Dr. Willard Moore, III, MD, a fellowship-trained, board certified orthopedic surgeon at Ochsner Health System who specializes in primary and revision hip and knee replacements, recently discussed what is new and interesting about these procedures.
First off, what is arthritis?
Arthritis is basically a worn-out joint. Joints are covered with cartilage, and if that cartilage wears out, you get pain, stiffness, swelling and limited function, Dr. Moore says. The most common form is osteoarthritis, which is usually related to wear over time. Previous injuries can accelerate development of osteoarthritis. Another type is autoimmune or inflammatory arthritis, in which the body essentially attacks its own joints. Rheumatoid arthritis is the most well known form of autoimmune arthritis.
How do you know you need replacement surgery?
Dr. Moore says that first, the whole patient must be evaluated. That includes assessing medical history for risk factors and potential complicating factors, including smoking, height-weight ratio, infection history, use of other medications and more.
After a patient is examined and X-rays are reviewed, the patient and his doctor review the spectrum of options available short of surgery. “What have they done so far?’’ Dr. Moore asked. Has the patient tried medications, injections or physical therapy first? If the patient is still experiencing pain and loss of function after these alternatives, then surgery can be considered.
Joint replacement is highly successful
Hip and knee replacements, which are elective surgeries, “are one of the most successful surgeries ever invented,’’ Dr. Moore says. “The success rate is really high.’’
More than 90 percent of patients do very well after these surgeries.
Most people are back at work full-time four to six weeks after surgery, he says.
Will they able to run marathons? While some people do, it’s important to remember that manmade materials do have a limited lifespan, and there is the potential to wear them out. However, over 90% of joint replacements are doing well at 15-20 years and more.
What can I expect in the hospital?
Most joint replacement patients will only need one night in the hospital, and some even go home the same day.
Dr. Moore says one of the biggest innovations in joint replacement surgery is the anesthesia used. Rather than general anesthesia, spinal anesthesia or nerve blocks are used. That means patients don’t need a breathing tube and experience better pain control, and less confusion and nausea after surgery.
Schedule an appointment with Dr. Willard Moore III
Joint replacement surgery involves resurfacing the joint, “just like retreading a tire,’’ Dr. Moore says. For knee replacements, the cartilage is replaced with a metal cap on the end of the femur and a metal and plastic piece on top of the tibia. The kneecap is typically resurfaced as well. For hip replacements, a metal socket with plastic liner is implanted in the pelvis, and a metal stem with a ceramic ball is typically implanted in the femur.
What’s the healing process like?
Patients typically are ready to walk up and down the hall, up and down stairs, and get in and out of a car before they leave the hospital. Physical therapy is arranged. “Most of the healing is in the first month’’ after surgery, Dr. Moore says. People seem to feel like they are turning the corner and getting back to normal at 3-4 months and most people continue to improve for a full year afterward.