Joint replacement surgery is a highly effective last resort
A Q&A with Dr. Gary Benedetti, orthopedic trauma surgeon and joint replacement specialist with Panorama Summit Orthopedics
For the Summit Daily
Editor’s Note: Sponsored content brought to you by Panorama Summit Orthopedics.
Joint replacement surgery is when an arthritic or damaged joint is removed and replaced with a device that replicates the movement of the original joint.
While the surgery is typically a last-resort option, it offers great benefits to patients who have exhausted other treatment options. Often, patients who have undergone a joint replacement procedure can return to previous activity levels.
For some more education on joint replacement surgery, we asked Dr. Gary Benedetti, an orthopedic trauma surgeon and joint replacement specialist with Panorama Summit Orthopedics, to further explain this complex procedure.
What are some of the most common joint replacement procedures?
Dr. Gary Benedetti: You can get arthritis in any joint, but the most common kind of osteoarthritis, ‘wear and tear’ arthritis, most commonly
affects the hips and knees.
Who’s at risk of needing a joint replacement?
DGB: Anyone who’s at risk for arthritis, or those who have had a previous injury to their joint. For some patients, it runs in their families. And for others, it’s a natural process of aging or normal wear and tear. It’s also more common in people who are obese.
How do you know when you have arthritis?
DGB: The pain starts out kind of mild or intermittent. You might get sore or achy at the end of the day, but over time the pain becomes more constant. You’ll feel more pain at rest, and it will feel worse after vigorous activities. The joints start to stiffen up and you’ll feel limitations doing everyday things such as walking up the stairs or putting socks on. Patients with knee arthritis may notice that their knee swells after activities.
Is joint replacement the best option for arthritis?
DGB: Joint replacement surgery is often a last resort for end-stage arthritis with severe symptoms. We always start with nonoperative treatment such as anti-inflammatory medications, an exercise program, modifying activities, and weight loss if needed. For arthritis in the knees, we can do steroid injections. The goal of any non-operative treatment is to decrease symptoms and return the patient to normal activities. But if over time the non-operative treatments aren’t working and quality of life isn’t good, that’s when we’d discuss joint replacement.
What does the procedure entail?
DGB: For the hips, I do a direct anterior approach. The patient lies on his or her back and the incision is in the front of the hip where we don’t cut any muscles. Patients like this approach because it doesn’t hurt as much and the recovery is faster. The surgery is about an hour and the patient is walking either that day or the next day.
Knee joint replacements are much different. We unzip the knee down the front, flip the knee cap out of the way and use cutting jigs to realign your bones, cement new components in and match what fits you best. I make sure everything is in proper alignment and the ligaments are nicely balanced. The surgery is about an hour to 90 minutes, but it’s a good three months of hard work for the patient during recovery.
Do patients return to normal functioning after a joint replacement?
DGB: Most patients with hip arthritis are pretty stiff by the time we operate. We improve their motion quite a bit, but it’s probably not returned to how it was when they were younger.
In knee replacements, the goal is to get full extension and then flexion is variable. Not all implants are designed to get full range back, but we can certainly get functional motion. If you’re already a skier, there’s a good chance you can go back to doing that.
Which patients are not candidates for joint replacement?
DGB: You have to be able to do the rehabilitation after the procedure. If you’re over a certain body mass index (BMI), then complications skyrocket exponentially. We’d want those patients to get their weight under control before operating.
And anyone with prior knee or hip infections would not be a good candidate.
Are there any misperceptions about joint replacement surgery?
DGB: This is a last resort operation. We want to make sure we’ve exhausted everything else before we do a joint replacement. In my practice, I offer evidence-based science that shows what works, and I educate patients on the things that probably won’t work (such as alternative treatments that aren’t evidence-based). This is a major operation that is highly effective — we see good to excellent results in about 80 to 90 percent of joint replacements — but there are risks and complications so we want patients to understand that going in.
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