Healthy Living for Life – Learn About Hip and Knee Replacements (Full Version)

living longer living healthier living better than ever before welcome to Mountain-Pacific's Healthy Living for Life a weekly series that gives you the information education and expert insight you need to become an active participant in today's ever changing health care climate here now as today's program hosts pain and limited movement are the biggest reasons for a hip or knee replacement but at what point should a person have surgery today we'll get the answer to that question and along the way learn all about hip and knee replacements including the process the risks and the rehab welcome to Healthy Living for Life a show dedicated to helping you do just that I'm your host Beth Brown stay tuned welcome back today we are talking with Dr Kerry Hale about hip and knee replacements welcome to our show Dr

Hale thank you thanks for being here so let's just dive right in can you start out by telling us what is osteoarthritis osteoarthritis is a degenerative condition that can happen to most of us actually as we age it's just a regular wear and tear of the joints themselves so the cartilage wears down okay so this is something that may lead to a knee replacement surgery it can yes okay what are some of the other reasons why someone may need a knee replacement surgery well arthritis can occur from not only the the regular wear and tear osteoarthritis but inflammatory arthritis such as rheumatoid arthritis gout those types of conditions people can also have what's called post-traumatic arthritis so say an ACL or meniscal injury when we're younger can lead over time to what we call this post-traumatic arthritis okay and if someone is experiencing these kind of conditions or pain is surgery usually answer or there other alternatives that might come up there are definitely other alternatives first before surgery patients can go through physical therapy strength training programs modifying their activities there's a whole host of different medications both pain relievers and anti-inflammatories that we can use and then there's certainly a role for injections and joints occasionally to help so number of different things that can be done okay and I know there are people lots of times they'll live for years with knee pain or maybe their knee isn't as mobile as it used to be what's the tipping point there where it's time to get them in for surgery so every patient is different and every situation is a little bit different I'd like to tell my patients that the time to consider joint replacement is when their pain and their dysfunction in their daily life is enough where they've had it and they've been through conservative therapies and they're ready and so there are different types of knee replacement that you can get right can you talk a little bit about those different types sure so there's sort of what we call a full knee replacement we we divide the knee into three different compartments and that's a replacement of all three compartments and that's the most typical replacement that's done here in the United States and worldwide there is another replacement called a unicompartmental arthroplasty which actually only a small percentage of patients would be eligible for because typically that's arthritis in just one compartment of the knee whereas usually there's arthritis and more than one compartment okay are there I mean will someone who gets this surgery just see vast improvements or what is the improvement once you have a knee replacement it's a big surgery to get through and I tell people that they may wonder for the first few weeks sort of after surgery what they did get themselves into the recovery time typically by about six weeks to a couple of months three months out patients are doing fairly well but with a knee replacement you'll see small steady improvements for an entire year after surgery okay and what exactly happens during the replacement are there mechanical things that are put in there or can you just talk a little bit about the procedure yeah so both sides of the joint the femur the thigh bone and then the tibia the larger bone in the leg basically using a series of jigs the arthritis is cut and planed off so are all of the cartilage is taken off along with a small amount of bone making nice smooth surfaces for the implants to fit very precisely on – okay you already talked a little bit about the recovery time and seeing improvements is there a typical time that people will expect or does that depend on the patient – in terms of the recovery time yeah so typically in about six weeks to two to three months patients are doing quite well and they're back to the most of the activities that they like to do they'll continue to see again some small improvements after that for the first year okay and are there preparatory things that people need to do before the surgery and to kind of ensure that that recovery takes place how it should so if patients can what we call prehab meaning if they're able to do some sort of strength training weight-bearing exercise before surgery it will help immensely in terms of speeding their recovery afterwards sometimes that's just not possible because if the knee hurts enough then you're just not able to do much on it but we try to encourage patients to be doing as much as they can in preparation okay are there times when people are experiencing these kind of pains or conditions but still wouldn't be a good candidate for a new replacement sure if a patient had a significant other illness or illnesses where it may not make it safe for them to undergo anesthesia or you know pretty substantial recovery those would be the instances where surgery wouldn't be recommended okay is age ever a factor less so now for sure so it's really on kind of your overall health and instead of an age because the age is only a number yeah yeah exactly okay we need to pause here for just a quick break but when we come back