Joint Replacement Center

The Somerset Joint Replacement Center is a program designed to restore function of your joint in the most expeditious fashion with the least amount of pain to ultimately get you back to the activities that you want to take place in. The Center is a collection of varied medical professionals all working towards the common goal of restoring the function of your replaced joint.  We are a Center of Excellence who on a weekly basis perform joint replacement surgeries and we have organized a pathway to make your experience the best possible experience here at Somerset Hospital. 

Knee Information

Why Do Joints Go Bad And How Joint Replacement Helps

Knee arthritis is a combination of genetic factors as well as environmental factors.  Certainly the wear and tear, old injuries, and things we do with our knees affect the rate at which the cartilage on the ends of the bone wear.  There is certainly also a genetic component that affects the ages at which various ages develop arthritis.  As the population ages, arthritis is becoming even more prevalent.  As folks continue to be more and more active with sports and other recreational activities, it does appear that arthritis is becoming more prevalent at younger ages as well. Joint replacement helps by essentially removing all of the arthritis from your joint and replacing it with synthetic arthroplasty components.  This allows you to regain function of your particular joint without the pain that you had previously associated with arthritis.

Risks And Benefits Of Joint Replacement

As with any surgery there are risks to undergoing total knee replacement.  These risks would include the risk of anesthesia which will be discussed with you by your anesthesiologist on the morning of surgery.  If you desire to speak to the anesthesiologist prior to the morning of surgery, this can be facilitated as well. Most of the knee replacements are done under spinal anesthesia to limit the risks of anesthesia that are associated with general anesthesia such as the risk of having a breathing tube, heart attack, stroke, etc.  Although most of the joint replacements are done under spinal anesthesia, the anesthesiologist can sedate you such that you do not remember hearing or seeing anything during your surgery even though you do not undergo general anesthesia.  Obviously, any time the skin is cut during any surgery there is a risk of infection, this is especially important during joint replacement that infection be presented.  We use sterile technique, give you peri-operative antibiotics in this regard.  Our infection rate since I have been doing joint replacements at Somerset Hospital is well below the National average.  We also take special precautions during surgery and wear special equipment and use special processing to limit any chance of infection during your surgery.  Any time you have a knee replaced, there is a risk of blood clots, you will be on blood thinners for one month after surgery to minimize this risk.  There is always the risk of the knee getting stiff as your body lays down scar tissue in response to the surgery.  Therefore, it is very important after a knee replacement that you active pursue your exercises so as to get the knee moving and not end up with a stiff knee.  The joints are made of medical grade plastic and metal and are not designed to last forever.  They are designed to let you walk around and perform activities of daily living with little to no pain.  Present studies show knee replacements lasting greater than 90% at 10-15 years.  We anticipate that the newer replacements are even better but we will not realistically know the true answer to that until 15 years from now.  The benefits are joint replacement are numerous, too numerous to probably list here, but they would include elimination of pain, improved ability to perform activities of daily living, basically getting your life back.

What To Bring To The Hospital For Your Inpatient Stay

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How Does the Joint Center Work?

For total knee replacement, after scheduling your knee replacement and discussing it with Dr. Girdany, your surgeon, in the office, you will be set up for preoperative testing.  This is done on all patients.  We will most likely need a letter from your primary care physician saying you are cleared for anesthesia for the surgery.  We will check routine testing including blood work, electrocardiogram, perhaps chest x-ray as is dictated necessary. In certain cases, we need to obtain further tests to evaluate the strength of your heart prior to surgery.  Your pretesting will be arranged by our surgery scheduler in our office on the day that you schedule surgery and as you go through the hospital to have your pretesting performed, you will be escorted to each particular station.  At the conclusion of your pretesting, you will have the opportunity to observe inpatient rehab where you will begin using your new joint following your surgery.  As far as the day-to-day stages in the hospital, you will come to the hospital on your day of surgery, the same day surgery folks will contact you the afternoon before to let you know what time you need to be at the hospital. Unfortunately this schedule is not set until the afternoon before surgery due to emergencies so that will be unable to give you the exact time at which your surgery will be scheduled until the afternoon before the surgery itself. 

