May 22, 2019 by John Fernandez and Tanya Racoobian
Joint Replacement Surgery: Knees and Hips
When a knee or hip joint wears away, due to injury or disease, joint replacement surgery may be an option you need to consider to reduce pain and restore your previous level of activity and quality of life.
“Joint replacement surgery involves removing the damaged or diseased parts of a joint and replacing them with manufactured parts, usually made of plastic or metal,” said Alexander van der Ven, M.D., an orthopedic surgeon who specializes in hip and knee replacements at Miami Orthopedics & Sports Medicine Institute.
Often, the cause of joint pain or dysfunction, he says, is osteoarthritis, which develops from an injury or over time as the cartilage and bones of the joint wear down. According to the U.S. Centers for Disease Control and Prevention, 30 million U.S. adults have osteoarthritis.
“Osteoarthritis results from loss of cartilage and when bone tissue fragments or breaks away,” Dr. van der Ven said. “This causes an inflammatory response in that joint, leading to swelling and pain initially.”
As that cartilage disappears and no longer protects the joint, bones begin rubbing against each other, causing pain. And if you’re in pain, you avoid moving that joint, leading to a tightening of ligaments and muscles around it, compounding the pain and leading to less functionality. When pain is constant and activity limitations occur, Dr. van der Ven says surgery may be necessary.
Joint Replacement Surgery
“Joint replacement surgery today isn’t what it was 20 years ago, but it’s still a complex surgery, whether it involves your knee or hip,” he said. “We’ve discovered over time, though, how to reduce the complications that used to occur and help patients recover quickly.”
Education Before Surgery
Dr. van der Ven says key to the success of the joint replacement procedures he performs are twice-weekly education sessions offered at Miami Orthopedics & Sports Medicine Institute. During these classes, which are mandatory before hip and knee replacement surgery, registered nurses and nurse practitioners meet with patients and explain what is to be expected during and after surgery in the hospital, at home and over the entire recovery period. They explain how to use mobility equipment and the importance of exercise during physical therapy and at home.
“We want people to understand that joint replacement surgery requires work to restore mobility and quality of life,” Dr. van der Ven said. “Patients who are educated, motivated, empowered and have prepared themselves for surgery, no doubt, have the best results.”
Minimally Invasive Surgical Technique
Joint replacement surgery has become less traumatic to the body over time as surgical techniques have evolved. “Today, we typically perform the surgery through a 3-inch incision,” Dr. van der Ven said. “We’ve also learned the benefits of spreading the muscles, rather than ‘taking them down,’ or detaching, them during surgery.”
He also says that the materials used in the joint implants has improved, so knee replacements no longer need to be repeated after 10-15 years. “The plastic of the newer knee replacement models doesn’t wear down as much as older-generation models,” he said.
A less-invasive technique, better quality materials used in the joint implants, along with a shorter period of time under anesthesia, means quicker healing and quicker recovery.
Dr. van der Ven also points to advances in blood conservation during surgery, which helps reduce complications and return patients to normalcy faster than in the past. “Blood transfusions during orthopedic surgery were historically common, but minimally invasive approaches to joint replacement have reduced the need for blood during surgery,” he said. As a result, risk of infection, as well as renal and cardiovascular complications are reduced, and patients generally do better overall following surgery.
Outpatient vs. Inpatient
Dr. van der Ven began performing hip replacement surgery on an outpatient basis a few years ago at Doctors Hospital. Many of his patients told him that they preferred recovering from surgery at home, especially since they were expected to walk the same day of hip surgery. “As long as they’re healthy and have a strong support system of family or friends to help them out at home, we allow them to go home after surgery,” he said. Conversely, patients who prefer the support of hospital staff, or are at risk for complications, stay in the hospital.
Dr. van der Ven says narcotics are no longer the mainstay of pain control following joint replacement surgery. Research has shown these medications don’t show a marked reduction in pain when compared with regular pain relievers, like acetaminophen and ibuprofen. “The dependence on narcotics can overshadow a patient’s recovery from joint replacement surgery, so we prescribe pain relievers that don’t carry the risk of dependency and addiction,” he said.
Unlike the recovery from the joint replacement surgeries of the past that lasted a full six months, today’s expected recovery time for hip replacements is six to eight weeks and for knees, it’s eight to 10 weeks. And unlike those recoveries that kept patients from putting weight on their joints for several days, today’s joint replacement recipients are expected to bear weight shortly after surgery, often the same day.
“Patients must be committed to their physical therapy and at-home exercises during their recovery,” Dr. van der Ven said. “Exercise not only helps the patient regain strength, muscle and mobility, but it releases the body’s natural pain medication – endorphins, helps prevent future injuries and keeps body weight under control. These are all key components of a healthy and quick recovery following joint replacement surgery.”
Dr. van der Ven takes pride in seeing his patients return to their normal lives after joint replacement surgery. “When patients take an active part in their recovery and closely follow their post-op care instructions, it’s no surprise when they return to full activity with no restrictions,” he said. “It’s the most successful elective surgery we have, and I am blessed to be able to see positive results.”