Are you wondering if joint replacement surgery might be an option for you? If so, here are some basics you need to know about this procedure.
We asked Dr. Donald Hohman and Dr. J. Conner Ryan, both orthopedic surgeons on the medical staff at Texas Health Center for Diagnostics and Surgery (THCDS), to weigh in. Here are their insights:
What is joint replacement surgery?
Dr. Conner Ryan: Joint replacement involves replacing a worn-out joint with metal and highly durable plastic components to resurface the damaged area. These are joints that have been damaged due to injury, wear-and-tear, or degenerated due to arthritis. These procedures may be performed to treat osteoarthritis, inflammatory arthritis or post-traumatic arthritis related to a hip, knee or shoulder injury.
Dr. Donald Hohman: In some cases, “replacement” is a bit of a misnomer, especially with knee replacement. Replacement surgery is more like a resurfacing of the ends of the bones. The surface becomes rough; the surgery takes off that rough, worn-out surface, and then replaces it with a new smooth surface. The hip replacement is a little bit more of an actual replacement where the ball and socket portions are reshaped, and then new ball and socket portions are inserted. But in almost all cases, we attempt to conserve as much bone as possible.
Who is a good candidate for joint replacement surgery?
Dr. Ryan: The most common underlying reason that leads to joint replacement surgery is osteoarthritis or other inflammatory conditions such as rheumatoid or psoriatic arthritis. The decision to proceed with joint replacement surgery is always based on individual circumstances and is ultimately a quality-of-life decision. Most people are seeking pain relief and better mobility.
Dr. Hohman: These are the people who have tried everything and say they just can’t live like this anymore. When joints start to wear out, there just aren’t a lot of good options. We see both young and older people with severe rheumatoid arthritis or psoriatic arthritis, which can cause horrific knee problems. The medications for these autoimmune diseases are improving, but surgery is still often necessary. I always caution patients that joint replacement is not a performance-enhancing operation. It's a quality-of-life operation. Joint replacement won’t get you back to running wind sprints or being a marathon runner. First and foremost, it’s for pain relief.
What are some signs and symptoms indicating the need for joint replacement surgery?
Dr. Ryan: Generally, joint replacement is recommended if non-surgical treatments such as nonsteroidal anti-inflammatory drugs (NSAIDs), injections, physical therapy, and walking aids are no longer providing lasting relief. When the pain is so bad that it’s disturbing your sleep, that’s a sign you need to consider joint replacement. Many patients come to our office because their hip or knee pain prevents them from simply walking without pain and from sleeping comfortably.
Dr. Hohman: I tell people there are three reasons someone decides to have a joint replacement. The first is for pain relief. The second is for pain relief, and the third, you guessed it, is for pain relief. If you find yourself unable to enjoy your normal activities of daily living due to joint pain, then it may be time to consider joint replacement surgery.
What are the benefits of joint replacement surgery?
Dr. Ryan: Pain relief, improved mobility and quality of life are the most important goals of most of our patients. In many cases, people with joint replacements usually return to routine activities they enjoy: hiking, biking, swimming and generally staying active. The implants are usually designed for low-impact activities which helps improve the lifespan of the prosthesis.
What are the risks and complications of joint replacement surgery?
Dr. Hohman: One concern for patients is infection. However, we have many processes in place before surgery to prevent infection. The way we process the equipment and the operating room is very, very meticulous, and it’s all geared towards minimizing the risk of contamination. So the risk of infection is kept very low.
Dr. Ryan: Another concern is the risk of blood clots. The risk is small, but it is not insignificant. To help minimize those risks, we give patients medications and get them up and moving quickly after surgery. We may also prescribe compression stockings and other measures to help with circulation.
How should a patient prepare for joint replacement surgery?
Dr. Ryan: It’s important to be as healthy and as well-nourished as possible before surgery. If a patient has a condition like diabetes, for example, we make sure it’s well controlled before we proceed. Sometimes we encourage people to take supplements to optimize their nutrition before surgery. The stronger and healthier you are going into surgery, the faster you’ll be able to recover.
Dr. Hohman: At THCDS, we also have a joint replacement navigator to help patients prepare for surgery, and it’s a tremendous luxury. The navigator serves as a “point person” to make sure that everything that needs to happen before, during and after surgery gets done. As soon as a patient decides to proceed with surgery, a joint replacement navigator reaches out to the patient to start this process. The navigator answers questions and makes sure patients have all the necessary information they need before surgery. After surgery, they check in on the patient to ensure they have all they need to recover successfully.
What happens during joint replacement surgery?
Dr. Hohman: The surgery itself takes about 35 to 40 minutes. We work as a team, and it’s really an efficient well-oiled machine. We don’t rush, but we want patients on the operating table for as little time as possible because that reduces the risk of infection and blood clots.
What is the recovery process like after joint replacement surgery?
Dr. Hohman: It varies, of course, but it’s not uncommon for patients to go home the same day as their operation. That’s because we’ve made so much progress in our surgical techniques, and in our ability to control pain. Some patients prefer to stay overnight, and a few may need a little bit of extra help and stay two nights. But that’s uncommon. The sooner you can return to your normal life, the better.
Dr. Ryan: By 4 to 6 weeks, most patients are back to their normal routines, or close to that. Every patient is different. Patients make the bulk of the recovery in the first three months and continue to get better for up to a year after the operation.
What are the alternatives to joint replacement surgery?
Dr. Ryan: Generally, joint replacement is recommended only after patients have tried non-surgical treatments such as topical agents, nonsteroidal anti-inflammatory drugs (NSAIDs), bracing, and walking aids without achieving lasting relief. We also talk to patients about injections. We try to acquaint every patient with their non-surgical options before we recommend proceeding with joint replacement surgery.
What are some of the latest advancements in joint replacement surgery?
Dr. Ryan: I’m trained in robotic-assisted knee replacement surgery which is used for total knee replacement. Robotic surgery uses computed tomography (CT) scans to allow for operative mapping of implant placement. Robotic surgery and conventional joint replacement both follow the same basic approach, but as a surgeon, I like the way the robotic system gives me a detailed view of the joint balance before and during surgery. That enables more accuracy and consistency.
Dr. Hohman: We’ve seen amazing advances in the prosthetic materials we use for the implants We’ve made big advances in the way we manage patients during and after surgery. Now we start managing pain even before people have pain. That’s how patients can get moving and recover more quickly. We also have seen some incredible improvements in surgical techniques. I perform hip replacement through the anterior, or front, of the hip. This is a minimally invasive, muscle-sparing approach. I've been doing that my entire career, and I think that has made a big difference for patients.