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Q: Do all patients require surgery?

A: No. Most patients can be effectively treated with physical therapy and other non-operative modalities; other patients may require surgery.

Q: What is the advantage of visiting a total care orthopaedic facility?

A: Visiting a total care orthopaedic facility provides you with an unparalleled continuum of care from diagnostic testing and treatment to physical therapy and rehabilitation. Our Center also offers you the expertise of a large group of talented specialized orthopaedic surgeons and a variety of on-site services that most orthopaedic practices cannot. At our on-site physical therapy and rehabilitation facility, for example, our staff of highly trained physical therapists provides a multitude of specialized services including individual rehabilitation programs, back school instruction, continuing education classes on shoulder and spinal mobilization, hand and aquatic therapy, and custom splinting and bracing. Physical therapy is sometimes used as a treatment in and of itself. It also plays a vital role post surgery, to ensure that each patient gains maximum flexibility and strength. At the Orthopaedic Center, we evaluate each patient individually and recommend the course of action that would most quickly and effectively allow you to enjoy immediate and long-term pain free activity.

Q: What are the possible complications of total joint replacement surgery?

A: While uncommon, complications can occur during and after surgery. Complications include, but are not limited to infection, blood clots, implant breakage, mal-alignment, and premature wear, any of which can require additional surgery. Infection and blood clots are two of the complications that concern surgeons the most. To avoid these complications, surgeons may take various measures, including prescribing antibiotics and blood thinners before and after surgery. Although implant surgery is extremely successful in most cases, some patients still experience pain and stiffness. Factors such as the patient’s post-surgical activities and weight can affect longevity. Be sure to discuss these and other risks with your surgeon.

Q: When should I have this type of surgery?

A: Your doctors will decide if you are a good candidate for this surgery. Their decision will be based on your medical history, exam and X-rays. Your doctors will ask you to decide if your discomfort, stiffness and disability justify undergoing surgery. There is no harm in waiting to have surgery if conservative, non-operative methods can adequately control your discomfort.

Q: Am I too old for this surgery?

A: Age is generally not a problem if you are in reasonably good health and have the desire to continue living a productive, active life. You should see your personal physician for an opinion about your general health and readiness for surgery.

Q: How long do total joint patients typically stay in the hospital?

A: In the past, a patient could typically expect to stay anywhere from 3–7 days, followed by six weeks or more of difficult therapy before returning to normal activities. With minimally-invasive surgery, some surgeons are finding that patients can be discharged in as few as one to two days, with significantly faster return to normal activities and less post-operative pain.

Q: Why do I need to visit a team of multi-specialized surgeons when all I need is the expertise of one?

A: No injury or disorder exists in isolation. Your bones, joints, ligaments, muscles, and nerves, for example, all work together to allow you to walk, sit, bend down to pick up an object off the floor, and so on. Because of the complex nature of many diseases and injuries, more than one specialist is often required to correctly diagnose and treat a condition as effectively as possible. No. Most patients can be effectively treated with physical therapy and other non-operative modalities; other patients may require surgery.

For more information on joint replacement surgery visit
www.biomet.com

Hip replacement video moderated by Dr Durbhakula:
www.or-live.com

What is arthritis?

Arthritis is a term that is defined as inflammation of a joint and used to describe over 100 different conditions that can affect the human body. Arthritis affects millions of Americans each year with symptoms including pain, stiffness, swelling, and loss of motion in affected joints.

Why does my hip hurt?

The bones in a joint are covered with a tough, lubricating tissue called cartilage to help provide smooth, pain-free motion to the joint. As the layer of cartilage wears away, bone begins to rub against bone, causing the irritation, swelling, stiffness, and discomfort commonly associated with arthritis.

What are the benefits of joint replacement?

The purpose of a joint replacement is to help restore pain-free or near pain-free movement to a joint. Activities that could not be performed before surgery, such as climbing stairs, walking acceptable distances, or driving, may be resumed as directed by your surgeon after total joint replacement surgery. Your orthopedic surgeon may have several patients who would be willing to speak with you about their experiences before and after total joint replacement surgery. Ask your orthopedic surgeon about this beneficial resource.