what else you need to know about knee replacement surgery and we'll also take a look at hip replacement surgeries too so stay tuned we'll be right back after these messages welcome back we're continuing our conversation with Dr Kerry Hale about knee replacements so thanks for sticking around with us Dr Hale so just to continue that conversation like we said our knee surgeries regardless of whether it's the full replacement or our partial replacement are they always 100% successful with patients they're not always 100% successful knee replacement surgery is a very successful surgery and somewhere you know 90% to 95% of patients are really happy that they had it done but there's always complications that could go along with a big surgery like that okay are there things that patients can do to ensure that success rate and that the best thing to do again is to try to be as as fit and healthy as you can be going into it and then certainly physical therapy and doing the the exercises that we need you to do after surgery plays a really big role in getting the knee range of motion back and the strengthening in the leg back after surgery okay and then how long does that new knee usually last for a person so we don't entirely know the answer to that there's really good 15 year data out of the Mayo Clinic showing that at 15 years 98% of all knee replacements are still functioning well and the interesting part of that data is that it's data from implants that were you know 15 20 25 years ago so hopefully the implants that we are using now the surgery that we're doing now will be even better lasts longer okay has there been times then where that 15 years has come up and somebody has been a good candidate for a second knee replacement or does that not really happen that definitely does happen for a number of different reasons and that's called a revision knee surgery and those are successful as well although the the success rate goes down a little bit and the complication rate does rise a little bit with a second third fourth surgery okay and we were chatting during the break and you mentioned that knee replacement surgeries are actually on the rise can you talk about that a little bit yeah they've definitely skyrocketed in the US and worldwide and the number of people that are living longer and are more active as they're getting older as has risen dramatically and so therefore the need for any replacements has as well okay and as health insurance usually you pay for any replacement surgery yes they do sometimes there's different conservative treatments medications physical therapy that kind of thing that needs to be done first before the insurance approves replacement surgery but if you go through that then okay great so let's switch gears or joints as the case may be and talk about hip replacements now what are some of the reasons why somebody might need a hip replacement surgery very similar to the knee replacement the most common cause is that osteoarthritis wear and tear arthritis of the hip sometimes injuries can play a role when we are younger there's an entity called avascular necrosis or austria necrosis of the hip that can occur which is the same outcome needing to have a hip replacement just a bit of a different mechanism of an injury to the hip so again as we asked about knee replacement are there other alternatives or options for folks other than surgery that I know the hip obviously is a little bit different than the knee but can you do physical therapy and things like that for that instead you can do physical therapy anti-inflammatories I typically don't recommend much in the way of injections for the hip they don't seem to work nearly as well as they do in the knee so okay and then are there partial hip replacements is that similar to or are there different kinds of hip replacement surgeries there's a what we call a total hip arthroplasty which is what the vast majority of surgeons in the us are doing there's something called a hip resurfacing surgery which has for the most part fallen out of favor because of the the bearing surfaces they're used in that surgery it's called a metal-on-metal hip and most of us are not doing metal on metal hips at this point because of some issues that have arisen with them okay so what is used if it's not metal anymore that yeah so in a hip replacement surgery the the femoral head or the ball of the hip we take that out and a stem typically a titanium alloy stem is used to it gets inserted in the upper portion of the femur and the bone grows on to the stem and then either a metal or ceramic head fits on to that stem and then there's a again a titanium cup which gets inserted into the pelvis into the cup of the hip and again bone grows onto the back of that and then usually there's a plastic liner that snaps into the cup and so the head articulates with the plastic liner okay Wow yeah so metal still is at play it's just avoiding that metal on metal part that is correct okay gotcha okay and so again at what point would you recommend hip replacement surgery for somebody who's experiencing pain or different hip conditions yeah so it's it once again it's when that pain and dysfunction is bothering people enough in their daily life hip replacements may last longer and there's actually a little bit of a better patient satisfaction rate overall with hip replacements versus knee replacements so patients that are a little bit younger at times with hip arthritis are offered hip replacement surgery maybe versus a knee replacement surgery okay all right it's a great information we do need to pause for yet another break but there's still more to learn about hip replacement surgery we'll continue our discussion with dr

