Five expert surgeons from the department of Orthopaedic Surgery at Keck Medicine of USC answer some common questions about joint replacement.
1. What is a joint replacement?
Joint replacement is actually the replacement of the worn cartilage with a new metal or ceramic surface against plastic. In the knee, the operation puts a new surface on the knee. In the hip, the metal stem in the femur and the metal shell in the pelvis is where we attach the new surface to your bone. Think of it as a resurfacing with metal on the end of the femur (upper bone) and plastic on the tibia (lower bone). The longevity of these operations is now 30 years when done correctly, so for most patients the joint will last the rest of their lives.
Donald Longjohn, MD
Assistant professor of clinical orthopaedic surgery at the the Keck School of Medicine of USC
2. What can a patient do now to avoid surgery later?
Genetics, anatomy and some environmental issues are not under our control but the hallmark of joint preservation is low-impact, consistent and directed exercise to build muscle and cardiovascular fitness without causing undue wear and tear to the joints. Eating a good balanced diet, avoiding smoking and maintaining a healthy lifestyle also help. Finally, many patients don’t get enough rest, which allows the body to recover and heal.
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Paul Gilbert, MDAssistant professor of clinical orthopaedic surgery at the Keck School of Medicine of USC
3. How has joint replacement surgery advanced over the years?
The two most important recent advances in total hip and knee replacement have been the development of advanced pain management regimens and the implementation of aggressive physical therapy protocols. Our patients start receiving pain medication three days prior to surgery to block pain receptors in the brain. Additionally, the affected joint is injected with pain medications at the end of the procedure. Total knee replacement patients also receive a regional block that relieves pain and allows them to walk the evening of surgery. The combination of these treatments results in excellent pain control.
Jay Lieberman, MDProfessor and chair, Department of Orthopaedic Surgery at the Keck School of Medicine of USC
4. What can a patient expect during their recovery?
Since joint replacement patients are of varying ages and health statuses, recovery is not the same in all patients. However, most patients are walking fairly well at two weeks and are well along the path to recovery by six weeks.
Patients will be up for a walk the same day of the surgery with a walker or crutches, and most will be able to go home one to two days after surgery. There will likely be some discomfort, but probably not as bad as might be expected, and appropriate pain medication will be prescribed. Frequent elevation of the leg is recommended to ease swelling in the leg at and below the area of surgery. Compression stockings are useful to help prevent excessive swelling and blood clots.
Donald Longjohn, MDAssistant professor of clinical orthopaedic surgery at the the Keck School of Medicine of USC
5. Is there an option for patients to undergo a less invasive surgery?
The knee has three main compartments: the medial (inside of knee), the lateral (outside of knee), and the patellofemoral (under the knee cap). Between 10-20% of our patients with knee arthritis have damage to only one compartment and the rest of the knee is unaffected. In these cases, it is ideal to replace only the worn part of the knee and to preserve the remaining normal structures. At Keck Medicine, we utilize robotic assisted technology to precisely place the partial knee replacements through a less invasive surgical approach which facilitates recovery and optimizes long term outcome
Daniel Oakes, MD
Associate professor of clinical orthopaedic surgery at the Keck School of Medicine of USC
Learn more at: joint-replacement.keckmedicine.org