What is a total hip replacement?

Total hip replacement involves removing the diseased bone and cartilage and resurfacing it with orthopedic implants. The implants are designed to create a new, smoothly functioning joint that prevents painful bone-on-bone contact.

How long does the typical hip implant last?

A total joint implant’s longevity will vary from patient to patient. All implants have a limited life expectancy depending on an individual’s age, weight, activity level, and medical condition. It is important to remember that an implant is a medical device that is subject to wear, which may lead to mechanical failure. Following all of your surgeon’s recommendations after surgery may enhance longevity, there is no guarantee that your particular implant will last for any specific length of time.

Do implants fail and can they be replaced?

Since implants are mechanical devices, they are subject to conditions that can lead to mechanical failure. The most common reason for implant failure in hip replacements is implant loosening or implant wear that leads to loosening. Implant wear particles can react with the bone, causing thinning of the bone that can lead to implant loosening. In most cases, failed implants can be revised successfully to provide good results.

What are my non-surgical options before considering joint replacement?

  • Assistive devices such as a support brace, a cane, or a walker may provide relief when joint pain does not affect everyday activity
  • Exercise or physical therapy can strengthen the muscles around the affected joint(s), possibly providing relief from pain while improving mobility and function
  • Medical management including nonsteroidal anti-inflammatory medications or steroid injections may assist in reducing painful joint inflammation and restoring function

When should I have joint replacement surgery?

Your surgeon will evaluate your health history, perform a physical examination, and take x-rays to decide if you are a candidate for this surgery. You must then decide if your discomfort, pain or stiffness, and overall loss of quality of life justify undergoing surgery. Generally, there is no harm in waiting to have surgery if conservative, non-surgical treatments are effective.

Is total hip replacement only for people with osteoarthritis?

There are several indications for total hip replacement including rheumatoid arthritis, arthritis resulting from previous injury to the bones in the joint, corrections of various bone deformities, or direct trauma to the joint.

 Is age a consideration for joint replacement?

Age is not a problem if you are in reasonably good health and have the desire to continue living a productive, active life. You may ask to see your personal physician for an opinion about your general health and readiness for surgery.

What can I expect from the surgical procedure?

  • Surgical incision on the side of your affected hip
  • Length of surgery will be approximately 1 1/2 to 2 hours. Preoperative care and time spent in the recovery room can add an additional 2-3 hours before you are back in your hospital room
  • Rehabilitation and walking begin the day after surgery
  • Hospital stay is normally 3 to 5 days

How long and where will my incision be?

Traditional total hip replacements require an incision between 6 to 8 inches long. Minimally invasive total hip replacement is designed to shorten the traditional incision, lessen trauma to soft tissues, and reduce recovery time.

The scar will be straight down the side of your hip, unless you have previous scars, in which case your surgeon may use an existing scar. It is common for patients to notice some numbness around their scar.

Will I notice anything different about my new hip?

Yes, you may have some numbness on the outside of the scar. The area around the scar may feel warm.  You may also notice some clicking when you move your hip as a result of the artificial surfaces coming together.

Are there risks from surgery?

While uncommon, complications can occur during and after surgery. Some complications include infection, blood clots, implant breakage, malalignment, and premature wear. Although implant surgery is extremely successful in most cases, some patients still experience stiffness and pain. No implant will last forever and factors such as the patient's post-surgical activities and weight can affect longevity. Be sure to discuss these and other risks with your surgeon.

There are many things that your surgeon may do to minimize the potential for complications. Your surgeon may have you see a medical physician before surgery to obtain tests. You may also need to have your dental work up to date and may be shown how to prepare your home to avoid falls.

How can I prepare for surgery?

Proper preparation and a great attitude are the best ways to accomplish a rapid recovery from joint replacement. With the help of a physical therapist, get yourself as physically fit as you can before surgery. Proper nutrition and optimal medical condition can help avoid complications. See your physician prior to surgery to ensure your blood pressure, heart, and lungs are in good shape. Be prepared to continue with your exercise program after surgery.

