and not taking narcotics. Classic teaching is that break-response time is diminished for 6 weeks after surgery. With newer techniques for pain control and more rapid therapy progression, many patients are now safe to drive 2-4 weeks after surgery. A good rule-of thumb is: “Would you feel safe behind the wheel if you were driving home and your child’s ball rolled into the street?”
When can I return to work?
It depends on your profession. If you have a sedentary or desk job, you may return to work in approximately 3-6 weeks. If your work is more labor intensive, it may take 3 months before you can return to full duty. Even with successful joint replacement, some job tasks may be difficult to complete.
How long will my joint last?
Current implant design is better than it has ever been. In general, each year after surgery adds 0.5-1% risk of revision. At 10 years following hip/knee replacement, there is a 90-95% chance that your joint will still function well. At 20 years, 80-85% have still not required revision. We continue to hope that the latest implants and designs will extend the life beyond these numbers.
Our Team
Thomas F. Burke, MD
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About Dr. Burke
Orthopedics Surgeon
Specializing in: Sports Medicine, Arthroscopy,
Trauma & Fracture Care, Shoulder Reconstruction
Daniel C. Mascarenhas, MD
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Glen Ross, MD
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Anthony J. Schena, MD
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About Dr. Schena
Orthopedic Surgeon
Specializing in Sports Medicine, General Orthopedics (Knee, Shoulder, and Joint Reconstruction)
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