Joint Replacement FAQs

Why is Arthroscopy necessary?
Diagnosing injuries and disease begins with a thorough medical history, physical examination, and usually X-rays. Additional tests such as an MRI, or CT scan also may be needed. Through the arthroscope, a final diagnosis is made which may be more accurate than through “open” surgery or from X-ray studies.
What are the joints that can be viewed with an Arthroscope?
Although the inside of nearly all joints can be viewed with an arthroscope, six joints are most frequently examined with this instrument. These include the knee, shoulder, elbow, ankle, hip, and wrist. As engineers make advances in electronic technology and orthopaedic surgeons develop new techniques, other joints may be treated more frequently in the future.
Will physical therapy be required after surgery?
Getting a full range of motion, strength and flexibility back after surgery usually takes time. That’s where pre-operative exercise and education and post-operative physical therapy programs come in – to ensure you’re physically and emotionally prepared for surgery and to maximize your recovery after surgery. What should I bring with me when I come for an appointment? When you come for your appointment remember to bring the following:

 

  • Drivers License or a valid ID
  • Insurance information
  • Referral Letter (if required)
  • Reports, X-rays, MRI’s, CT scans etc and any other relevant information
  • List of medications (if any)
What activities are possible after getting either a hip or knee replacement?
There are really no restrictions after getting hip and knee replacements. We want our patients to be active. We want them to be completely pain free. The only thing that I restrict my patients from is any impact type of activity after the surgery, because this is an artificial joint and it has absolutely no ability to heal itself. The worst results I found in patients who abused their joints, who played soccer, who played basketball after the surgery. They need a revision, which means replacement of the hardware in a relatively short time. Today we have excellent results at 20 years. The people who abuse their joints don’t last that much. I definitely allow skiing, tennis, I allow people to go on elliptical. Again, the only thing we don’t want is impact type of activity after the artificial joint replacement surgery.
What are the complications potentially associated with any joint replacement surgery?
I go over numerous complications which are a possibility. The complications typically are less than 1%. We talk about infections. There are many things that we do to decrease the risk of infections. We give antibiotics before the procedure. We give antibiotics for about 24 hours after the procedure. During preoperative testing we make sure that there is no infection elsewhere in the body which can travel to the hip or to the knee joint. That’s a significant complication. In the operating room we take many precautions to decrease the risk of infection. Another risk is injury to the blood vessels and the nerves around the hip joint, which is pretty rare. There’s a small risk of injury to the bone. When we insert the prosthesis the bone can actually break. That is also a pretty rare possibility. It’s a possibility especially in older population where the bone density is low. We worry about blood clots. The most important thing that prevents blood clots is patients getting up and walking. I use aspirin in the long term for prevention of blood clots. The other thing that we use to prevent blood clots is stockings to be worn after the surgery. We also use sequential compression devices for the legs during and after the surgery to keep the blood flowing.
Where should a patient go after getting a hip or knee replacement done?
My clear preference is for the patient to go home after getting their hip replacement done. Today we’re talking about doing ambulant joint replacement surgery. But even if the patient has to stay for a day or two in the hospital, the preference is clearly to go home. Everything is set up even before the surgery. The case manager makes sure that there is physical therapy. There is a visiting nurse that is set up before the surgery that comes to the patient’s house to take care of him or her after the surgery. All the medications are called into the pharmacy the day of surgery. Everything is set up before the surgery and most of my patients go home the next day.
Is surgery the best option for every patient?
Not always. I recommend patients for joint replacement surgery only after all non-surgical approaches are exhausted in relieving joint pain. Healthy diet, regular exercise, and over the counter pain meds, such as ibuprofen and acetaminophen are the usual non-surgical approaches available. Steroid injections can also be a helpful option, but physicians often limit the use of steroids. In my opinion, use of over-the-counter nutritional supplements – glucosamine and chondroitin – is not recommended because, they are not regulated by the US. Food and Drug Administration and the evidence regarding their efficacy is scarce or none. Moreover, these nutritional supplements can also affect blood sugar and cause gastric problems. If the patient is allergic to shellfish, Glucosamine can cause an allergic reaction.
What is total joint replacement surgery?
Total joint replacement is one of the most promising orthopedic surgeries of modern times,  with advancement in various disciplines such as treatment, implants, and minimally invasive operative techniques. Relieving pain and restoring the joint motion are the main objectives of this procedure. After the surgery, patients are able to carry out their daily activities without any discomfort.
What is the criteria in choosing patients for total joint replacement?
I use three criteria in selecting patients for total joint replacement surgery. The patient who meets all the three criteria are eligible for surgery. First, I inquire about joint pain with limited mobility due to which a patient can no longer perform even their daily tasks such as climbing stairs or stepping in and out of the tub. Then, I examine the painful knee or hip for range of motion and shape, as well as patient’s gait, or manner of walking. Finally, I review diagnostic imaging results to find out if the patient suffers from arthritic degeneration of the joint. The patient fulfilling all t three criteria will be considered for the procedure.
What does Dr. Karkare tell a patient scheduled for total joint replacement?
In general, surgical candidates can remain active until the date of their surgery. Inactivity and limited muscle mobility might exacerbate the existing condition. Hence, I recommend the patients scheduled for surgery to remain active. Swimming is a preferred choice to maintain the muscle bulk and joint flexibility. It relieves the body weight while exercising. Water exercises are advised even to those patients who are unable to swim as it isn’t necessary to swim in order to participate. Cautious use of pain medications before surgery can ease post-surgery pain control.
What are the advantages of newer surgical options?
The latest minimally invasive surgical techniques offer a faster recovery and better maintenance of walking pattern. The anterior approach of reaching the joint from the front requires a small incision and avoids the cutting of muscle; unlike standard hip replacement, where the joint is approached from back side and requires muscles to be cut. Moreover, this anterior approach makes the patient pain free in shorter time, and reduces the recovery time and overall muscle disruption. Most of the patients resume walking at the earliest and have good strength. Further, the implants made from a combination of plastic and ceramic offer better results than those developed in the past. Newer implants provide more comfort as they match well with the natural anatomy, resist wear and tear, and give an enhanced range of motion and reduce risk of joint dislocation.
How can patients achieve optimal joint mobility after surgery?
I suggest physical therapy which is of prime importance. It is extremely necessary for patients to be proactive with their routine physical therapy. The range of motion that a knee replacement patient achieves within the first three months after surgery is likely the range of motion for the rest of life. The range of motion after hip replacement typically depends upon the structure of the hip joint.

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