What type of rehabilitation can one expect following surgery?

Exercise is necessary for proper healing. Depending on the orthopedic surgeons prescribed recovery outline, physical therapy may begin between 24 and 48 hours after surgery. Formal physical therapy may begin in the hospital and continue as directed by the surgeon. Patients should always follow the recovery schedule prescribed by their surgeon.

What activity range can be expected after this surgical procedure?

Diligent physical therapy, proper diet, and a willingness to follow all of the surgeon's recommendations will promote a more complete recovery after surgery. Most patients should be able to walk unassisted and drive about 4 to 6 weeks after surgery. After a thorough evaluation by the physician, activities such as golfing, bicycling, and swimming may be resumed.

How long until I can walk and resume my regular activities after surgery?

Walking with support typically begins the day after surgery. Walking support may be continued for 2 to 6 weeks. The hospital can arrange for these devices as needed.

Most patients can climb stairs after 3 days and are discharged to home at that time. With less invasive surgical techniques, some patients can climb stairs sooner and be discharged to home after 1 or 2 days. Dancing, golfing and other low-impact activities may be permissible between 6 to 12 weeks. Returning to your daily activities will depend somewhat on your individual circumstances. Consult with your surgeon or therapist for advice on acceptable activities.

Are there any restrictions on exercise or movement with my new hip?

Yes, you will be restricted from performing high-impact activities such as running, singles tennis, and basketball. You will also be restricted from performing contact sports and downhill skiing.  Positions which require you to cross your legs or bend at the hip should be used with extreme caution.

Are regular visits with your surgeon required after surgery?

The surgeon will set a follow-up schedule for the first year after surgery to evaluate your progress.  Usually these follow-ups occur three, six and nine months after the surgery. Annual visits may be required thereafter. Complications can occur with implants, so seeing the surgeon when you notice a change in symptoms can assist in evaluating any changes that may occur with your new joint.

What is arthritis?

Arthritis is a term that is defined as inflammation of a joint and used to describe over 100 different conditions that can affect the human body. Arthritis affects millions of Americans each year with symptoms including pain, stiffness, swelling, and loss of motion in affected joints. 

Why does my knee hurt?

The bones in a joint are covered with a tough, lubricating tissue called cartilage to help provide smooth, pain-free motion to the joint. As the layer of cartilage wears away, bone begins to rub against bone, causing the irritation, swelling, stiffness, and discomfort commonly associated with arthritis.

What are the benefits of joint replacement?

The purpose of a joint replacement is to help restore pain-free or near pain-free movement to a joint. Activities that could not be performed before surgery, such as climbing stairs, walking acceptable distances, or driving, may be resumed as directed by your surgeon after total joint replacement surgery. Your orthopedic surgeon may have several patients who would be willing to speak with you about their experiences before and after total joint replacement surgery. Ask your orthopedic surgeon about this beneficial resource.

What is the difference between a partial knee replacement and a total knee replacement?

Only part of the joint surface is replaced during a partial knee replacement. A total knee replacement involves resurfacing the entire knee.

How long does the typical knee implant last?

A total joint implant’s longevity will vary from patient to patient. All implants have a limited life expectancy depending on an individual’s age, weight, activity level, and medical condition. It is important to remember that an implant is a medical device that is subject to wear, which may lead to mechanical failure. Following all of your surgeon’s recommendations after surgery may enhance longevity, there is no guarantee that your particular implant will last for any specific length of time.

Do implants fail and can they be replaced?

Since implants are mechanical devices, they are subject to conditions that can lead to mechanical failure. The most common reason for implant failure in knee replacements is implant loosening or implant wear that leads to loosening. Implant wear particles can react with the bone, causing thinning of the bone that can lead to implant loosening. In most cases, failed implants can be revised successfully to provide good results.

What are my non-surgical options before considering joint replacement?