On the day of surgery, you will undergo your surgery, go to the recovery room for approximately an hour and then be transferred up to the third floor into a dedicated joint replacement suite.  These suites have been designed to maximize your comfort, maximize the pleasure you experience during your stay and give you the best environment to achieve your goal of having a fully functional joint with little pain following your surgery.  You will initially have pain medication given to you through the IV, you will likely have a pain button to allow you to administer your pain medications so you are not waiting on nursing or other healthcare staff to help alleviate your pain.  As stated earlier, most of the joint replacements are done under spinal anesthesia so that you can be numb for some time following the surgery therefore avoiding pain. On the next day following your surgery, you will get up with the therapist after breakfast.  I will try to get you disconnected from the IV’s and other lines that you may have attached to you which could include drains in your joints.  We will begin you on the pain pills, get you up and start you using your joint which hopefully you will do twice that day once in the morning and once in the afternoon.  By day three in the hospital, you will continue with more therapy, you will probably find the worst is over and it is beginning to be easier to complete your therapy.  Day three if you are meeting all of your goals in therapy, you could be considered for discharge.  If you are staying in the hospital that night, we anticipate having a movie night where you can select a movie of your choice from a video library and we will provide popcorn to help you relax and step back a little bit from the workout regimen that you have been going through to restore the function to your leg.  On day four, most folks are able to go home. In the event you are not able to go home or you have a home situation where you do not have a lot of help at home, we can try to arrange for you to go to an inpatient rehabilitation facility where you can get more therapy and have some help as you continue to get back on your feet. 

After you have been discharged home, you will have home health following you. They are compromised of several components including home health nurses that an help draw your blood to monitor for blood thinners.  We will also have the home physical therapists come in and supervise you doing your exercises.  Your exercises need to be done twice a day every day but the home therapists will come in once or twice a week to make sure you are performing these correctly.  You will be seen in Somerset Orthopaedics Office as an outpatient approximately two weeks after surgery at which time in most cases your stitches or staples will be removed and we will show you an x-ray of your joint.  Follow up thereafter will be dictated as per your surgeon but in most cases with knee replacement after completing your home therapy, you will then begin outpatient therapy both for range of motion as well as strengthening of your leg.  Once you are recovered fully from your knee, you will simply need annual radiographic follow up of your joint to assess for how it is wearing via x-ray and there will be quarterly support groups provided through Community Education which you would certainly be welcome to attend to develop some camaraderie with other folks who have gone through joint replacement similar to yours.

Frequently Asked Questions

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Hip Information

Why Do Joints Go Bad And How Joint Replacement Helps

Conditions that lead to hip replacement are quite varied.  The most common condition is hip arthritis.  This is typically a result of both genetic as well as environmental wear and tear type factors.  Other reasons which necessitate joint replacement include dysplastic hips which can be present since birth, avascular necrosis which is a condition in which the hip loses it’s blood supply for various reasons, or post-traumatic conditions such as fractures can sometimes be best served with total hip replacement. 

Risks And Benefits Of Joint Replacement

The risk of total hip replacement as with any surgery include the risk of anesthesia, these will be discussed with you by your anesthesiologist prior to surgery.  If you wish to discuss them with anesthesia even prior to the morning of surgery, this can certainly be arranged.  A significant proportion of the hip replacements we do under spinal anesthesia thereby avoiding the necessity of having general endotracheal anesthesia.  The risks of hip replacement include the risk of blood clot which therefore we treat with blood thinners for one month after surgery.  There is a risk of infection any time you cut the skin with surgery, we therefore use sterile technique and give you perioperative antibiotics to prevent infection.  We also wear special equipment and use special technique during surgery to minimize the risk of infection during total hip replacement. Our infection rate for total hip replacement at Somerset Hospital in my hands thus far has been significantly below the National Average for joint replacement across the United States.

Other risks of hip replacement include the risk of dislocation of the ball from the socket.  It will be emphasized to you throughout your hospital stay and thereafter to avoid getting your legs in any unusual positions so as to maintain the ball within the socket especially during the first three months after surgery while your body is scarring this implant in.  One may not cross their legs, take their hand below their knee or point their toes way in or way out especially in the first three months following a total hip replacement.  You will have a special pillow to utilize in bed to remind you not to cross your legs while you are in the hospital.  There is also a risk  of changing the length of your leg during a hip replacement. We do things during surgery to objectively measure this, however, in some circumstances it may be necessary to adjust the length of your leg in order to obtain a stable hip.  There is a small chance of needing a shoe lift on the operative or contralateral side to balance out the leg lengths following hip replacement though most patients do not require this.  There is also a risk of bone fracture when placing these metal components into your bone depending on the quality of your bone.  These will be treated by your surgeon as necessary and we have various techniques we can do to deal with these type of situations which are relatively common in the older population.  Depending on the nature of your bone, your weightbearing course postsurgically may need to be delayed to allow healing prior to full weightbearing, however, most people are able to get up and put some weight on their leg the day after surgery. 

