Orthopaedic joint replacement surgeon, Dr. Nirav Patel discusses joint replacement surgery and answers commonly asked questions about the surgery, including what patients are eligible and signs that physicians should be aware of. To refer a patient, please call 240-762-5100.
Joint replacement. Surgery is indicated primarily for pain relief but also functional gain. This is in the presence of significant hip or knee osteoarthritis. Clinical indicators of severity can be pain at night but also a significant disruption in quality of life in general. We recommend exhaustion of non optative measures first and this involves the use of analgesics, activity modification, weight loss, walking aids, and home exercises with physical therapy, intra-articular corticosteroid injections can also be used as part of this process. Arthroplasty is defined as a surgical reconstruction and replacement of a joint. So essentially the terminology is the same. This usually applies to the hip and knee joint but also can apply to other joints such as the shoulder, elbow, ankle and other joints. It is often worth trying some form of rehabilitation prior to referring to an orthopedic surgeon. This may be as simple as a home exercise program to more formal physical therapy for a stretching and strengthening program. If the diagnosis is unclear, then direct referral to me as a surgeon is warranted. Importantly, it is worth noting that I employ physical therapy prior to joint replacement in all my patients undergoing joint replacement surgery. This is known as rehabilitation and will facilitate recovery and rehabilitation following surgery. The commonest condition to be treated with joint replacement of the hip and knee is osteoarthritis. This can be primary where it is a function of time, age wear and genetics or secondary to other conditions such as a vascular necrosis, childhood diseases or trauma with hip fractures, especially in those who are young and active. A hip replacement is an excellent procedure. Other conditions which can occur in addition to osteoarthritis are inflammatory arthropathy, such as rheumatoid arthritis, which is also well treated with joint replacement surgery. The data on how long a hip and knee replacement last does vary in general. The accepted range is 15 to 25 years. Studies have shown that 90% of hip and knee replacements last about 15 years at 25 years. The number drops to about 60% for total hip replacements and 80% for total knee replacements. Fortunately, there is no requirement for any imaging to be done prior to seeing me in the office, high quality plane radiographs can be obtained after my consultation with advanced imaging as necessary. Beyond that, if you wish to manage patients beforehand, then obtaining anterior posterior and lateral radiographs, ideally, weight bearing of the affected joint can be done. There is certainly no requirement for any advanced imaging. Prior to seeing me in the office, there are certain contraindications to joint replacement surgery. First and foremost, there should be the absence of infection either in that joint or elsewhere in the body. Importantly, the patient must be medically well enough to undergo elective orthopedic surgery. And allied to this, there must be necessary clearances from medical providers to minimize per optative risk of complications. Ideally, the patient must be able to comply with post op rehabilitation instructions. In addition, at Johns Hopkins and most other institutions, we have employed strict criteria which are evidence based to minimize the risk of complications following joint replacement. Notably, this is the absence of smoking and any anemia as well as malnutrition, but also weight management strategies and A BM I cut off of less than 40 pain management before surgeries involves high dose acetaminophen and non steroidal anti inflammatories if the patient can tolerate it. This is in addition to the use of ice compression elevation, especially in the setting of an acute injury heat can also be used for comfort. The provision of intra-articular corticosteroid injections is also valuable in managing pain levels. Although a joint replacement cannot be performed within three months of this procedure. I encourage all referrals to my office for patients, irrespective of whether they are a candidate for joint replacement or not. Either way we should work together to help reduce pain and improve function in these patients. And I can use the resources available at Johns Hopkins with my colleagues for onward referral as necessary to get them there. I'd like to extend an offer to reach out to me. Should you have any questions or concerns at any point?
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