  • Assistive devices such as a support brace, a cane, or a walker may provide relief when joint pain does not affect everyday activity
  • Exercise or physical therapy can strengthen the muscles around the affected joint(s), possibly providing relief from pain while improving mobility and function
  • Medical management including nonsteroidal anti-inflammatory medications or steroid injections may assist in reducing painful joint inflammation and restoring function

When should I have joint replacement surgery?

Your surgeon will evaluate your health history, perform a physical examination, and take x-rays to decide if you are a candidate for this surgery. You must then decide if your discomfort, pain or stiffness, and overall loss of quality of life justify undergoing surgery. Generally, there is no harm in waiting to have surgery if conservative, non-surgical treatments are effective.

Is total knee replacement only for people with osteoarthritis?

There are several indications for total knee replacement including rheumatoid arthritis, arthritis resulting from previous injury to the bones in the joint, corrections of various bone deformities, or direct trauma to the joint.

Is age a consideration for joint replacement?

Age is not a problem if you are in reasonably good health and have the desire to continue living a productive, active life. You may ask to see your personal physician for an opinion about your general health and readiness for surgery.

What can I expect from the surgical procedure?

  • Surgical incision on the front of the knee, alongside the kneecap
  • Length of surgery will be approximately 1 1/2 to 2 hours. Preoperative care and time spent in the recovery room can add an additional 2 to 3 hours before you are back in your hospital room
  • Rehabilitation and walking may begin the day after surgery
  • Hospital stay is normally 3 to 7 days

How long and where will my incision be?

Traditional total knee replacements require an incision between six and eight inches long. Minimally invasive total knee replacement is designed to shorten the traditional incision, lessen trauma to soft tissues, and reduce recovery time.

The scar will be straight down the side of your knee, unless you have previous scars, in which case your surgeon may use an existing scar. It is common for patients to notice some numbness around their scar.

Will I notice anything different about my new knee?

Yes, you may have some numbness on the outside of the scar. The area around the scar may feel warm. Kneeling may be uncomfortable for a year or more. You may also notice some clicking when you move your knee as a result of the artificial surfaces coming together.

Are there risks from surgery?

While uncommon, complications can occur during and after surgery. Some complications include infection, blood clots, implant breakage, malalignment, and premature wear. Although implant surgery is extremely successful in most cases, some patients still experience stiffness and pain. No implant will last forever and factors such as the patient's post-surgical activities and weight can affect longevity. Be sure to discuss these and other risks with your surgeon.

There are many things that your surgeon may do to minimize the potential for complications. Your surgeon may have you see a medical physician before surgery to obtain tests. You may also need to have your dental work up to date and may be shown how to prepare your home to avoid falls.

How can I prepare for surgery?

Proper preparation and a great attitude are the best ways to accomplish a rapid recovery from joint replacement. With the help of a physical therapist, get yourself as physically fit as you can before surgery. Proper nutrition and optimal medical condition can help avoid complications. See your physician prior to surgery to ensure your blood pressure, heart, and lungs are in good shape. Be prepared to continue with your exercise program after surgery.

What type of rehabilitation can one expect following surgery?

Exercise is necessary for proper healing. Depending on the orthopedic surgeons prescribed recovery outline, physical therapy may begin between 24 and 48 hours after surgery. Formal physical therapy may begin in the hospital and continue as directed by the surgeon. Patients should always follow the recovery schedule prescribed by their surgeon.

What activity range can be expected after this surgical procedure?

Diligent physical therapy, proper diet, and a willingness to follow all of the surgeon's recommendations will promote a more complete recovery after surgery. Most patients should be able to walk unassisted and drive about 4 to 6 weeks after surgery. After a thorough evaluation by the physician, activities such as golfing, bicycling, and swimming may be resumed.

How long until I can walk and resume my regular activities after surgery?

Walking with support typically begins the day after surgery. Walking support may be continued for 2 to 6 weeks. The hospital can arrange for these devices as needed.

Most patients can climb stairs after 3 days and are discharged to home at that time. With less invasive surgical techniques, some patients can climb stairs sooner and be discharged to home after 1 or 2 days. Dancing, golfing and other low-impact activities may be permissible between 6 to 12 weeks. Returning to your daily activities will depend somewhat on your individual circumstances. Consult with your surgeon or therapist for advice on acceptable activities.

