As May marks National Arthritis Awareness Month, we at OrthoAlliance (OA) are pleased to host a three-part webinar series focused on Arthritis and Total Joint Replacement. This series, featuring esteemed physicians from OA and leaders from the Arthritis Foundation, will cover essential topics ranging from understanding arthritis and its symptoms to exploring conservative and surgical treatments, including joint replacement of the hip, knee, shoulder and ankle. Read on for a summary of frequently asked questions, or watch the recordings from completed webinars.
If you’re interested in scheduling an appointment with an OrthoAlliance Physician, find a location near you and learn more at orthoalliance.com/providers/.
May 8, 2024 – OrthoInsights: Overcoming Arthritis Part 1
- Hip: Dr. Wesley Lackey, Midwest Center for Joint Replacement
- Knee: Dr. Zackary Byrd, JIS Orthopedics
- Shoulder: Dr. Robert Rolf, Beacon Orthopaedics
- Ankle: Dr. Terrence Philbin, Orthopedic Foot & Ankle Center
May 15, 2024 – OrthoInsights: Overcoming Arthritis Part 2
- Hip: Dr. John Martin, Central Indiana Orthopedics
- Knee: Dr. Gregory Sarkisian, Precision Orthopaedic Specialties
- Shoulder: Dr. Scott Stephens, OrthoNeuro
- Ankle: Dr. Adam Miller, Beacon Orthopaedics
May 22, 2024 – OrthoInsights: Overcoming Arthritis Part 3
- Hip: Dr. Benjamin Pulley, Orthopaedic Associates of Zanesville
- Knee: Dr. Jeff Yergler, South Bend Orthopaedics
- Shoulder: Dr. Edward Westerheide, Orthopedic Specialists & Sports Medicine
- Ankle: Dr. Mark Prissel, Orthopedic Foot & Ankle Center
Arthritis
Common symptoms of arthritis include pain, stiffness, swelling, loss of mobility and limited range of motion. In the beginning stages of arthritis, someone may not have any symptoms, but signs of the disease may be visible on an x-ray. As the surface of the smooth cartilage covering the joint softens, the cartilage begins to lose the ability to absorb the impact of movement and is easily damaged from excess use or injury. Large sections of cartilage may wear away completely with time, causing pain and stiffness from the bones rubbing against each other. Someone with arthritis at this stage will most likely have more noticeable symptoms, with those symptoms affecting their quality of life. Due to pain, they may be less active, no longer participate in their favorite activities or have difficulty getting a good night’s sleep. A diagnosis can come from the evaluation of an orthopedic provider, in addition to x-ray imaging of the affected joint.
Most commonly, arthritis starts affecting people later in life, around 50-60 years old, but unfortunately, we see it starting earlier and earlier. People who have had traumatic injuries or a specific sports injury earlier in life, depending on the consequences of that injury, are presenting with arthritis at much earlier ages. On the other hand, some people make it into their seventies before they start having any symptoms.
Arthritis can be caused by a variety of factors. Most commonly, it’s gradual wear and tear over time where the articular cartilage starts to wear away, similar to how the tread on a tire can slowly wear away. There are many different things that can predispose arthritis, such as genetics, deformities and traumatic injuries. For example, in a situation such as a torn meniscus, if a significant amount of the meniscus is lost then it can lead to increase contact pressures on the joint and can accelerate arthritis.
Although there is not a definitive way to prevent arthritis, there are certainly recommendations to help reduce risk, such as maintaining a healthy weight and trying to remain active with low impact activities. Additionally, while there is no cure for arthritis, it can be treated and managed to minimize pain and maintain a good quality of life. Treatment options range from conservative approaches, such as making lifestyle changes, to a more aggressive approach, like joint replacement. Each individual is unique, and so the treatment plan should be unique, too.
There are several factors, including menopause, anatomy and joint elasticity. Menopause plays a big factor due to changes in hormones. Hormones earlier in life can be protective against arthritis and so as women age that protective effect can go away. After menopause, women are also more prone to obesity than men and obesity is a risk factor for arthritis. Additionally, women tend to be quad dominant, meaning the muscles in the front of the leg (thigh) are stronger than the muscles in the back of the leg (hamstring) and that changes the joint reactive forces which makes women more susceptible to ACL tears. Women also tend to have more elastic joints than men do, especially in relation to gestation and post-partum type situations. That joint elasticity can lead to micro instability. Lastly, women tend to have shorter legs than men and wider hips than men, which puts more pressure on the joint.
