Saturday, February 24, 2018

Hip and Knee Replacement Surgery

January 1, 2015 by · Leave a Comment 

hip and kneeIn the U.S. alone, painful knees and hips cause an excess of one million people to undergo hip and knee replacement surgery every year. For those suffering from excruciating pain, surgeons like Dr. Gus Katsigiorgis is offer hope of returning to an active life.

The Chief of Orthopedics at Franklin Hospital, part of the North Shore-LIJ Health System,Dr. Katsigiorgis recommends a hip or knee replacement surgery to patients who suffer from “significant pain that affects their daily lifestyles and that is also associated with restriction of motion.” Potential candidates for such surgery have been diagnosed with degenerative or congenital arthritis that isn’t made bearable by non-operative treatments such as exercise, weight loss, and medication. According to the Centers for Disease Control and Prevention, arthritis is the leading cause of disability in the United States, limiting the activities of more than 16 million adults.

As the knee is a commonly injured joint, many patients who have had surgery for a torn meniscus or ligament, or a Dr. Scuderi Giles-fsfracture in the joint, may develop post-traumatic arthritis over the years, making them potential candidates for replacement surgery. With a hip, the first warning sign may be a dull ache in the hip and groin region occurring during and after episodes of increased activity. Boaters may notice such aching after climbing on and off the boat, moving about, or even standing for a period. However, points out Dr. Giles R.Scuderi, Vice President of the Orthopedic Service Line at the North Shore-LIJ Health System, “Not all joint pain is arthritis and many aches and pains, once diagnosed appropriately, can be treated non-operatively.”

In joint replacement surgery, the ends of both damaged bones must be swapped out for artificial parts to create new joint surfaces. For a total hip replacement, the surgeon replaces damaged cartilage with new material. The implant used in replacement surgery can actually wear off after 20 years or so, requiring patients to undergo revision surgery. “So we tend to recommend weight loss and not having the surgery before the age of 50,” says Dr. Katsigiorgis. Though the most common age range for patients undergoing total hip or knee replacement is between60-65 years, Dr. Scuderi notes a recent downward trend,with an increasing number of patients between the ages of 40 and 55 years being considered for surgery. These candidates with severe degenerative arthritis have failed to obtain relief through non-operative treatment and suffer from associated disability.The upper age limit for undergoing replacement surgery is determined by the patient’s overall health and well-being,per Dr. Scuderi. “It is more their physiologic age versus their chronologic age.”

Prior to surgery,patients undergo a thorough medical evaluation. They are encouraged to maintain a reasonable level of activity in order to maintain the limb’s motion and strength; many hospitals have a pre-operative joint replacement class to acquaint patients with the surgery and the expected course of recovery. All are encouraged to attend in order to reduce anxiety and comprehend what will be expected during the recovery phase.

Depending upon its complexity,surgery for hip or knee replacement may take one to two hours. Patients have the choice to either opt for regional anesthesia, such as a spinal or epidural anesthetic, or general anesthesia (this is often preferred by patients undergoing total hip repair, known as arthroplasty).Post-surgical pain may be managed with injections of local anesthetics or regional nerve blocks.

hip and kneeaTypically, a patient is released from the hospital two to three days after undergoing surgery. Some patients then go to rehabilitation facilities, while others go home to receive visiting care. Dr. Katsigiorgis says where patients go for hip and kneeabpost-operative care is based on whether “they would be able to renegotiate their home.”Precautions, physical therapy, and other steps in post-operative care are very important, Dr. Scuderi stresses.  “Patients must understand they are active participants in their recoveries, and must follow the exercise program to regain their motion and strength.” Once patients are able, they go to outpatient physiotherapy for the durations of their recovery periods, which usually takes from six to 12 weeks.

As with any surgery,knee and hip replacement carries risks, including complications with anesthesia, wound healing, infection, and continued joint pain and stiffness. As blood clots may develop, patients are given blood thinners following surgery, wear pneumatic stockings, and are encouraged to get out of bed and walk (with their therapists). Patients who have undergone total hip replacement are given precautions about certain movements so that the hip does not dislocate as the supporting soft tissues heal.

As a person recovers from knee or hip surgery, it’s best to discuss activities such as boating with the surgeon. To gain his approval for a return to boating, Dr. Scuderi would determine if the post-surgical patient had regained the strength and motion necessary to transfer from the dock to the boat and climb up and down a ladder. Smaller boats with low seats or benches may be problematic following a total hip replacement, cautions Dr.Scuderi. In the early months following surgery, patients should avoid rough seas,as balance may not yet be fully restored. However, he is confident that at some point past successful knee and hip replacement surgery, “Patients can resume an active lifestyle and regain their personas, or their abilities to reclaim the activities that they enjoy.”

 By Tania Bhattacharya

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