An Orthopedic surgeon answers questions that patients ask most.
We all hope our joints will last forever. But as we age, we sometimes start to feel pain in our hips and knees. It may happen occasionally at first. Then it can become constant. Does joint replacement surgery await in your future?
If so, there’s good news: Thanks to continued advancements, joint replacement implants are lasting longer than in the past, and people in pain are able to get these surgeries at younger ages.
When should I consider joint replacement surgery?
If you’re in significant pain, you should seek the care of an orthopedist. It’s rare to be recommended for surgery on your first visit. Instead, we prefer that most people begin with nonsurgical treatments to see if those bring any relief. These treatments may include injection therapy, physical therapy, oral medications or a combination.
How do you evaluate patients who have joint pain?
We start by asking about your family history. How long have you been in pain? How does pain affect your activities of daily living? What modifications have you had to make? We also ask about the location of your pain and will order X-rays or other imaging tests to find the root cause.
In addition, we’ll ask you to walk. If we see that your joint pain causes you to walk abnormally, it could be a sign that other structures in your body, such as your foot, ankle or spine, are affected as well.
What determines whether I need a partial or full joint replacement?
When it comes to the knees, a partial replacement today may last as long as a total replacement. To qualify for a partial knee replacement, pain should be isolated to either the outside (lateral) or inside (medial) compartment of your knee. Partial knee replacement is not recommended for people who have ligament instability, obesity, severe osteoporosis, an autoimmune condition affecting the joints or a decrease in range of motion of 10 percent or more. Partial hip replacements are rarer and typically are reserved for select patients who sustain a hip fracture.
What should I look for when choosing a doctor or hospital?
Look at the experience of the hospital and the surgeon. Ask your surgeon about their success rates and complication rates. Seek hospitals that have earned certification from professional organizations like The Joint Commission for hip and knee replacement surgeries. Also consider word of mouth. A referral from a friend will go a long way toward making you more comfortable with your surgeon.
How have joint replacements advanced?
We’ve seen significant advances over the past decade in three main areas:
- Surgical approaches: The anterior approach to hip replacement has become more popular because it allows surgeons to remove less muscle, which may lead to faster recovery and less discomfort in patients. However, there is no single approach that works for every patient. The anterior, posterior and lateral approaches all have potential benefits and drawbacks depending on the patient’s anatomy and pain.
- Pain management: We now use multimodal therapy with most patients. That means we use a combination of acetaminophen (Tylenol) and nerve medicine, while avoiding the use of narcotics whenever possible. This has improved patient comfort and allowed many patients to return home either the same day as surgery or the day after.
- Technology: Numerous technologies— including manual instruments, surgical navigation systems and robotic-assisted surgery systems—help orthopedic surgeons ensure proper placement of prostheses, which leads to improved functionality and longevity of implants. As a result, implants today can last 20 to 25 years or longer.
Experts on Joint Revision Surgeries
While hip and knee replacements last longer on average today than in the past, there are times when a person may need to replace part or all of an original implant. This may be due to an infection around the implant, a nearby serious bone break or general wear and tear over time. Replacement procedures, called joint revision surgeries, generally entail a higher risk of complications than the original operations.
Surgeon experience matters, and patients at RWJBarnabas Health benefit from a team with deep expertise in joint revisions. “Our faculty performs hundreds of revisions a year,” says RWJBarnabas Health orthopedic surgeon Frank Liporace, MD. “Our length-of-stay and complication rates are nearly similar to those of primary joint replacement surgeries.”
One way to reduce the risk of needing a revision surgery: Attend follow-up appointments as scheduled. “I ask patients to return to me every one to two years after their initial joint replacement surgeries so I can check on the wear of their implant,” Dr. Liporace says.
Learn more about joint surgery services at RWJBarnabas Health.
