Joint Replacement Treatment Options with The CORE Institute Steven L. Myerthall, MD
What are the signs and symptoms a patient would experience that would require a hip or knee replacement at The CORE Institute?
Patients
may consider hip replacement surgery if their joints are causing severe
hip pain and loss of function. The decision to have surgery depends on
several factors including age, health, activity level, and the degree of
pain you are experiencing.
Joint paint can be managed with
medicine, exercise, physical therapy, and in some cases, weight loss. If
these treatments do not relieve pain, other options include joint
injections and arthroscopic surgery. In the most severe cases, surgery
to replace the joint is an option. Most people have joint replacement
only when they can no longer control the pain in their hip with medicine
and other treatments and the pain is significantly interfering with
their everyday life.
Can you talk about the difference between traditional hip replacement and the Direct Anterior Approach?
During
your surgery, your orthopedic surgeon will remove the damaged cartilage
and bone, then position new metal, plastic or ceramic joint surfaces to
restore the alignment and function of your hip.
Many different
types of designs and materials are currently used in artificial hip
joints. All of them consist of two basic components: the ball component
(made of a highly polished strong metal or ceramic material) and the
socket component (a durable cup of plastic, ceramic or metal, which may
have an outer metal shell). Special surgical cement may be used to fill
the gap between the prosthesis and remaining natural bone to secure the
artificial joint.
The CORE Institute offers two alternatives
for patients who are looking for a hip replacement. The first approach
is the minimally invasive total hip replacement, where an incision is
made on the side of the hip; the muscles are split and detached from the
hip. A second, newer option called the "direct anterior approach,"
makes total hip surgery a more viable option with an easier and less
painful recovery for patients. In addition, it provides patients a more
rapid recovery for a total hip replacement using an innovative surgical
table.
First, the direct anterior total hip arthroplasty is the
only surgical approach that allows the procedure to be performed
without having to cut any of the muscles or tendons that are so critical
for hip function. Simply put, it is the most tissue-preserving approach
to total hip arthroplasty. Secondly, in order to perform direct
anterior hip surgery, patients lie on their back in the supine position
and the leg is extended and rotated. This prevents the damaging of
important hip muscles because only the portion of the hip being replaced
is exposed.
The results are incredible. Most patients are
discharged two to three days after surgery. Patients have had a variety
of experiences in the post-operative period. Most notably is a swift
recovery, which enables patients in many cases to walk without a walker
or even unaided within one to two weeks following surgery. In fact, many
return for their first post-operative follow-up visit to The CORE
Institute with a cane or without any assistive devices at all. We hear
from many of our patients that they experience less pain and walk
without limp only days after surgery. When considering hip replacement,
the greatest advantages of the direct anterior approach include a faster
recovery in the early post-operative period, tissue preserving surgery
with minimal muscle trauma and less post-operative restrictions on hip
motion.
Perhaps most importantly, CORE patients are amazed by their results.
What should a patient's expectation be after they receive a hip or knee replacement? An
important factor in deciding whether to have hip/knee replacement
surgery is understanding what the procedure can and can't do. Most
people who undergo hip/knee replacement surgery experience a dramatic
reduction of hip/knee pain and a significant improvement in their
ability to perform the common activities of daily living. However,
hip/knee replacement surgery will not enable you to do more than you
could before your hip/knee problem developed.
Following
surgery, you will be advised to avoid certain activities, including
jogging and high-impact sports, for the rest of your life. You may be
asked to avoid specific positions of the joint that could lead to
dislocation. Even with normal use and activities, an artificial joint
(prosthesis) develops some wear over time. If you participate in
high-impact activities or are overweight, this wear may accelerate and
cause the prosthesis to loosen and become painful.
