Advancements benefit those needing knee, hip replacements
As you begin to age, two of the more common surgeries senior citizens have are knee and hip replacements. Even though these surgeries have been around for a long time and are fairly common, there have been many updates, new technology and medical breakthroughs that shorten the recovery period.
Johns Hopkins Medicine explains that knee replacement, also called arthroplasty, is a surgical procedure to resurface a knee damaged by arthritis. Metal and plastic parts are used to cap the ends of the bones that form the knee joint, along with the kneecap. This surgery may be considered for someone who has severe arthritis or a severe knee injury.
One of the leaders in these surgeries is Houston Methodist, which offers a Rapid Recovery process that assists patients in getting up and about as soon as the same day and home the following day after surgery.
“We term Rapid Recovery as being essentially one of the biggest gains, and important factors in these surgeries,” said Stephen J. Incavo, M.D., chief of Adult Reconstructive Surgery and deputy chairman, Department of Orthopedic Surgery, at Houston Methodist Hospital.
Rapid Recovery includes surgical incisions where less tissue disruption occurs, and surgery is more exact and less invasive.
“We have also changed how we handle surgical pain, which is a big improvement for patients. The morning of the surgery, several oral medications are given to lessen the patient’s pain response. During surgery, soft tissue anesthetic injections are used, which help decrease soft tissue pain after surgery. We also use a regional spinal block that lasts four to eight hours after surgery. The advantage of a regional block is that it wears off slowly so that oral pain medication can be started. The regional nerve block avoids the severe pain traditionally experienced by patients immediately following surgery, so they miss the worst pain,” Incavo said.
Patients also wake up quicker and much less groggy from anesthesia.
“With these techniques we nearly eliminated the use of heavy narcotics, which can cause nausea and vomiting and disorientation after surgery. We have also eliminated the need for a urinary catheter, which used to be routine.” Incavo said.
All of these things are working for the patient’s comfort.
There have been technical changes as well, but Incavo cautions that new technical advancements need to be carefully studied before any true benefit can be determined.
One of the technical changes is planning the patient’s surgery using a preoperative MRI scan.
“Using an MRI scan with the surgery execution and even the surgical implant can be tailored to the patient. This pre-op planning work may make surgery less invasive, and more accurate. Some surgeons have adopted computer assisted techniques to guide the bone cuts made during surgery,” Incavo said.
However, solid evidence that these new, and expensive, technologies actually improve results is not yet available.
The recovery process after the initial hospital stay has also changed somewhat. When the patient goes home the following day, they are given home exercises and they are quickly moved to outpatient physical therapy.
To maximize the Rapid Recovery process, it is important for the patient not to be over-medicated.
“We have a pain scale of 1-10, with one being very little pain and 10 being severe pain. We shoot for a pain level of three or less for the first couple of weeks while physical therapy is happening,” Incavo said. “Understanding that there will be some pain is important for the patient’s overall positive attitude.”
It depends on the age of the person, the physical fitness and weight of a patient when it comes to their recovery. But the first week or two, it is expect for the patient to be on a walker and then use a cane, for a few weeks. We expect total recovery in three to four months, but again, it depends on the patient,” Incavo said.
The manufacturing and quality of the metal implants has not changed much. But where there is the biggest change is that ultra-high molecular weight polyethylene, or in other words a high quality of plastic, being used for the bearings. These new bearings wear out much more slowly. This is especially true for hip replacements, which may last over 25 years before the plastic bearing shows any wear.
“In the past, the bearings would wear out in about 10 years and would need to be replaced. Now, after 10 years, we are not seeing any wear of the bearings,” Incavo said.
When it comes to hip replacements, the same Rapid Recovery principles are used. Patient recovery may be even faster due to less physical therapy requirements.