Hip or knee pain can impact daily functionality. Dr. Seth Greenky, SOS orthopedic surgeon, discusses when to consider joint replacement.
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Bill Klaproth (Host): Hip joint pain and knee pain may be the result of many unique circumstances for each patient, such as arthritis, injury, inflammation, aging and more. So, how do you know if it’s time to consider total joint replacement? Well let’s find out with Dr. Seth Greenky, a Board-Certified Orthopedic Surgeon and the Medical Director for the Orthopedic Service Line at St. Joseph’s Health as well as the Section Chair for Orthopedics. He is also fellowship trained in total joint replacement of the hip and knee. Dr. Greenky, thank you for your time. So, how do you know if it’s time to consider a joint replacement?
Seth Greenky, MD (Guest): Well joint replacement is sort of the end game for joints specifically the knee and the hip that are worn out for a multitude of reasons, be it a previous injury or osteoarthritis or rheumatoid arthritis. And the joint replacement, the surgery is sort of the last thing. That means you’ve already tried other modalities like medicines and perhaps injections in the joint or physical therapy and modification of activity and weightloss. So, everything else has been tried, it hasn’t worked and it’s very much of a disabling, painful condition.
Host: So, this is the last resort. All the other noninvasive measures have been tried and for whatever reason, hasn’t worked or the joint is too damaged; then it’s time for joint replacement.
Dr. Greenky: Correct.
Host: So, then what are the benefits of total joint replacement surgery?
Dr. Greenky: Well I think that we’re in a society now that values activity and I think people want to remain mobile. And so, what happens with arthritic joints is you become stiff and painful and the desire to exercise or walk or be outside doing things becomes extremely limited. And the joint replacement allows you to return to a more regular functional life and enjoy life. It’s a quality of life issue.
Host: Got it. So, is anyone a good candidate for joint replacement surgery?
Dr. Greenky: Joint replacement surgery is once you do it, you can’t go back. So, it’s removing or modifying your own joint. So, it’s most appropriate for people that get above a certain age, although we do it on younger and younger people. You wouldn’t do it on a child unless they had a condition like a tumor or a cancer that you had to deal with. So, it’s the end game and it’s middle aged to older people primarily but not exclusively.
Host: Got it and then how long does a new joint usually last then?
Dr. Greenky: Well the joint longevity depends on a lot of issues as you can imagine, not the least of which is the person’s weight, their height, their activity level. So, an elderly person who is relatively small, it’s going to last forever. In a young linebacker for the Green Bay Packers is going to wear out a little bit sooner. But the years that we put on it generally is 20 plus.
Host: 20 plus. Okay. That’s really good to know. So, then let’s shift focus just a little bit and talk about some alternatives to joint replacement surgeries such as injections and physical therapy. Can you talk about that?
Dr. Greenky: Absolutely. So, someone comes in with a joint complaint and they have a degree of arthritis; the different modalities that we go through usually starting from the simplest and working up to the more complex is physical therapy which just means exercising and doing things to strengthen the muscles around the joint, different types of medicine, most commonly anti-inflammatories and that would be Aleve and Motrin and ibuprofen type medicines. And then we move on to injections which consist of cortisone. There are different lubricants you can put in and more recently, stem cells have become a very hot topic. And then lastly when nothing else has been successful, you move to surgery.
Host: Got it. So, you kind of walk up the ladder with the least invasive to then at the end total joint replacement.
Dr. Greenky: Correct.
Host: So, can you also talk about advances in this type of treatment for hips and knees? I know which lead to decreased hospital stays and recovery time. Can you talk about the advances in medicine overall?
Dr. Greenky: Sure. So, the actual advances in design of joint replacements has been relatively dramatic. There’s new materials that we’re using that have much better longevity and so that is a major thing. And then, how we control pain has become a big topic. So, pain used to be one of the big things with joint replacements and now that we’ve learned how to control the pain better; it’s not such a deterrent to people. In terms of how long you need to be in the hospital, when I first started, people were in the hospital for a week. Then it became four days. Then it became two days and now we’re frequently doing joint replacement as an outpatient meaning that they come in the morning of surgery and they go to their own home that same day.
Host: That is amazing. So, that leads me right to my next question then. If you could maybe tell us what should someone expect before and then after joint replacement surgery?
Dr. Greenky: Well we try – before joint replacement surgery, first we sort of assess their medical condition and make sure that they are appropriate candidates from that viewpoint. And then we go through a very – pretty extensive educational process, what to expect, what we expect of them, therapy afterwards, et cetera. And then by the time they are going to actually have the joint replacement, they are fairly educated on what to expect; they have the joint replacement and they still got to work. It’s still an effort and engagement by the patient to make it successful.
Host: Right. So, you’ve got to do that follow up work. And then last question can people in general, return to normal activity if they were active, if they were a tennis player per se; will they be able to return to that again?
Dr. Greenky: I think people do this to return to a level of activity and we try to educate them as to what they can expect. For example, you are not going to be a marathon runner again. Okay, you’re not going to probably be a soccer player. However, you can play doubles tennis, racquetball, you can go on strenuous hikes, you can swim, you can bicycle. There’s pretty much nothing you can’t do other than super high end pounding impact loading type activities.
Host: Well I know that’s good news for a lot of people. Dr. Greenky, thank you so much for your time today.
Dr. Greenky: Thank you.