Knee | Hip

Surgical options

Knee

Sometimes, if nonsurgical treatment, rehabilitation and therapy is unsuccessful, the only way to heal a knee problem may be through surgery. If the knee is irreparably damaged or has eroded away because of arthritis, then knee surgery may be the next logical step. Statistically, 20% of knee patients will require surgery.

Remember that although surgery may be a 'scary' word, today more than ever, people are recovering from surgery and regaining peak performance.

Essentially, when surgery is done well and the recovery period is carefully and thoroughly completed, return to athletic activity is more than likely not a problem. Below are some specifics regarding knee surgery:

Knee Replacement Surgery

Quality of life is never to be underestimated and when a knee problem is so debilitating that it is impossible to enjoy hobbies that are important to you like gardening or playing with your children or grandchildren, than it is crucial to seek medical help.

Fortunately, before even considering knee replacement surgery as an option, generally physicians will try to find other ways of assuaging the pain. For instance, physical therapy, analgesics and walking aids might be the answer to many knee problems including those stemming from arthritis.

However, it is also nice to know that when other treatments prove to be futile, knee replacement surgery is an option. So prevalent is this surgery, in fact, that over 250,000 knee surgeries are performed each year in the United States alone. It is estimated that in 2040, more than 500,000 knee and hip replacement surgeries will be performed due to the influx in aging Baby Boomers. Knee replacement will help renew the ability to participate in several fun, day to day activities such as gardening, going on walks, golfing, and overall mobility. It is important to try other options before knee replacement surgery, however, since they only last for 15 to 20 years and are not easily replaced. For this reason, physicians are very selective about the types of candidates for the surgery.

So, who is a candidate?

Knee replacement is a procedure generally reserved for those who are over 60 years of age who are in relatively good health, aside obviously, from their knee pain. In fact, 72 percent of knee replacements are done on those over the age of 65. Generally, this means, they maintain a healthy weight, they do not suffer from cardiovascular problems, and they are not suffering from a terminal illness.

Active knee replacement candidates will find it comforting to know that they will be able to resume some athletics following surgery such as golf, swimming, and walking. Some knee replacement recipients have even continued to play tennis and snow ski. Unfortunately, a knee prosthesis is not quite as effective as a healthy, natural knee, however it will be a great improvement over the preoperative pain and discomfort.

Who is not a candidate?

To receive knee replacement surgery, you must be a good candidate. If not, surgery could prove counterproductive. For some, knee replacement surgery is not in their best interest. Those who are too young, with the exception of those who suffer from severe rheumatoid arthritis, should consider other types of treatment for knee pain since after 15 or 20 years, the prosthesis will need to be replaced. Unfortunately, the bone will need to be cut short to make room for a new prosthesis and function and mobility is likely to be damaged during the second operation. Those who are overweight are not good candidates as the prosthesis (just as the natural knee) is designed to carry a weight in proportion to the person’s body. Too much weight on the prosthesis can cause it to be damaged and subsequent knee surgeries will be necessary. Those with cardiovascular problems and with terminal illnesses are also not good candidates as the surgery may be too much for the body to handle. Also those with poor skin coverage over the knee are not good candidates as surgery could impair movement of the knee.

What knee replacement surgery is like?

During knee replacement surgery, you will be under general anesthesia meaning you will be asleep and without pain during the entire procedure, which usually lasts a few hours. The knee is opened up and the kneecap is moved out of the way. Doctors then, shave off the bottom of the femur and the top of the tibia and fibula bones. The prosthesis is then glued to the bones with special, surgical cement. The knee is then sutured back together and drainage tubes are used to prevent clogging.

Usually, a hospital stay for knee replacement surgery lasts between four and five days. During your time at the hospital, your leg will be attached to a device called Continual Passive Movement (CPM), which will move your knee to prevent stiffness. After the hospital stay, the patient will probably require the aid of a walker for a few days before putting full weight on the leg. Overall, full recovery can take anywhere from two months to one year although dramatic improvements should be seen sooner than that.

The future of joint replacement surgery

Scientists are currently in the processof developing joint replacement methods that will last much longer than the current prototype. While doctors now use a glue to bind the old bone with the new prosthesis, they one day hope to use ceramics as a bone substitute.

When a bone breaks in the body, the bone cells will form together to rejoin the broken bone. In the same way, bone cells can join with coral or ceramics forming one, continuous bone. While the glue or cement that doctors use will eventually deteriorate, ceramics will last much longer as they have better chances of being accepted by the cells. While recovery may take longer initially, the effects of surgery will last much longer than current replacement methods.

Torn ACL Surgery

The Anterior Cruciate Ligament (ACL) works a lot like a guy wire that keeps the femur and the tibia stable. When an athlete tears their ACL, usually it is from a sudden impact that can cause an audible pop or at least a great deal of pain.

Generally speaking, a partially torn ACL stands a chance of recovery without surgery. If the ACL is completely torn, most will need surgery to repair the ligament. Many of those with a torn ACL will need surgery to get back to activity. The procedure itself takes about one hour.

Torn ACLs are one of the most common problems associated with sports. It is important to understand your options if you have a torn ACL.