Osteoarthritis, or “wear and tear” arthritis, occurs when cartilage in your joints wears away over time. Psoriatic arthritis is an autoimmune disease and can affect skin, nails and joints. A lot of psoriatic arthritis patients have similar symptoms as osteoarthritis patients and the treatments (conservative or surgical) are no different. However, with psoriatic arthritis patients, rheumatology is involved in conversations and planning of the patient’s surgery.
Conservative and Surgical Treatments
If possible, we try to start with the most conservative approaches first, such as making appropriate lifestyle changes. If a patient is overweight, we discuss weight loss which decreases the amount of stress on their joints. If the patient is into heavy lifting or CrossFit activities that put a lot of stress on the body, we discuss making modifications. Physical therapy or home exercises are additional conservative methods patients can try to improve motion and strengthen muscles around the joints, which dampens the load that the joints feel. Anti-inflammatory medications (such as Aleve or Ibuprofen), pain relievers (such as Tylenol) and steroid injections have also proven to be successful to temporarily reduce pain or inflammation caused by arthritis.
In terms of surgical treatment for arthritis, the most effective treatment would be joint replacement. Joint replacement is recommended when the patient has end-stage arthritis and conservative approaches have failed or arthritic symptoms are affecting their quality of life. Perhaps the most important factor is determining if someone is healthy enough to undergo surgery, which is why it’s essential to have a detailed conversation with an orthopedic surgeon before deciding.
As orthopedic specialists, we often tell patients they’ll know when the time is right. The joint will be so painful that patients will often find themselves avoiding their favorite activities or sleeping poorly. Routine activities, such as walking or climbing stairs, will become difficult. We understand that surgery can be a difficult decision, so we let the patient make that decision, which typically comes after conservative treatments have failed. Our goal with any surgery is to get the patient back to doing what they love.
Absolutely. A hip, knee, shoulder or ankle replacement can be performed as an outpatient procedure. However, not all patients are candidates for an outpatient joint replacement, and so inpatient joint replacements are also commonly performed.
With any joint replacement, we would consider a successful result to be a happy patient. As orthopedic specialists, our goal is for the patient to return to the activities they loved doing prior to when the joint became arthritic and painful.
If you get a partial knee but you really need a total knee, then there’s a good chance that you’ll need to get that knee redone in the future. That’s why we thoroughly evaluate with imaging how much of the knee is affected with arthritis before surgery. During surgery, we may discover that more of the knee is affected with arthritis and decide to switch gears from a partial knee to a total knee. Ultimately, we never perform a knee replacement, partial or total, with the intent of replacing it again.
There are many debates about this topic amongst medical professionals, but one thing we can all agree on is that obesity increases the risk of complications. With this in mind, this topic should be a conversation between the patient and the surgeon as each patient is unique and there are many factors to consider.
There are a lot of advancements coming down the pipe with shoulder replacement, including robotics. However, patients should understand that the surgeon still has to do the exposure and the procedure, so robotics and/or 3D printing doesn’t make a bad surgeon better. What 3D printing does is it maps the boney anatomy and, on the computer, preoperatively the surgeon can try to maximize exactly how they want to reproduce the shoulder once in surgery. Overall, these advancements help make our best surgeons even better.
The short answer is no. However, there are several factors that should be considered when determining if someone is a candidate for surgery, such as the health of the patient, activity level, how motivated they are to recover, if they have a support system, etc. Overall, this should be a conversation between the patient and surgeon as each patient is unique.
Ultimately, it depends on the health and history of the patient. This should be a conversation between the patient and surgeon.
Patients can typically expect 20+ years without discussions of a revision.
Each patient is unique, so treatment plan can vary from patient to patient, but it is commonly recommended for the hip replacement to be performed first. Often in these cases, patients can have referred pain to the knee from the hip and sometimes knee pain can diminish after a hip replacement, if on the same side. Additionally, recovery from hip replacement is often times easier than recovery from knee replacement.
The determination of a knee replacement or knee revision is based more on the health of the patient than the patient’s age, so there is not necessarily an age limit for either procedure.
