Repairing a severely injured or diseased joint is more than treating just
that body part. It's caring for the whole person to improve their quality
of life. We offer skilled hands-on evaluation, appropriate diagnostic
testing, and state-of-the-art surgical equipment and techniques to give
you the best care.
Americans today enjoy longer, more active lives than ever. But as we age,
a lifetime of movement and even overuse can take its toll and result in
problems with joints and muscles. Stiff and painful joints can sometimes
be life-altering and prevent you from participating in activities you
once enjoyed.
The orthopedics staff at MWHC has the clinical expertise to quickly and
accurately diagnose the problem and develop an individually customized
plan of care to relieve your joint pain or discomfort.
Rest assured that we exhaust every appropriate treatment option before
surgery is considered. However, if a surgical procedure becomes the right
choice, our skilled orthopedic surgeons are standing by to play their
role in a complete continuum of care that produces outstanding clinical results.
Our team will prepare you mentally and physically every step of the way.
We will continually monitor and manage your entire pre- and post-surgical
performance and progress. It's a full-service approach, coordinated with
your primary care physician, orthopedic surgeon, and clinical support
staff, to restore your joint's maximum function as quickly and safely
as possible.
Our orthopedic surgeons replace all major joints, including hip replacements
and knee replacements.
If you're scheduled for joint replacement surgery at Mary Washington Healthcare,
read on for more detailed information on our Joint Care Plus Program,
which will assist your return to optimum health.
Joint Care Plus Program
We look forward to helping restore your quality of living. Our program
is a comprehensive and individually customized course of treatment for
your joint replacement. You play a key role in your successful recovery,
and our goal is to keep you involved through each step of the program.
Your care team includes physicians, physician assistants, care management,
nurses, and physical and occupational therapists who specialize in total
joint care. We will review with you every detail of your care, from pre-operative
education to post-operative care and exercising.
For the best outcomes after surgery, you should prepare yourself for what
to expect before, during, and after the procedure. Please review the patient
education video(s) on this website for your type of surgery before you
come in for your Pre-Admission Testing (PAT) Nurse Practitioner appointment.
Regardless of the type of surgery you will have, you and your caregiver
should watch the coach's class video to be well prepared when you return home.
When knee pain, swelling and stiffness interfere with your ability to perform
daily activities, your doctor may prescribe physical therapy, anti-inflammatory
medications or steroid injections. When these treatments no longer provide
relief, you may be a candidate for a total knee replacement (TKR). This
is a surgical procedure to remove and replace your damaged knee joint
with an artificial joint (called a prosthesis).
Now a common procedure, approximately 600,000 total knee replacements are
performed in the United States each year.
Your Knee
The knee is the largest joint in the body and is involved in just about
everything you do! The ends of the femur (thighbone), tibia (shinbone)
and kneecap (patella) form the knee and are coated with a thin layer of
cartilage where they touch. That cartilage helps the bones move easily
and provides protection.
C-shaped wedges, called menisci act as shock absorbers between the femur
and tibia. Thigh muscles provide strength while long ligaments hold the
femur and tibia together and keep them stable. The rest of the knee is
covered by the synovial membrane which releases lubricating fluid to reduce
friction. When any of these parts fail to work in harmony, the result
can be pain, weakness or impaired function.
Signs that you may be a candidate for knee surgery
There are no age or weight restrictions for TKR surgery. Our approach is
to exhaust all possible treatments before recommending surgical treatment.
Your surgeon will help you determine if and when TKR is a good choice
for you. In addition to a complete medical evaluation of your knee, diagnostic
tests such as X-ray or MRI may be performed. In general, good TKR candidates
experience:
Severe pain and stiffness that interferes with every day activities
Moderate to severe pain even when at rest
Chronic inflammation or swelling
Deformity of the knee
Less invasive treatments do not provide satisfactory relief
How TKR works
During the one to two hour TKR procedure, your surgeon resurfaces the bones
involved in the knee - the tibia, femur and patella. Typical steps include:
Remove damaged cartilage from the bone surface
Shape the bone surfaces to receive the prosthetic components
Place the prosthetic components
Insert a spacer between the femur and tibia to help the parts glide smoothly
Preparing for TKR
For the best outcome with your joint replacement, you must know what to
expect before, during and after your surgery. Through our Joint Care Plus
program, you will be involved in every step of your treatment and recovery
from pre-operative teaching to post-operative care and exercise. Your
team includes physicians, physician assistants, care management, nurses,
and physical and occupational therapists specializing in total joint care.
