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Total Knee and Hip Replacement: What’s New Isn’t Always What’s Necessary

By | 2018-10-08T15:04:37+00:00 September 18th, 2018|Categories: Health A-Z, Healthy Aging|Tags: , , |

The most important aspect of surgery isn’t what’s new, but what’s best for the patient, particularly when it comes to joint replacement surgery.

While robotic techniques are emerging, research and experience has shown that minimally invasive surgery delivers the same or better outcomes at a lower cost. For example, quad-sparing knee replacement surgery is a minimally invasive procedure that preserves the quadriceps tendon. The technique requires only a 4-inch incision to insert the same artificial joint used in conventional knee replacements, and it requires cutting less muscle, which typically means a quicker recovery. Because this technique promotes better leg control after surgery, most patients can walk within 24 hours of surgery with the help of physical therapy.

The best treatment, however, may not be knee or hip replacement surgery. Non-surgical options for knees include cartilage replacement or cartilage regeneration. Other surgical options include osteotomy, whereby a bone in the knee is cut to shorten or lengthen it or change its alignment, or knee arthroscopy, a surgical procedure that allows doctors to view the knee joint with a very small incision and a tiny camera without making a large incision in the skin and other soft tissues.

One advancement that we’re excited to roll out in the next few months is outpatient or same day knee replacement. This surgical protocol will enable joint replacement patients to leave the hospital the same day or the day after surgery. Patients will still be supported after surgery with at-home nursing and physical therapy, as well as follow-up calls with a care coordinator. Same day joint replacement will ensure patients get the recovery services they need in a more familiar, comfortable environment to speed a return to normal activities.

There’s Hope for Hip Pain
For hip replacement candidates, a newer approach is direct anterior hip replacement. This minimally invasive surgical technique involves making a 4-inch incision on the front of the hip, which allows the joint to be replaced by moving muscles aside without detaching any tendons. While this approach is reliable, safe and effective, it isn’t appropriate for all patients.

A more traditional technique may be recommended, like the mini-incision posterior hip replacement. In this approach, the surgeon makes a 4-inch incision through the buttock, which makes it possible to reach the joint by separating the muscles and preserving the piriformis tendon. This technique typically results in a quicker recovery and shorter hospital stay.

Like knees, non-surgical options for hips also include cartilage replacement or cartilage regeneration. Other surgical options include hip arthroscopy, a minimally invasive technique using a small camera.

Faster Recovery to Get You Moving
Joint replacement surgery has evolved in the last 10 to 15 years. Now, in most cases, you’ll be walking on your new joint the day of surgery, walking unrestricted next day, and will be able to move up and down stairs in a few days. In fact, the physical therapy department at the hospital features a short staircase designed to get patients used to walking up steps with their new knee or hip joint.

We’ll work to manage your pain safely and effectively to minimize your discomfort. If opioids are prescribed, we’ll “dial down” the dosage as soon as you feel relief or we can prescribe a lower-level pain reliever, like NSAIDS or Tylenol. If you can’t tolerate opioids or would prefer not to take them, there are several alternatives, including ice, transcutaneous electrical nerve stimulation (TENS), therapeutic taping, or cryotherapy, a type of therapy using extremely cold temperatures. Ensuring that you feel well enough to move the joint and participate in physical therapy is the main goal in managing your pain.

How to Choose a Surgery Center
When choosing a hospital, be sure to find a facility that performs an adequate number of surgeries, has good outcomes and low complications rates (check Medicare.gov for this data). You may want to consider an accredited surgical center of excellence, which is designed to deliver high-quality care and specialized attention while providing coordinated, streamlined services for fewer complications, less pain and more rapid recovery. CentraState Medical Center is accredited by The Joint Commission as a Total Joint Center of Excellence for hips and knees.

The Total Joint Center of New Jersey at CentraState Medical Center provides comprehensive, integrated care through a team of board-certified orthopedic surgeons, specially trained orthopedic nurses, a total joint coordinator, patient care technicians, physical and occupational therapists, dietitians, and other care providers. The center performs innovative procedures, including quad-sparing knee replacement and direct anterior hip replacement, and provides an expedited recovery process where patients can leave the hospital after a brief stay and recover in the comfort of their own home. In addition to offering advanced surgical services for joint pain, the center also provides non-surgical treatment options, including pain management and a tailored rehabilitation program designed to increase mobility, build strength and relieve joint pain.

When choosing a surgeon, look for one who is fellowship trained in joint replacement. Also, be sure to choose a physician who reviews all of your treatment options, including non-surgical procedures. He or she should talk with you to understand your goals and expectations for treatment, and work with you to decide what course of treatment is best for you.

orthopedist freehold njAlan S. Nasar, MD, is a board-certified, fellowship-trained orthopedic surgeon. He is the director of the Total Joint Center of New Jersey at CentraState Medical Center and chairman of the medical center’s Department of Orthopedic Surgery. Dr. Nasar can be reached by calling 866-CENTRA7.

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