Arthroplasty Surgery – Los Angeles
Arthroplasty, is a surgical procedure in which parts of the knee joint are replaced with artificial parts. A joint functions as a hinge joint, and the surfaces where these bones meet can become worn out over time, often due to arthritis or other conditions, which can cause pain and swelling. This happens many times in Los Angeles.
Total knee replacement is the most common option to relieve pain and to restore function to an arthritic knee, but arthroplasty is about joint repair, so it is not relegated to only knee procedures. The most common reason for knee replacement is that other treatments (weight loss, exercise/physical therapy, medicines, and injections) have failed to relieve arthritis-associated knee pain.
The goal of knee replacement is to relieve pain, improve quality of life, and maintain or improve knee function. It is important to have significant pain and/or disability prior to considering this procedure. Approximately 700,000 knee replacement procedures are performed annually in the US. This number is projected to increase to 3.48 million procedures per year by 2030.
ALTERNATIVES TO ARTHROPLASTY
While total knee replacement can be helpful under the right circumstances, you should discuss the risks, benefits, and alternatives with a doctor. Alternatives to total knee replacement include:
Nonsurgical treatment — Nonsurgical treatment methods are initially recommended for patients with osteoarthritis or inflammatory arthritis. This includes:
●Weight loss. The knee sees about four pounds of pressure for each pound of body weight, so even a small amount of weight loss (eg, 10 to 15 lbs) can lead to reduced pain.
●Exercise/physical therapy. Strengthening the muscles around the knee help take pressure off the knee. Motion of the joint helps to keep it from getting stiff.
●Medications, including over-the-counter and prescription. These include pain relievers such as acetaminophen and anti-inflammatory drugs such as ibuprofen or naproxen. Patients should discuss use of these medications with their primary care provider and pharmacist to be sure the risk of side effects is acceptably low.
●Knee bracing or shoe inserts, both of which may help align the knee and balance the weight on the joint.
●Injections, either with a cortisone-like drug or a hyaluronic acid derivative.
Arthroscopy — Arthroscopy is a minimally invasive surgical procedure in which a doctor examines the inside of a joint with a device called an arthroscope. The doctor can repair any damage through small surgical incisions in the skin. Arthroscopy is only helpful for a certain type of knee problems. Arthroscopic surgery has not demonstrated significant benefit for patients with osteoarthritis.
Osteotomy — Osteotomy is a surgical procedure that involves cutting the leg bone, realigning it, and allowing it to heal. It is used to shift weight from a damaged part of the knee to a normal or less damaged one. Osteotomy is not recommended for patients older than 60 years of age or for those with inflammatory arthritis (such as rheumatoid arthritis).
Partial knee replacement — A “partial” or uni-compartmental knee replacement involves replacing only one part of the knee joint. You should talk to your doctor about the possible risks and benefits.
THE KNEE REPLACEMENT PROCEDURE
The surgery takes two to three hours. Most people stay in the hospital for one to four nights after surgery, although shorter stays are becoming more common. Blood clots in the legs (called deep vein thromboses) are a common concern after knee replacement surgery. To reduce the risk of blood clots:
●Mobilize early. Work with your physical therapist to try and get up the day of surgery or the day after. Learn exercises to do while in bed.
●You will take a medicine, either as a pill or a shot. Most patients continue to take this medicine for a few weeks after surgery.
●You will need to wear compression boots (devices that go around the legs and inflate periodically) while you are lying down. Once you are able to get up and walk, you will wear anti-embolism stockings. These stockings fit snugly around the foot, ankle, lower leg, and knee to help prevent blood clots.
Infection is another major concern. Take antibiotics within an hour of the procedure and for up to 24 hours after. Eating a healthy diet, avoiding obesity, and smoking cessation all are helpful for minimizing infection risk.
Rehabilitation — Start moving the feet and ankles immediately after surgery. Some surgeons use a continuous passive motion device, which raises and slowly moves your leg while you are in bed. It is common to begin physical therapy the day of or one day after surgery, while you are still in the hospital.
Physical therapy is an important part of the recovery process. After leaving the hospital, some people have physical therapy in their home or at a clinic, while others stay in a rehabilitation facility or nursing home for a few days.
The rehabilitation program generally includes exercises to improve range of motion (how far you can bend and straighten your knee) and to strengthen your leg muscles. Your surgeon and physical therapist will help to set goals as you progress through rehabilitation.
The goal of the rehabilitation period is to regain strength and movement in the knee; it is important to avoid overworking or straining the knee during this recovery period. You can usually resume your normal activities within three to six weeks after surgery. After several months of rehabilitation, you will be able to have a more active lifestyle.
Potential complications — Serious complications are not common after knee replacement. However, it is important to be aware of the major potential complications.
Studies have shown that a successful joint replacement partially depends upon the experience of the surgeon and the hospital. In one study, outcomes were better in people who had:
●A surgeon who performed more than six knee replacements each year
Better outcomes included better knee function and lower rates of complications after surgery.
POSSIBLE ARTHROPLASTY SIDE EFFECTS
Blood clot — Having total knee replacement increases the risk of a blood clot forming in a vein (called a thrombosis). The most common place for a thrombosis to develop after knee surgery is in the deep veins of the leg (called a deep vein thrombosis [DVT]). Symptoms of a DVT include leg pain and swelling. Call the doctor’s office if a DVT is apparent.
Infection — Infection following knee replacement is a relatively uncommon but serious complication. Signs of infection include fever, chills, pain in the knee that gets worse suddenly, increasing redness, or swelling. Call the doctor’s office if a possibility of an infection is near.
Stiffness — Occasionally, despite physical therapy, a patient’s knee may get stiff and may not bend or straighten properly. If this occurs, then the patient may return to the operating room in order to bend and/or straighten the knee under anesthesia.
Early failure — Although most studies demonstrate that 80 to 90 percent of total knees will last between 15 to 20 years, early failures may occur due to a variety of reasons. These include loosening of the implants, infection, fractures of the bone around the implants, and instability. When early failures occur, revision surgery may be necessary.
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