Hale right after these messages stay with us we'll be right back welcome back Dr Hale is still with us as we continue to talk about hip replacement surgery so let's talk about you you already talked about the procedure a little bit but there are different approaches to the hip surgery can you talk about those a little bit there are there's the in the United States there's two main approaches that are used now about 50% each way and there's something called a posterior approach which most of us trained on and then there's more of an newer approach called the anterior approach and there's some different reasons why different people would get different approaches and some pros and cons to both approaches okay so we talked a little bit about the recovery from knee replacement what is the recovery like for hip replacement it's typically much quicker actually than the knee replacements there's no specific physical therapy that I typically have patients doing after hip replacement surgery I tell my patients that walking is their exercise afterwards and really you know for six weeks patients are doing really well and kind of back to their usual activities okay and what's the success rate when it comes to hip replacement knee replacements really high as hip replacement high – it is very high probably actually a little bit higher than knee replacement overall if you looked at all the the data from worldwide really so close to hundred percent close yeah I would say yes there that's great okay and what is so you said four to six weeks that's a pretty average time that someone might be able to expect are there any times where there are complications where that might go a little bit longer if somebody had a really arthritic hip to begin with sometimes if they had a big what we call leg length discrepancy the so that leg would be a lot shorter than the other from their arthritis if their hip was really stiff before surgery meaning that the muscles and tendons and ligaments around it all all needed time to heal as well and become more limber after surgery so in those cases it can take a little bit longer okay and again similarly to the knee replacement question are there times when someone is just not a good candidate for hip replacement or their risks that they should know about if they could or could not be a good candidate and as with any replacement it's mostly just overall health and and being able to undergo in anesthesia from a heart-lung standpoint that kind of thing okay and how long does a hip replacement usually last at least hopefully at least 15 plus years there's very good data out there to support that okay and other times when people have had to do that sort of a thing twice – sure yeah yep okay and so also asking I know this is important for folks to know health insurance is a hip replacement something that they can expect their insurance to cover yes okay about you probably a relief for folks who are interested in something like that and are there things that folks can do to make sure that hip replacement lasts as long as it should so I tell my patients that they can go do anything that they would like to do with their hip or their knee except run and I think that running or you know high-impact jumping activities while you might feel like you could do them with your joint replacement I don't think it's a good idea because I think it could lead to earlier wear of the joint okay so certain sports things like that yeah I mean I think people can hike and bike and swim I allow people to downhill ski play tennis but a lot of running you know basketball a high impact jumping I don't think it's a good idea okay gotcha so let's back up long before the surgeries ever happened and just talk about somebody is experiencing either knee or hip pain what do they do with their first step oh they can speak with their primary care provider if they'd like to they can also call an orthopedist either a non operative orthopedist or an orthopedic surgeon and our office for example you can call and make an appointment you don't need a referral you don't okay that was gonna be my next question so a referral is not required you can just cut out the middleman and go straight to an orthopedic physician okay and then if it is determined then that surgery is required we've talked about you know hospital safety and surgery safety on this show before can we talk a little bit about infection prevention and some of the things that can happen in surgery as far as patient safety goes sure infection is a really big issue and joint replacement surgery it's a subject that has a lot of attention is paid to and because infection in that setting is a just disastrous for patients in our health care system so we have patients go through a process using a special soap before surgery checking for what we call MRSA before surgery and then when they're in the hospital receiving IV antibiotics special dressing that we use just really paying very close attention and close monitoring for that can you I mean this might seem a little bit obvious but can you talk about the difference between an orthopedic doctor and an orthopedic surgeon and when somebody should go see one or the other sure the the orthopedic doctor may be somebody a primary care physician with an emphasis in sports medicine or orthopedics who they just see patients in the clinic maybe do some minor procedures in clinic versus an orthopedic surgeon who sees these patients both in clinic and operate okay perfect thank you so much for your time and all your expertise we're out of time that's our show so I'd like to thank all of you at home for tuning in this week and we hope you'll tune in again next week until then stay fit stay well and stay healthy for life with Healthy Living for Life have a great week Healthy Living for Life is brought to you by Mountain-Pacific Quality Health we'd love to hear from you if you have suggestions for future programs visit our website at mpqhforg or call us at 406 443 4020 you can also catch us on youtube by visiting our website and clicking on the YouTube icon special thanks to Fire Tower Coffee House and Roasters production facilities provided by Video Express Productions

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