Your care team’s goal is to keep you motivated for an optimal recovery.
They will encourage you to prepare, eat well and do your exercises so
you can quickly gain strength and mobility to become more independent.
Give yourself a leg-up in the process by learning and practicing the post-surgical
exercises in advance of your procedure.
Pre-admission
In addition to a scheduled 30-minute telephone nurse interview to review
your medical history and medications, you will schedule an appointment
with the Pre-Admission Testing (PAT) nurse practitioner. During this comprehensive
pre-surgical evaluation, typically 3-4 weeks before your surgery, the
nurse practitioner identifies your risks so a plan can be put in place
to prevent complications. The appointment takes approximately one hour
during which blood and urine samples may be taken, and you will have an
EKG. The nurse practitioner can also answer your specific questions about
the procedure or the preparations you need to make.
Preparing your home
Part of your pre-operative teaching includes how to prepare yourself and
your home for your post-operative care. We want you to be as independent
in your home as possible and reduce the risk of injuries due to falls.
If you live alone, you will want to make arrangements for a friend or
family member to stay with you for at least one week following your discharge
from the hospital. These steps will help you prepare your home:
Make sure light switches are accessible
Put away throw rugs or tack them down
Make sure stairways are well lit
Make sure handrails on the stairway are sturdy
Clear floors of clutter
Clearly mark raised thresholds
Clear loose cords from your floor
Program your phone with emergency numbers
Make sure furniture has good back and arm support
Create a lighted path from bedroom to bathroom
Keep a charged flashlight near your bed
Install safety and guard bars by your bath tub (if possible)
Place rubber mats in and in front of your bath tub
Use a wide sturdy step for high cabinets
What to Pack
You won’t need much during your approximately three-day hospital
recovery. Bring a positive attitude and the motivation to work hard along
with these items:
Loose fitting clothes (scrubs, sweats, tee shirts) that won’t rub
your incision
Closed shoes like sneakers (we provide floor gripping socks)
A list of your medications and dosages (do not bring any medications from home)
Talk to your doctor about which medications to take on the morning of your
procedure.
Following Surgery
Several hours after your surgery, you will be asked to sit up and dangle
your legs from the bed. You may also stand up and take a few assisted
steps. The first full day after your surgery will include individual therapy
as well as group physical therapy sessions where you will begin learning
to walk with your new joint. Our team will assure that you are using the
correct techniques so you are safe and will not hinder your recovery.
In fact, getting mobile is an important part of the process! We also carefully
monitor your pain and assure that it is under control so you can progress
through your rehabilitation.
Your discharge plan is completely customized. Based on your needs and your
surgeon’s preferences, we will arrange for a visit from a homecare
nurse. Arrangements will also be made for you to continue your physical
therapy three times a week for at least four weeks.
Individuals with many stairs in their home or who cannot arrange for a
caregiver to be with them for the first week, may need to recover at a
skilled nursing facility until they are able to be independent at home.
The key to optimizing your total knee replacement results is your commitment
to performing the exercises that build your strength and range of motion.
Our staff is dedicated to providing the motivation and support you need
to be successful.
After viewing the video,
click here to let us know you have completed Joint Care Plus Patient Education.
Please read the Joint Care Plus packet you received from your surgeon's
office for details on what to expect before, during, and after your hospital stay.
Total Hip Replacement
Total hip replacement (THR) is a surgical procedure to remove and replace
your damaged hip joint with an artificial joint (called a prosthesis).
The procedure may be performed if you fracture your hip or if you have
hip pain, swelling and stiffness that interferes with your ability to
perform daily activities and is not relieved by physical therapy, anti-inflammatory
medications or steroid injections.
According to the American Academy of Orthopaedic Surgeons, more than 285,
000 total hip replacement surgeries are performed each year.
Your Hip
The hip is one of your body’s largest joints. It is a ball and socket
joint meaning the ball-shaped femoral head, located at the top of the
thigh bone, fits inside a socket formed by the acetabulum, which is part
of the pelvis bone. The ends of the bones are coated with a thin layer
of cartilage where they touch to provide protection and help them move easily.
