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.