Those changes include use of regional rather than general anesthesia, along with nerve blocks, rehab efforts that begin within hours of surgery, and less-invasive surgical techniques, according to Dr. Josh Hickman of the Joint Center at LDS Hospital. "It all adds up to make a big difference."
Hickman and Dr. Kent Samuelson, chairman of the Division of Orthopedic Surgery at LDS Hospital, are featured in today's Deseret News/Intermountain Health Hotline. From 10 a.m. to noon they'll take phoned-in questions about knees and hips, from preservation to replacement. Call 800-925-8177.
There are options when it comes to painful joints, Samuelson said. But when nothing short of completely replacing it will work, surgeries now typically involve smaller incisions, which mean less trauma down deep, and better options for pain management.
Different surgeons prefer different approaches. Hickman does both anterior and posterior hip replacement and can't see much difference in the result, although the anterior approach may have a slightly higher complication rate, he said.
When regional spinal anesthetic used during hip surgery wears off, the patient can get out of bed and start walking. Patients usually go home a day or two after surgery, able to maneuver in and out of bed on their own and up and down stairs on crutches, Samuelson said. Most, in fact, go home the next day.
Of the two, knees are typically more painful and take longer to rehabilitate, so patients used to have to stay in the hospital longer. That's not necessarily true any more, Samuelson said even if both knees are done on the same day, which used to be uncommon.
"Sometimes, if the patient is elderly and there's no one at home to help, they need to go to a rehab-type facility. They're usually in the hospital three days, then go to rehab," he said.
With hips, the main therapy is walking, with some extra effort to strengthen the muscles around the hip.
Knees have to be able to do four things, so the exercises are different. The patient has to be able to get the knee to go out straight and also to bend. There are four muscles on the front part of the thigh that have to be strengthened. And patients need to walk.
Some patients receive therapy in a rehab center, while others have outpatient therapy or do their exercises at home. During the hospitalization, the patient is taught what should be done at home. "We also teach a family member who's going to be with them what they need to do," Samuelson said. "It tends to be most efficient that way. Those who get two good treatments in a day are the ones that do the best."
The joints themselves vary in design. Samuelson favors the metal on metal hip, with a large ball, because it seldom slips out of its socket and there are fewer precautions the patient must follow, such as avoiding low chairs. But ceramic heads are good too, he said. While knees are pretty standard in terms of materials, they vary in design. Some bend more than others; some try harder to create normal knee motion. The designs keep evolving.
The biggest problem for either type of joint, traditionally, has been fixation, the joints coming loose from the bone. Porous ingrowth surfaces look promising.
No improvements, though, eliminate the need for patients to use common sense and go easy on their new joints. Samuelson says the Internet has created some problems. "Patients come in with a stack of papers. 'I read about this guy who's running marathons."
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