Are there any restrictions on exercise or movement with my new knee?

Yes, you will be restricted from performing high-impact activities such as running, tennis, and basketball. You will also be restricted from performing contact sports and downhill skiing.  Positions which require you to bend or put weight on your knee should be used with caution.

Are regular visits with your surgeon required after surgery?

The surgeon will set a follow-up schedule for the first year after surgery to evaluate your progress.  Usually these follow-ups occur three, six and nine months after the surgery. Annual visits may be required thereafter. Complications can occur with implants, so seeing the surgeon when you notice a change in symptoms can assist in evaluating any changes that may occur with your new joint.

What is arthritis?

Arthritis is a term that is defined as inflammation of a joint and used to describe over 100 different conditions that can affect the human body. Arthritis affects millions of Americans each year with symptoms including pain, stiffness, swelling, and loss of motion in affected joints.

Why does my shoulder hurt?

The bones in a joint are covered with a tough, lubricating tissue called cartilage to help provide smooth, pain-free motion to the joint. As the layer of cartilage wears away, bone begins to rub against bone, causing the irritation, swelling, stiffness, and discomfort commonly associated with arthritis.

What are the benefits of joint replacement?

The purpose of a joint replacement is to help restore pain-free or near pain-free movement to a joint. Activities that could not be performed before surgery may be resumed as directed by your surgeon after total joint replacement surgery. Your orthopedic surgeon may have several patients who would be willing to speak with you about their experiences before and after total joint replacement surgery. Ask your orthopedic surgeon about this beneficial resource.

What is a total shoulder replacement?

Total shoulder replacement involves removing the arthritic humeral head (ball) and replacing it with a metal ball and resurfacing the glenoid (socket) with polyethylene (plastic). The implants are designed to create a new, smoothly functioning joint that prevents painful bone-on-bone contact.

How long does the typical shoulder implant last?

A total joint implant’s longevity will vary from patient to patient. All implants have a limited life expectancy depending on an individual’s age, weight, activity level, and medical condition. It is important to remember that an implant is a medical device that is subject to wear, which may lead to mechanical failure. Following all of your surgeon’s recommendations after surgery may enhance longevity, there is no guarantee that your particular implant will last for any specific length of time.

Do implants fail and can they be replaced?

Since implants are mechanical devices, they are subject to conditions that can lead to mechanical failure. The most common reason for implant failure in shoulder replacements is implant loosening or implant wear that leads to loosening. Implant wear particles can react with the bone, causing thinning of the bone that can lead to implant loosening. In most cases, failed implants can be revised successfully to provide good results.

What are my non-surgical options before considering joint replacement?

  • Exercise or physical therapy can strengthen the muscles around the affected joint(s), possibly providing relief from pain while improving mobility and function
  • Medical management including nonsteroidal anti-inflammatory medications or steroid injections may assist in reducing painful joint inflammation and restoring function

When should I have total shoulder replacement surgery?

Your surgeon will evaluate your health history, perform a physical examination, and take x-rays to decide if you are a candidate for this surgery. You must then decide if your discomfort, pain or stiffness, and overall loss of quality of life justify undergoing surgery. Generally, there is no harm in waiting to have surgery if conservative, non-surgical treatments are effective.

Is age a consideration for joint replacement?

Age is not a problem if you are in reasonably good health and have the desire to continue living a productive, active life. You may ask to see your personal physician for an opinion about your general health and readiness for surgery.

What can I expect from the surgical procedure?

  • Operation- approximately 1 ½ to 2 hours
  • Hospitalization- usually 1 to 3 days
  • Rehabilitation-usually up to 12 months of regular exercise at home. This will vary with each patient and with each surgeon

Can I expect to regain full motion of my shoulder after surgery?

