Do you need a joint replacement?
When it comes to having a joint replaced, hips and knees are the most common while ankles, shoulders, elbows and wrists may also need to be replaced at some point. Christopher Sheu, MD explores what all is involved when you get a joint replacement.
Do You Need a Joint Replacement?
Joints aren’t made to last forever. As we age, there’s a great deal of wear and tear that occurs to knees, hips, shoulders, elbows, ankles and wrists. Sometimes, an incidence of trauma—sports injury, vehicle accident—can result in a person needing a joint replacement sooner than typical. Also, genetic factors can contribute to joint degradation.
The good news is, joint replacement surgery is a viable option. Surgical techniques and joint implants have progressed significantly over the last 10-20 years, allowing individuals to realize benefits such as faster recovery and less pain.
What’s Involved in Joint Replacement Surgery?
According to Dr. Christopher Sheu, the primary complaints when a joint begins to fail include pain, decreased function and/or range of motion and weakness. “Depending on the joint, you may also have patients who experience instability, locking, catching,” he notes.
When these symptoms become debilitating, it’s time to think about undergoing joint replacement surgery. Most surgeries are performed in an outpatient surgery center, where patients can return home the same day.
“Typically, there's a minimally invasive or small incision along the joint. We take care to preserve the soft tissues upon our dissection down to the joint itself and we remove the diseased portions, replacing that with a prosthetic joint,” explains Dr. Sheu.
Physical therapy works with patients afterward to regain their motion and strength and get them back to their full capacity. This is more common in knee and shoulder joint replacements. With knees, physical therapy generally begins three to five days after surgery. This is because the knee can get stiff rather quickly. Physical therapy for shoulders doesn’t start until about two weeks post-surgery.
For the hip, most patients don't need physical therapy. It's a matter of just walking; getting up immediately after surgery. “But, for those who are a bit slower and who may need extra help, we start therapy around the six-week mark,” notes Dr. Sheu.
Posterior vs. Anterior Approach
Traditionally, hip replacements are done in a lateral or a posterior approach. There are different intervals of the muscles and soft tissues surrounding the hip, where surgeons dissect through in order to get to the joint.
This is the most utilitarian and common approach, through the back of the hip. It is an entry point that has more soft tissue and involves a larger dissection, sometimes muscle detachment, and results in a longer hospital stay, increased recovery time and different post-surgical precautions.
With the advent of the anterior hip replacement—a minimally invasive approach—surgeons enter through the front of the hip. “As you can imagine, that involves going through a lot less tissue and allows for direct access to the joint itself. It's a procedure that has less precautions after surgery. It usually has less pain and quicker recovery compared to the posterior approach. And, a decreased risk of a hip dislocation—which is not uncommon but still exists as a possible risk after joint replacement,” explains Dr. Sheu.
Each joint has a medical-grade plastic liner that acts to dissipate forces and decrease wear. Current technology allows a joint to last about 20 to 30 years. “That probably will get better as advancements in medical manufacturing and implants progress,” adds Dr. Sheu. “It really depends on how much you use it. The more you use it, obviously, the faster it will wear out and vice versa.”
Get Back to the Activities You Love Dr. Sheu shares one of the greatest aspects of orthopedics is the immediate gratification of patient feedback. Many come to him and say, “Why didn’t I do this sooner?” Most patients remark upon their increased motion, decreased pain and being able to get back to the activities they love to do.
“I think it’s really important to keep people informed with regards to what the surgery entails and the advancements in medical technology. Patients are recovering faster. They're doing better, they're becoming more functional. For all of those things, I think we all need to be a little bit better informed.”
For more information on joint replacement, visit the Orthopedics section of our website.