A thin tissue called the sinuvial membrane surrounds the hip joint to cushion
the bones and keep the cartilage lubricated to eliminate friction. A band
of ligaments holds the ball to the socket to keep the joint stable.
Causes of Hip Pain
When any of these parts fail to work in harmony, the result can be pain,
weakness or impaired function. The most common cause of hip pain is arthritis
including osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.
With arthritis, the protective layer of cartilage may peel away until
the bones grind against each other, causing acute pain. Other causes of
hip pain include avascular necrosis and childhood hip disease.
Signs That You May Be a Candidate for Hip Surgery
With severe arthritis, you may be unable to move or bend at the hip which
can severely limit your mobility and quality of life. After all other
treatments are exhausted, including medications, physical therapy and
assistive devices such as a walking cane, total hip replacement may be
considered. Hip replacement is also a treatment for some hip fractures,
hip deformities and infection.
There are no age or weight restrictions for THR surgery, but most candidates
are between the ages of 50-80. In addition to a complete medical evaluation
of your hip, diagnostic tests such as X-ray or MRI may be performed.
Most candidates have:
Hip pain that limits everyday activities such as walking or bending
Hip pain that continues with resting
Stiffness in the hip that limits the ability to move or lift the leg
No relief from other treatments such as medications, physical therapy and
assistive devices
How THR Works
During a THR procedure, your surgeon removes damaged bone and cartilage
and replaces it with prosthetic components. Typical steps include:
Remove damaged cartilage from the bone surface
Shape the bone surfaces to receive the prosthetic components
Place the prosthetic components
Insert a spacer between the new ball and socket to allow for a smooth gliding surface
Preparing for THR
For the best outcome with your joint replacement, you must know what to
expect before, during and after your surgery. Through our Joint Care Plus
program, you will be involved in every step of your treatment and recovery
from pre-operative teaching to post-operative care and exercise. Your
team includes physicians, physician assistants, care management, nurses,
and physical and occupational therapists specializing in total joint care.
Your care team’s goal is to keep you motivated for an optimal recovery.
They will encourage you to prepare, eat well and do your exercises so
you can quickly gain strength and mobility to become more independent.
Give yourself a leg-up in the process by learning and practicing the post-surgical
exercises in advance of your procedure.
Pre-admission
In addition to a scheduled 30-minute telephone nurse interview to review
your medical history and medications, you will schedule an appointment
with the Pre-Admission Testing (PAT) nurse practitioner. During this comprehensive
pre-surgical evaluation, typically 3-4 weeks before your surgery, the
nurse practitioner identifies your risks so a plan can be put in place
to prevent complications. The appointment takes approximately one hour
during which blood and urine samples may be taken, and you will have an
EKG. The nurse practitioner can also answer your specific questions about
the procedure or the preparations you need to make.
Preparing Your Home
Part of your pre-operative teaching includes how to prepare yourself and
your home for your post-operative care. We want you to be as independent
in your home as possible and reduce the risk of injuries due to falls.
If you live alone, you will want to make arrangements for a friend or
family member to stay with you for at least one week following your discharge
from the hospital. These steps will help you prepare your home:
Make sure light switches are accessible
Put away throw rugs or tack them down
Make sure stairways are well lit
Make sure handrails on the stairway are sturdy
Clear floors of clutter
Clearly mark raised thresholds
Clear loose cords from your floor
Program your phone with emergency numbers
Make sure furniture has good back and arm support
Create a lighted path from bedroom to bathroom
Keep a charged flashlight near your bed
Install safety and guard bars by your bath tub (if possible)
Place rubber mats in and in front of your bath tub
Use a wide sturdy step for high cabinets
What to Pack
You won’t need much during your approximately three-day hospital
recovery. Bring a positive attitude and the motivation to work hard along
with these items:
Loose fitting clothes (scrubs, sweats, tee shirts) that won’t rub
your incision
Closed shoes like sneakers (we provide floor gripping socks)
A list of your medications and dosages (do not bring any medications from home)
Talk to your doctor about which medications to take on the morning of your
procedure.
