Pink Prescriptions - April 2020

Feeling Out of Joint? What You Should Know About Knee & Hip Replacements


April 2020 Issue - Pink Prescriptions
Feeling Out of Joint? What You Should Know About Knee & Hip Replacements

Sure, most of us look for that parking space closest to the entry of our favorite store or restaurant, even though we can walk perfectly fine and without pain. It’s an interesting behavior, which seems to point to a conclusion that walking is something people want to minimize, that is until their ability to walk is threatened by pain, injury or degeneration. Then we wish we would have walked more when we could and valued our independent, pain-free mobility. The good news is total joint replacement of the hips or knees can give people a second chance for leading an active and possibly pain-free life. According to the American Academy of Orthopaedic Surgeons, total joint replacement is one of the most commonly performed, elective surgical procedures in the United States. This procedure traditionally has been performed on older people, requiring long recovery times, often accompanied by a lot of pain. Now, there are almost 7-million Americans with either knee or hip replacements, and the majority of them now live their lives free again doing things they love to do. Some of them even park far away on purpose so they can walk…just because they can!

PinkRx0420 Sardana
Vandit Sardana, MD, FRCSC—
Beaufort Memorial Hospital

How do you know when you need a knee, shoulder or hip replacement?
When a patient comes in complaining of joint pain, it’s often caused by osteoarthritis, a condition that occurs when the protective cartilage cushioning at the ends of your bones wear down over time.

The pain can be so severe, it can:  1) Keep you from activities like gardening, playing golf, or even walking. 2) Wake you up at night, depriving you of quality sleep. 3) Cause you to limp. Left untreated, it can affect your gait, which will extend your post-operative recovery.

The first course of treatment I recommend is physical therapy, along with a topical anti-inflammatory gel and cortisone injection. If the patient is still experiencing pain after three months, it may be time to consider joint replacement surgery.

While most people who have a joint replacement are over 60, it can also be an appropriate option for younger patients who have severe degeneration of the joint they can no longer perform daily activities.

What’s new in joint health?
Robotic technology is the latest advancement for total knee replacements. The Mako Robotic Arm-Assisted Surgery System helps ensure the surgeon removes only diseased bone, reducing trauma to the surrounding soft tissue.

More importantly, we’re able to balance the artificial joint with greater accuracy. The robot’s software provides objective feedback as we move the knee through a range of motion, allowing us to tweak the placement of the joint until it’s perfectly balanced for the patient’s unique anatomy. A properly balanced knee will function more naturally and last longer, just as a well-aligned car will have longer-lasting tires.  

For hip replacement, we’re now using an anterior approach, which means we’re performing the surgery from the front of the hip. By using this technique, we avoid cutting muscle, speeding the patient’s recovery. Rather than having to wait six weeks to begin physical therapy, the patient can begin the rehabilitative process immediately.

In addition, there’s a lower risk of dislocating the new prosthesis since the muscles used to support the hip joint remain strong. With this approach, there are no restrictive precautions that are required with traditional hip surgery. We are seeing people resume activities like pickleball and golf within three to four weeks following surgery, which is remarkable compared to the three months or more needed with traditional surgery.

A board-certified orthopaedic surgeon with Beaufort Memorial Orthopaedic Specialists, Dr. Vandit Sardana is fellowship trained in both hip and knee replacement. He sees patients in both Beaufort and Bluffton and can be reached at (843) 524-3015.

PinkRx0420 JohnsonHilton Head Regional Healthcare - Kirk H. Johnson, M.D.

Why are hip injuries so detrimental
to the elderly?

The mortality rate for hip fractures in the not too distant past was 50 percent! Unlike elective total hip replacements, hip fractures are unplanned. People who experience this are usually female with osteoporosis, transported by ambulance, followed by surgery...all very stressful with unavoidable confusion for the patients. Today, when this happens, we try to help people by performing surgery right away, getting them up and out of bed as soon as possible, minimizing narcotics and more. Unfortunately, in spite of all of these efforts, hip fracture patients often lose one level of ambulatory capacity. For instance, an independent community ambulator will now be a household ambulator, needing help to get out and about.

Hip replacements, on the other hand, are planned with proper arrangements set and education provided in advance. There is no “emergency” confusion. The experience and outcome for the patient is much different. Last year, I treated a delightful lady at 102 years old! When we first met, she was 96 years old and said, “I’m too old. I’m going to die soon.” Her story was the same at 98 years old. Finally, at 102, she proclaimed, “I’m not dead!” She had an elective hip replacement and went home the following day. With the help of home-based physical therapy, she returned to complete independence.

Is age the biggest factor in joint deterioration?
The primary determinant of joint deterioration is genetics, not age. We cannot pick our parents! Many families have a predictable pattern of osteoarthritis, sometimes with an onset as early as 40 years of age. Others can get into their 90s with very little osteoarthritis. Lifestyle choices such as inactivity, obesity and smoking can  also contribute to the development of osteoarthritis.

Kirk H. Johnson, MD is a board-certified and fellowship-trained orthopedic surgeon specializing in total joint replacement. He comes to the Lowcountry after 30 years as an associate professor of orthopedic surgery. Orthopedic Associates of the Lowcountry, 843-682-7480.

PinkRx0420 BurkeDavid Burke, RPh - Burke’s Main Street Pharmacy

Do CBD products or glucosamine help delay joint surgery or reduce pain?
For those who may suffer from severe joint pain, stiffness, limping, muscle weakness, limited motion and swelling joint replacement surgery may be necessary. Most physicians will attempt to avoid surgery by first having patients try physical therapy and medications.

Glucosamine is a supplement that may ease joint pain and inflammation. It has not been proven to rebuild cartilage, but it may reduce the collagen breakdown, which in turn reduces the inflammation and pain.

After joint replacement surgery the pain level can still be severe during the recovery period. Opioids can be prescribed to alleviate pain, but these drugs should not be used more than 15 days.  CBD has been proven to be an effective alternative to provide pain relief and reduce inflammation after joint replacement surgery.  CBD can enter the patient’s skin right at the source of the pain to provide quicker relief.   

David Burke, RPh is a registered pharmacist and partner of Burke’s Main Street Pharmacy, Chairman of the HH Hospital Board of Governors and a member of the Cardinal Health National Advisory Board. Located at 1101 Main Street, HiHI; 843-681-2622.

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