The benefits of hip replacement therapy are quite numerous, most especially would include improved quality of life secondary to decreased pain and an improved ability to ambulate, get around, and do the things that you want to do following your hip replacement.  Most people do limp after hip replacement, this is due to several factors including the surgery itself.  Immediately following surgery you will begin ambulating with a walker.  Usually within one month or less, most people transition to a single cane and by three to twelve months after surgery, a significant amount of people will be able to ambulate without any assistive devices, however, there are some folks that continue to use a cane throughout their lifetime simply because it makes ambulating easier.  A significant portion of people limp prior to the hip replacement which is a factor in this as well.

What To Bring To The Hospital For Your Inpatient Stay

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How Does the Joint Center Work? What Are The Stages And What Should I Expect?

When your hip is scheduled in the office, you will then meet with our surgery scheduler who will arrange for your preoperativetesting.  In a significant number of cases, we do send you to your family doctor for preoperative medical clearance to make sure that you are okay for anesthesia. Routine preoperative testing which can include lab work, electrocardiograms, chest x-rays, and other tests as deemed necessary will be ordered to insure that we proceed with your surgery in the safest fashion possible. When you go and have your preoperative testing at the hospital, you will be escorted from station to station and at the conclusion of your testing have the opportunity if you so desire to visit our inpatient rehab center where you will do your therapy following your surgery.  In addition, special x-rays will be taken of your joint which is to be replaced and your surgeon will use computer software to appropriately size implants to best be prepared for what is necessary to reconstruct your hip at the time of surgery.  You will then need to return to the office within one week prior to the scheduled surgery for your preoperative history and physical.  This will likely be performed by the physician assistant and is a Somerset Hospital requirement.  You will be called the afternoon before your surgery to be told the exact time to show up for surgery.  The surgery schedule is not finalized prior to this time and no one including our office can give you the exact time prior to the afternoon before surgery. 

On the day of surgery, you will arrive, the nurses will get you into our fashionable preoperative gown, the anesthesiologists will talk to you, an IV will be started and you will undergo your surgery.  Following your surgery which in most cases takes two hours or less, you will be transported to the recovery room where you will recover for approximately one hour.  You will be transferred then up to our joint replacement suite which are newly decorated rooms that have several amenities including a sleep recliner and flat panel TV with DVD player where you will basically relax on the first day in which you had your surgery.  The second day, your physician will be around in the morning to greet you.  The typical plan that day would be begin to get up out of bed and start moving.  Your weightbearing status will be result of multiple factors including your bone quality, the type of prosthesis that you need implanted in your hip and several other factors but you will get up the day after surgery and begin walking with physical therapy.  We will attempt to get you discontinued from many of the IV’s, etc., on the day after surgery.  Initially after surgery, you will have your own pain button so that you can give yourself your own pain medicine without having to wait on any type of staff to assist you. 

On the second day after surgery, you will again go to physical therapy twice, once in the morning and once in the afternoon where you will continue to work on ambulation.  By this point, you will be taking the pills for pain and should be largely disconnected from most auxiliary medical equipment.  We have deemed your third day in the hospital or second night after surgery as movie night at which point you will have the opportunity to choose from a library of films where you can relax after you have worked hard in therapy that day, watch some movies and have some movie popcorn brought right to your bedside.  The majority of the folks will be able to go home by the fourth day, you may complete therapy on that fourth day if it is necessary.  When you go home, you will be given complete written instructions by what is expected of you.  You will have home health come visit you in your home once or twice a week following discharge home. In the event you are not able to safely go home or you do not have help at home, our case managers will help facilitate placement in an inpatient rehab facility where you can have help around 24 hours a day and continue to get physical therapy as you get back on your feet.

 

You will see your surgeon again two weeks postoperatively at which time your stitches or staples will be removed.  Follow up will then be dictated as deemed necessary by your surgeon but total recovery time for a total hip until you are 100% would be on the order of three to six months, I typically tell my patients I look at this as a three to six month investment.  There is going to be quarterly support groups through community education at which point you will have the opportunity to enjoy some social camaraderie and light food with others who have gone through experiences similar to yours. 

Frequently Asked Questions

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