During knee replacement surgery the ACL is sacrificed in the vast majority of knee replacement designs. The implants themselves have various ways of supplementing or simulating the function of the ACL. There was a push earlier in the 2000s to implement the “bi-cruciate” retaining knee and although the design of the implants were reasonable, the execution and results were substandard. The goal was to create a more anatomic and natural feeling knee, preserving kinematics and proportion; however, early failure for various reasons led ACL sparing designs to fall out of favor. There are ACL substituting designs that specifically address the ACL function after surgically sacrificing it; however, by and large, the most common four or five knee designs sacrifice the ACL. Furthermore, by leaving an anatomic structure like a cruciate ligament in the knee and putting in an implant that requires it to function, you’re exposing yourself to more modalities of failure of the implant and more ways to wind up with a revision procedure which may otherwise have been unnecessary.
There are more successful knee replacement implants than we can reasonably name. OrthoAlliance surgeons use several techniques, stability philosophies and alignment styles that are catered toward patients on an individual level for personalized care. Most of the knee implants made by big companies have good track records and most are made of close to, if not exactly the same, materials with differences in the surface treatments like oxidation or ionization processes to “ceramicize” the metal, and differences in how oxidative stress from the human environment is dealt with to increase implant longevity. The most important thing is that your surgeon picks the implant that allows them to do the best they can for you and give you the best outcome based on their own training, philosophies, preferences, etc. Surgeons have access to many systems during training and it’s like going to be fit for a golf club. There are a lot of golf clubs with competitive philosophies that work well for a lot of people, but ultimately, there’s one that feels right and leads to better shots in your hands. That’s the best knee system to use.
Recovery After Joint Replacement
An important part of the decision-making process to joint replacement is making sure patients understand what to expect, as everyone is different. Recovery can be painful the first couple of weeks, which we try to control with pain medication.
- Hip and Knee Replacement
Physical therapy is critical, almost as important as the operation. Patients should understand the importance of pushing through the uncomfortableness the first few weeks and continue moving to avoid stiffness. By six weeks, patients seem to have “turned the corner” and are feeling better, realizing the surgery was a good idea, but they have a little more recovery and work to do. By three months, most patients are back doing the majority of their day-to-day activities. Planning a trip or vacation is typically reasonable around this timeframe. By a year, things are about as good as they will be. - Shoulder
As the third most common joint replacement procedure, shoulder replacements have shorter hospitalizations and fewer complications than hip and knee replacements. After surgery, pain control includes NSAIDS, nerve medication and the nerve block used during surgery. Eighty percent of patients are taking only Tylenol at 3-5 days post-operative. Physical therapy is important to return to full strength and function and typically lasts up to 12 weeks post-operative. Lifting restrictions are in place up to six months after surgery. - Ankle
After ankle replacement surgery, most patients are non-weightbearing for about a month and then in a boot for another month. Once there’s been time for soft tissue healing and the swelling has gone down, physical therapy begins. Patients continue to improve up to a year or two after surgery.
Recommendations can vary by physician. We encourage you to speak with your doctor regarding specific limitations.
OrthoAlliance is a network of orthopedic practices in Indiana, Ohio and Kentucky. We encourage those suffering from arthritis pain to not delay scheduling an appointment. Discussing goals and concerns with your doctor will help determine the best course of treatment. To learn more and find a location near you, visit https://orthoalliance.com/providers/
Results vary from patient to patient as everyone is different. As an example, one patient might be biking on a trail three weeks after a hip replacement (and that’s not normal), while another patient may have more severe pain for three months. Patients typically aren’t done healing for six months, maybe even a year. However, what patients should understand is the pain they go through following surgery is worth it, because what we care about is the thirty-year outcome of the joint replacement. Regardless, the long-term goal is to be pain free for the rest of the patient’s life.
This question is best answered in the clinic by a hip or knee specialist to thoroughly evaluate the patient and symptoms.
We don’t encourage patients to run on a regular basis after an ankle replacement as it could cause the implant to deteriorate prematurely. If a patient has a desire to run after ankle replacement, it should be discussed with the surgeon prior to the procedure.
Every patient is different, but patients can typically expect to ease back into golf around 6-8 weeks after hip replacement.