Following Surgery
Several hours after your surgery, you will be asked to sit up and dangle
your legs from the bed. You may also stand up and take a few assisted
steps. The first full day after your surgery will include individual therapy
as well as group physical therapy sessions where you will begin learning
to walk with your new joint. Our team will assure that you are using the
correct techniques so you are safe and will not hinder your recovery.
In fact, getting mobile is an important part of the process! We also carefully
monitor your pain and assure that it is under control so you can progress
through your rehabilitation.
Your discharge plan is completely customized. Based on your needs and your
surgeon’s preferences, we will arrange for a visit from a homecare
nurse. Arrangements will also be made for you to continue your physical
therapy three times a week for at least four weeks.
Individuals with many stairs in their home or who cannot arrange for a
caregiver to be with them for the first week, may need to recover at a
skilled nursing facility until they are able to be independent at home.
The key to optimizing your total hip replacement results is your commitment
to performing the exercises that build your strength and range of motion.
Our staff is dedicated to providing the motivation and support you need
to be successful.
Please view
this informative video prior to your surgery. After viewing the video, fill out the form to let
us know you have completed Joint Care Plus Patient Education.
Please read the Joint Care Plus packet you received from your surgeon's
office for details on what to expect before, during, and after your hospital
stay. If you would like another copy of the packet, please download them
here.
Anterior Approach To Hip Replacement
Some surgeons use an anterior approach when performing hip replacement
surgery. This less invasive alternative to traditional hip replacement
provides the same outcomes, but because the surgeon can access the hip
joint without cutting through major muscle groups, which can take up to
6 months to heal, you are likely to experience less pain and be less restricted
with your movement during recovery. You can typically get back to your
normal routine more quickly following this type of procedure.
About the Procedure
All of the preparatory steps for surgery are the same with the anterior
approach. The major difference is during the procedure itself. You lay
on your back on a specially designed operating table that enables the
surgeon to access your hip joint through a 4 to 6 inch incision in the
front of your hip rather than the side or the back. Your surgeon can follow
a natural pathway between muscles and tendons to remove and replace your
damaged joint.
Recovery
Recovery is similar to that with a traditional hip replacement. Physical
and occupational therapy will still be an important part of your recovery
as you work to gain strength and range of motion. Because the muscles
around your hip joint remain intact, you will have reduced risk of dislocation
of the new ball from its socket during the first months of recovery.
Risks
Because of the pressure placed on your femur during the procedure, the
anterior approach is not recommended if you have osteoporosis. Your surgeon
will recommend the best approach based on your risks and needs.
Source: American Association of Orthopedic Surgeons
Joint Revision Surgery
Prosthetic joints are more durable and function better because of advancing
surgical techniques and improvements to their design and composition.
With typical wear and tear your artificial joint may need to be replaced
in ten to twenty years through a highly specialized procedure called revision
surgery. In just ten percent of total hip and total knee surgeries, replacement
components fail prematurely due to infection, loosening or dislocation
and must also be replaced through revision surgery.
Indications that you may need joint revision include:
Pain
Swelling
A limp
Stiffness
Instability
You may also experience a decline in the function of your joint. A physical
exam or X-ray can evaluate the position and condition of your prosthesis.
Your surgeon will determine if revision surgery is the best option for
you. Non-surgical treatments include pain medication, use of assistive
devices such as a cane or walker, and limiting activities.
Revision Surgery
Success rates for revision surgery are greater than 90 percent according
to the American Association of Orthopaedic Surgeons. Key to success is
proper planning and understanding of the patient’s condition including
existing bone quality, ability to reconstruct existing bone and soft tissue
structures and the ability to affix the new components to the bone.
It is likely that your surgeon will make a more extensive incision for
revision surgery. The surgeon carefully removes the replacement components
and prepares your bones and ligaments to receive the new prosthetic joint
by removing any abnormal bone or scar tissue. The hip or knee bones are
carefully reconstructed before the new implant is inserted and adhered.
Following Surgery
Rehabilitation is similar to what you experienced during your initial joint
replacement. Special care is taken to protect against infection or damage
to the replacement joint. Physical therapy can begin within 24 hours of
your procedure, but your activities may be restricted for 6 to 12 weeks
depending on your recovery.
Source: American Association of Orthopedic Surgeons
