3 “It would be embarrassing to get out of a car because everybody had to help me. Somebody would have to pull me up. I felt like this old woman.”“My life got progressively less active, less fun, and less participative.”“Just a day on my feet was exhausting and the pain became greater and greater until Advil and ibuprofen and all of those kinds of drugs couldn't numb it out. It just got worse and worse.”New slide with quotes pulled from patient testimonials
4 You’re Not Alone…More than 43 million people have some form of arthritis.It is estimated that the number of people affected by arthritis will increase to 60 million by 2020.Source: CDC
5 This program will touch upon the following topics: Understanding the Causes of Joint PainTreatment OptionsWhat Joint Replacement Surgery InvolvesRealistic Expectations After Joint Replacement
6 Did you know?Nearly 21 million Americans suffer from osteoarthritis, a degenerative joint disease that is a leading cause of joint replacement surgery.Add a new slide with images of daily tasks – stairs, gardening, getting out a car, etc.Source:
7 Most Common Types of Arthritis OsteoarthritisRheumatoid ArthritisPost-traumatic ArthritisAvascular Necrosis
8 OA Symptoms May develop suddenly or very slowly Arthritis can cause pain and stiffnessSome types of arthritis may cause swellingSimple tasks may be difficult to do
9 Other Conditions Rheumatoid Arthritis Post-traumatic Arthritis Membranes or tissues lining the joint become inflamedPost-traumatic ArthritisIrregularities lead to more wear on the jointAvascular NecrosisBone may collapse and damage cartilageAdd images?
10 Rheumatoid Arthritis One of the most crippling form of arthritis: affects approximately 2.1 million Americanstwo to three times more women than menaverage onset for rheumatoid arthritis is between the ages of 20 and 45 years oldSource: CDC
11 Joint Degeneration Pain from arthritis and joint degeneration can: Be constant or come and goOccur with movement or after a period of restBe located in one spot or in many parts of the bodyBe worse during certain times of the day or during certain activities
12 Joint Degeneration Interference With Daily Activities… NEW IMAGES – Daily Tasks photos?
17 Preparing for your Doctor’s Visit The Orthopaedic EvaluationA thorough medical historyA physical examinationX-raysAdditional tests, as needed
18 The Orthopaedic Evaluation: What YOU should bring… A list of all medications / dosages you are currently takingInformation on prior surgeries and/or treatments (medication, PT, injections)Copies of X-rays, MRI or reportsPrior diagnosesFamily history
19 The Orthopaedic Evaluation The physical examination enables your surgeon to evaluate important aspects of your joints, including:Size and lengthStrengthRange of motionSwellingReflexesSkin condition
20 The Orthopaedic Evaluation X-ray Evaluation An abnormal X-ray may reveal:Narrowing of the joint spaceCysts in the boneSpurs on the edge of the boneAreas of bony thickening called sclerosisDeformity or incorrect alignment
26 Bracing and Assistive Devices A cane in the opposite hand decreases joint forces by 50% !“Unloader” braces can take pressure off the painful side of the knee and stabilize the joint
27 Physical Therapy Passive range-of-motion exercises may help: Reduce stiffnessKeep joints flexible4-5 times bodyweight through knee climbing stairs!Quadriceps strengtheningTransition from high to low-impact exercisesCycling, elliptical, swimmingAvoid deep knee bends against resistance
28 What is Arthroscopy?Arthroscopy is a surgical procedure used to visualize, diagnose and treat problems inside a joint.A small incision is made in the patient's skin and then pencil-sized instruments are inserted that contain a small lens and lighting system to magnify and illuminate the structures inside the joint.
29 Partial Joint Replacement Surgical procedure in which only the damaged or diseased surfaces of the joint are replaced, leaving much of the natural bone and soft tissue in place.Post-operative pain may be reducedRecovery period may be shorter than total knee replacement
30 Total Joint Replacement Surgical procedure in which certain parts of an arthritic or damaged joint are removed and replaced with an artificial joint.The artificial joint is designed to move just like a healthy joint.
