Are you having joint pain? Has the idea of getting a joint replacement surgery crossed your mind? Or maybe you’re just curious about knee and hip replacements and want to know how they work? On May 3, Hurley Medical Center hosted a virtual joint pain livestream. Dr. Paul Telehowski, a Board-certified orthopedic surgeon with over 20 years of medical experience, explained how joint surgery works and what you can expect with your joint surgery, and answered live questions from viewers.
One of the main causes of knee and joint pain is arthritis. Arthritis is a degenerative joint disease and occurs when the cushion between joints breaks down. This causes the bones to scrape against one another and can lead to pain, stiffness and swelling in the joint. Arthritis can be very painful and only gets worse over time. There are a variety of pain management treatments that can be used; however, if the joint pain is too severe, a replacement surgery is one of the best options in relieving joint pain.
To figure out the best course of treatment for joint pain, a person must consult with an orthopedic surgeon who will test their range of motion and observe how much grinding is going on in the joint. They may have to go through a series of X-rays and in some cases an MRI to evaluate the ligaments and cartilage in the joint. From there, the doctor will recommend the best course of treatment. Typically, treatment starts with encouraging an increase in physical activity and weight loss, followed by physical therapy. They might prescribe pain medications or injections to help relieve the joint pain. If those options are not the right fit, a joint replacement surgery might be the recommended course of action.
A joint replacement surgery will be recommended if the person experiences severe pain that limits their everyday activity. If a person is living with pain both during activity and while resting, and other conservative treatments have not yet brought relief, a total replacement will be recommended. A total joint replacement can make the joint pain go away so the person can go back to their normal activities pain-free.
If you’ve never looked into total replacement surgery, it can be a little scary. How do they perform it? What can you expect going into the surgery? What does recovery look like? Thankfully, Dr. Telehowski outlined the entire process from start to finish.
Dr. Telehowski is currently using the ROSA system to map out the total joint replacement surgery. The ROSA system is a robotic surgical assistant that takes measurements of the individual and uses that data to inform the surgeon of the person’s anatomy. This method increases precision by allowing surgeons to plan out every detail of the surgery, specific to the person’s anatomy, without having to make a single cut. It uses a camera and a tracker during surgery to ensure that the pre-op plan is carried out as intended. This increases the precision of the surgeon and leads to a higher standard of care.
Before surgery, you can expect to go through a thorough medical evaluation to make sure you are healthy enough for the surgery. Doctors recommend to have any dental or urinary procedures done before the joint replacement, as those types of procedures will not be able to be done until after the patient is recovered. You can also expect to do some home planning, to make sure your home is suitable for the recovery process and they might recommend that you take a joint replacement class, so you know exactly how to take care of yourself before, during and after surgery.
On the day of the surgery, you will be placed under anesthesia for one to two hours while the surgery takes place. You will then be taken to a recovery room for monitoring and be admitted to the joint floor of the hospital. This floor is set up specifically to treat joint replacement patients. Here, patients will be monitored while they rest and will even get up and walk a little bit. Most people will be discharged from this floor a day after their surgery, so don’t expect to stay admitted to the hospital for too long.
You will then recover at home, where you will attend follow-up visits with your doctor at the two-week, six-week, and three-month marks after your surgery. In terms of pain medications, less is more during recovery from surgery. Over the course of the next few weeks, expect to attend physical therapy, your follow-up appointments, and to take some time off of work to heal.
Dr. Telehowski then opened the floor for questions, where viewers of the livestream were able to send in questions in real time. After answering the questions, he encouraged all viewers to contact him with any other questions and make an appointment if they are having joint pain or thinking about a knee or hip replacement surgery.
How long does a knee replacement last?
This depends on how much the individual uses their joints. For most patients over 60, a joint replacement can last them the rest of their life. A person in their 40s or 50s might outlive a knee replacement and, at that point, they can speak with their doctors about the best course of treatment. Generally speaking, you can expect for your joint replacement to last 20 to 25 years; however, there is no absolute guarantee on how long the joint replacement will last.
Am I a good candidate for joint replacement if I am diabetic?
Yes, as long as the diabetes is well under control. Your surgeon will need to consult with your personal care provider to determine if your diabetes is under control, and, if not, you will need to make some changes to get under control. Typically, doctors want a person’s Hemoglobin A1C levels to be under 7.5, as it has been shown that there is an increased risk of complications of the surgery if above those levels.
Will total replacement surgery make my pain go away?
Replacement surgery is very successful at relieving arthritis pain. Most people who get the replacement surgery get immense pain relief, as well as increased function of the joint that was replaced.
I’ve noticed that my replaced joint clicks during exercise. Is that normal?
It is totally normal to have some clicking during moderate activity. For most people, the clicking isn’t painful and nothing to be worried about. If it is painful or you are worried about it, consult with your doctor so they can take an X-ray to make sure nothing is wrong.
When can I drive after surgery?
Most doctors use the guideline of no driving for at least one month.
How long will I be out of work after my joint replacement surgery?
This answer depends on the type of work. If it is a very sedentary desk job, you might be out for three weeks to one month if you have someone who can drive you to and from work. If your job is moderately active, you can expect to take about three months off of work. For a very active position, you might need up to four months off. If you have an extremely strenuous job like construction or firefighting, you might not be able to go back to work at all. That should be a conversation you have with your doctor so you can figure out if a total replacement is right for you.
How long do I need to go to physical therapy after surgery?
Most people need therapy for six to eight weeks after surgery. This number also depends on where the person starts. If they started with more range of motion, they might not need as much physical therapy as someone who started with a limited range.
Is the ROSA System safe?
Absolutely. The ROSA System is a robotic arm that does not do any cutting; it is more of a measurement tool. It simply helps doctors map out how to align the joint and gives them a clearer image of your unique anatomy. The doctor completes the surgery in full. Dr. Telehowski describes the ROSA System as “adding another level of accuracy to what was already a very good surgery, which is why I have chosen to use it.” Dr. Telehowski averages over 200 joint replacements per year and uses the ROSA system to provide precise measurements for each patient.
If I have one replacement surgery how long do I have to wait to get another?
Dr. Telehowski will only do one replacement surgery at a time. In his professional opinion, having both done at once is too tough on the patient and is associated with a higher rate for possible infection. In his practice, he will perform one replacement surgery, wait until that joint is recovered and the patient is out of physical therapy (minimally three months), and then he will start thinking about the other joint.
Does knee replacement straighten a leg that has turned inward?
Yes, knee replacement surgery straightens out the leg with the help from the ROSA system to see a detailed alignment of the leg. The joint will wear out too quickly if the leg is left crooked.
Is swelling normal after my joint replacement?
Yes, pretty much everybody swells after joint replacement surgery.
Am I too old for a joint replacement?
Age does not stop you from being able to receive a joint replacement surgery, but overall health does. A person’s medical conditions determine if they are able to withstand a joint replacement surgery. If someone is unhealthy or has many medical conditions, they may not be a good candidate for a joint replacement surgery. Any patient that has a heart condition needs to see a cardiologist before they can go through with a joint replacement surgery.
My joint is fully recovered after two years and I still get some swelling. Is that normal?
Yes, sometimes swelling can occur on a fully recovered joint. This is similar to the clicking issue. It’s just something that comes with the surgery. If you are having frequent swelling or if the swelling is painful, check-in with your doctor to make sure something else isn’t going on.
For more information, a recording of the live stream can be viewed at the following link: https://www.youtube.com/watch?v=e02iVZPe3DA.
Kudos Magazine Volume 7.2