If you have a completely torn ACL, you will likely need surgery to repair this ligament. If you have a partially torn ACL, depending on the extent of the tear, some people are able to rehabilitate the knee with extensive therapy AND COMMITMENT TO EXERCISE to the point that they have use of the knee again. But you may not have the same strength in the knee joint that you had prior to your knee injury.

Generally speaking, the more you expect to play aggressive sports in the future, the more likely you will need knee surgery to repair a fully torn or partially torn ACL. If you are professional athlete, chances are you will need surgery to get back to full activity.

If you have a torn ACL, the good news is that the problem is fairly common as knee injuries go, and in the hands of a surgeon who specializes in knees, the post surgical knee can be as effective as the knee prior to injury. But most of that depends on the willingness of the athlete to invest the time to rehabilitate and strengthen the knee.

Use of the patellar tendon or hamstring to repair a torn ACL

You should be aware that repairing the torn ACL does NOT involve sewing two torn ends together. Think of your ACL as a rubber band. Once it snaps, it can not be sewn together. Instead, you have to replace the rubber band completely. And that is exactly what the knee surgeon does. They attach a new rubber band to your shin, thread it through your knee and anchor it your femur.

You should ask your physician HOW they repair the ACL. Some knee surgeons use a patellar tendon while many others use a hamstring ligament. There are pros and cons to each.

Harvesting a patellar tendon from the front of the knee makes for a more painful recovery and painful rehabilitation. However, professional athletes who are used to pain from training are more able to tolerate this approach, especially considering that the patellar tendon is viewed by some surgeons to be a higher performance replacement for the torn ligament than the hamstring. Using a hamstring ligament is less painful on rehab of the knee, and some surgeons feel that for most people, the strength of the ligament is sufficient.

Overall, most surgeons would agree that the performance of the knee after ACL replacement is directly linked to how much commitment is given to strengthening the knee with exercises. With the right knee specialist, and with specialized knee rehab, a professional athlete can regain their competitive form and play professional sports again.

Using an arthroscope, the knee surgeon can repair the knee through two tiny half-inch incisions instead of a longer incision which requires a longer recovery and causes a bigger scar. The surgeon will remove a strand from the patellar tendon or hamstring, which will ultimately become the new ACL. A hole is then drilled through the shin bone and a new ACL is threaded through. The new ligament is prepared and secured into place. A plastic dowel locks the new ACL into place. About 30 minutes later, the anesthesia will wear off and the patient is dismissed from the hospital.

During the recovery process, a patient will start off by walking around. A few months later golf is acceptable. After five or six months, the patient is usually allowed to play sports without restriction.
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Hip

Hip Replacement Surgery

Over time, the impact of joint disease, arthritis, or excessive body weight can erode the hip joint.

According to the American Academy of Orthopaedic Surgeons, each year in the United States, about 193,000 hip replacements are performed. With the aging of the baby boom generation, that number is expected to grow as this large segment of the population moves into their 50s and 60s. It is estimated that more than 500,000 knee and hip replacements will be done each year by 2040. Also, the joint implant technology involved is improving, enabling the artificial joint to last longer.

The surgery itself, lasting between two to three hours, is performed on those who experience the chronic and debilitating effects of hip disease. An incision is made in the beauty of the patient. The surgeon then removes the diseased bone and cartilage and fits the prosthesis into the joint. The prosthesis is inserted and the incision is sutured.

Since hip prosthesis rarely lasts longer that 15 to 20 years, and outcomes of revisions are less effective than original replacements, young people are not good candidates for the surgery. In fact, in the United States, 65 percent of hip replacements are given to those over the age of 65. It is also not recommended for the extremely obese, those with a terminal illness, those with nerve disease, those lacking ample skin around the hip.

Types of Hip Prosthesis

Acrylic with Cement Fixation

This is the first type of hip prosthesis developed. Essentially, the prosthesis is secured to the hip with a cement adhesive. Over time (10 to 15 years) the cement will erode and need to be replaced. Usually these implants are used in older, less active adults or in people with weaker bones. The recovery time for this prosthesis is faster than other methods.

Without Cement Fixation

The difference between the cement and uncemented version of the hip prosthesis is the lattice grid that comprises the socket part of the uncemented prosthesis. After the diseased bone and cartilage has been removed, the latticed grid is inserted into the socket. After a while during healing, the remaining hip bone will grow into the grid much like ivy grows into a trellis and suture itself to the prosthesis. The new bone grows into the implant, securing it in place. This is a much more natural cohesion and lasts longer than the traditional prosthesis. Also, it affords much more mobility to the active hip replacement recipient than the cemented type.

When a bone breaks in the body, the bone cells will form together to rejoin the broken bone. In the same way, bone cells can join with coral or ceramics forming one, continuous bone. While the glue or cement that doctors use will eventually deteriorate, ceramics will last much longer as they have better chances of being accepted by the cells. While recovery may take longer initially, the effects of surgery will last much longer than current replacement methods.

Hybrid Fixation

The hybrid fixation is where one part of the hip prosthesis (generally the stem) is cemented together while the other part of the hip (generally the socket) is inserted without cement.

Scientists are now working on using ceramics and coral to be used as joint replacements in the future. Hospital stay after surgery usually lasts for five days. After the hospital stay, the patient will probably require the aid of a walker for a few days before putting full weight on the leg.
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