After surgery, patients usually gain additional range of motion previously lost to the diseased joint. It is important to remember that the soft tissues play an important role in shoulder movement. Damaged or unrepairable soft tissues in the shoulder will have an affect on unrestricted movement of the shoulder after surgery. Proper preoperative and postoperative physical therapy will also affect the desired surgical outcome. It is important to talk with your physician prior to surgery so he or she can evaluate your condition and give you a better understanding of what you can expect after the surgical experience.

How long and where will my incision be?

The incision is approximately three inches long, usually made of the front of the shoulder to gain access to the joint.

Will I notice anything different about my new shoulder?

Yes, you may have some numbness on the outside of the scar. The area around the scar may feel warm.  You may also notice some clicking when you move your shoulder as a result of the artificial surfaces coming together.

Are there risks from surgery?

While uncommon, complications can occur during and after surgery. Some complications include infection, blood clots, implant breakage, nerve damage, fracture, and premature wear. Although implant surgery is extremely successful in most cases, some patients still experience stiffness and pain. No implant will last forever and factors such as the patient's post-surgical activities and weight can affect longevity. Be sure to discuss these and other risks with your surgeon.

There are many things that your surgeon may do to minimize the potential for complications. Your surgeon may have you see a medical physician before surgery to obtain tests. You may also need to have your dental work up to date and may be shown how to prepare your home to avoid falls.

How can I prepare for surgery?

Proper preparation and a great attitude are the best ways to accomplish a rapid recovery from joint replacement. With the help of a physical therapist, get yourself as physically fit as you can before surgery. Proper nutrition and optimal medical condition can help avoid complications. See your physician prior to surgery to ensure your blood pressure, heart, and lungs are in good shape. Be prepared to continue with your exercise program after surgery.

What type of rehabilitation can one expect following surgery?

Exercise is necessary for proper healing. You will begin moving your shoulder within the first 48 hours after surgery. Early movement is important to prevent the muscles in the shoulder from becoming tight. The types of exercises you may perform are gentle, range of motion exercises designed to help restore motion to the muscles in the shoulder. As your rehabilitation continues, you may begin strengthening exercises that are designed to restore strength to your shoulder.

A regular exercise program at home to promote strengthening and mobility will continue up to 12 months following surgery. It is important to follow your surgeon's prescribed recovery outline. Do not attempt exercises that are not prescribed by your surgeon, and do not attempt to alter your exercise schedule without contacting your surgeon.

What activities are acceptable after surgery and what activities should I avoid?

Although total shoulder replacement is designed to restore motion and decrease pain, it does not return your shoulder to “normal.” Like any mechanical device, it can wear out with use. Activities like heavy lifting or manual labor can cause early wear and failure of the shoulder implant. Many activities should not begin until the soft tissues around the shoulder heal, which can take 3 to 6 weeks. All postoperative activities should be cleared with your surgeon.

How long until I can resume my regular activities after surgery?

Patients with total shoulder replacement typically require several weeks before returning to any type of lifting or repetitive movement activities. Driving can normally be resumed in 2 to 6 weeks after surgery but only if your doctor indicates and you are not taking any pain medication. Talk to your doctor before participating in an activity that may place excess stress or movement on your shoulder. Consult with your surgeon or therapist for advice on acceptable activities.

When will I be able to return to work?

Returning to work depends on your type of work. Return to work can be as early as 2 to 6 weeks for sedentary jobs. Returning to a job that requires significant use of the arm will usually take at least three months. Office workers often return in 2 to 3 weeks, while patients with more strenuous jobs may require more time away from work. The timing of your return to work depends considerably upon your commitment to recovery.

Are regular visits with your surgeon required after surgery?

The surgeon will set a follow-up schedule for the first year after surgery to evaluate your progress.  Usually these follow-ups occur three, six and nine months after the surgery. Annual visits may be required thereafter. Complications can occur with implants, so seeing the surgeon when you notice a change in symptoms can assist in evaluating any changes that may occur with your new joint.

Locations & Directions
OrthoBethesda

Camalier Building
10215 Fernwood Road
Suite 502
Bethesda, MD 20817

Washington Joint Institute

Highline at Greensboro District
8401 Greensboro Drive
Suite 120
McLean, VA 22102