31 Joint Replacement Joint replacement is a treatment option when pain: Is severeInterferes with daily activitiesInterferes with work
32 Joint ReplacementJoint replacement is a decision that should include:YouYour primary care providerYour orthopaedic surgeon
33 Did you know?Total joint replacements of the hip and knee have been performed since the 1960s.Today, these procedures have been found to result in significant restoration of function and reduction of pain in 90% to 95% of patients.New slide – add in more stats or key points to sides. Make it more visualSource: National Development Conference, National Institutes of Health, December 2003
34 Joint Surgery May be suitable for patients who: Have a painful, disabling joint disease of the joint resulting from a severe form of arthritisAre not likely to achieve satisfactory results from less invasive procedures, medication, physical therapy, or joint fluid supplementsHave bone stock that is of poor quality or inadequate or other reconstructive techniques
35 Joint Replacement: Preoperative Preparing begins weeks before the actual day of surgery!In general, patients may need:Routine blood testsUrinalysisPhysical examinationExerciseQuit smokingStop certain medicationsClassroom preparation
36 Total Joint Replacement Goals of total joint replacement are to help:Relieve painRestore motion and function
37 Prevalence…More than 300,000 knee replacements are performed each year in the US.1More than 300,000 hip replacements are performed in the United States each year.2New Slide
38 Total Joint replacement – Where? And Who? These are my personal recommendations…Somewhere with a comprehensive programAdequate resources for patient’s post-op careA surgeon the patient is comfortable withAn “experienced” surgeon
39 Your Hip JointThe hip must bear the full force of your weight and consists of two main parts:A ball (femoral head) at the top of your thigh bone (femur)A rounded socket (acetabulum) in your pelvis
40 How’s this for an endorsement? “The Operation of the Century:Total Hip Replacement”The Lancet, October 2007
43 Your Knee Joint Femur – thigh bone Cartilage – tissue between bones that provides cushioningPatella – knee capTibia – shin boneSynovium – tissue surrounding the joint that provides lubricating fluidLigament – flexible tissue that holds knee joint together
44 What Causes Knee Joint Pain? One of the most common causes of joint pain is arthritis. The most common types of arthritis are:Osteoarthritis (OA)Rheumatoid Arthritis (RA)Post-traumatic Arthritis
45 Total Knee Replacement End surface of femur replaced with metalEnd surface of tibia replaced with metalPlastic liner is inserted between femur and tibiaPatella is resurfaced with plastic
47 Knee Replacement: Total versus Unicompartmental Majority of patients predominantly affected in one compartment onlyRelatively easier recoveryLess surgeryMaintain cruciate ligaments“feels more natural”Does not preclude TKA laterMost do not need to be converted
48 Computer NavigationNo benefit in skilled hands for the average patientMay help surgeon who do less joint replacements, but need to know when not to trust it…Definitely helpful in outliers:Significant deformity or malalignmentOld hardwareTotal knee replacement is primarily a Soft Tissue Procedure.
51 RecoveryEvery individual is different and every treatment plan is different.“You’ll be mad at me for two weeks”Estimated Recovery Schedule:In-hospital: 2 – 5 daysSignificant Functional Improvement: 2 wks – 3 mosMaximal Improvement: 6 – 12 months
52 Recovery Directed exercise program The physical therapist or another member of the staff works with you to help you:Regain muscle strengthIncrease range of motionStart with home PT and progress to outpatient therapy
53 General Guidelines to get back to your Routine You'll practice stair-climbing in the hospital and should be able to do this by the time you leaveYou should have no restrictions on leaving your home as long as your safety and comfort are assured. A good balance of exercise, rest, and relaxation is best for helping your body heal and gain strengthWhen to resume driving a car, going to work, and/or participating in sports activities are all highly individualized decisions.
54 Limitations After Surgery Athletic activities that place excessive stress on the joint replacement should be avoided.Examples include:Difficult Skiing (snow or water)Contact sportsRegular runningFrequent jumpingPatients don’t listen to me…
55 “Doc, how long will it last?” Impossible to predict for an individual.Many factors determine the outcome including:AgeWeightActivity levelBone strengthMaterials are getting better all the time – many joints replaced today will last a lifetime.
56 Expert care in joint replacement when You need it. “I look forward to personally helping patients get back to the active lifestyle they deserve!”A Virginia native with fellowship training in Joint Replacement, Dr. Harris specializes in the latest advances in Adult Reconstruction, including minimally invasive and computer-assisted procedures.Barton Harris, MDOrthopaedic SurgeonFellowship-Trained inHip and Knee ReplacementMinimally Invasive and Tissue-sparing techniquesDirect Anterior Hip ReplacementPartial Knee ReplacementCustom Total Joint ReplacementRevision Total Joint ReplacementExpert care injoint replacementwhen You need it.ext 3024