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Why hip and knee replacements are on the rise

May 04, 2017 | David So, MD
man having his knee examined by orthopedic surgeon

Bad hips? Achy knees? You’re not alone. These common problems may be related to aging, injuries and, increasingly for many Americans, obesity.

The potential solutions — total hip or knee replacements — are growing in popularity by leaps and bounds, the very actions that are impossible with bad hips and legs.

As a surgeon on the UC Irvine Health hip and knee orthopaedic team, I can state with confidence that hip and knee replacements today are highly reliable. An overwhelming percentage of patients who elect to get replacement hips or knees enjoy significant pain relief and improved joint function not long after surgery.

More hip and knee replacements than ever

This high patient satisfaction is encouraging more people than ever to elect to have these procedures. It is estimated that by 2030, the number of total knee replacements performed in the US will increase by more than 600 percent compared to 2005, while total hip replacements are expected to increase by almost 200 percent over the same time period.

In addition to word of mouth, other factors for this increase include the facts that baby boomers are now senior citizens, our life expectancy keeps increasing and the obesity epidemic means we’re putting more wear and tear on these weight-bearing joints.

Nonoperative treatments come first

If you are suffering from knee or hip osteoarthritis, keep in mind that UC Irvine Health doctors always try nonoperative treatments first. It’s only if these fail do we consider surgery in order to improve your quality of life.

Hips and knees are weight-bearing joints, so weight loss is often a recommended first approach. This can be difficult when your mobility is limited by arthritic joints and it hurts to exercise, so proper diet may be emphasized along with a low-impact exercise program. How to lose weight for good ›

I typically suggest swimming, cycling or use of an elliptical machine. Other options include anti-inflammatory medications such as Advil or Aleve, bracing, intra-articular injections, physical therapy or a walking aid.

Hip and knee surgical expectations

Should you decide joint replacement is your best option, you will be asked to attend one of our joint replacement classes to help you prepare for surgery. At the class you will meet with our nurse practitioner and physical therapists for details about your procedure, your hospital stay and the pre- and post-operative instructions.

The surgery itself typically takes two to three hours. Hip surgery replaces your damaged joint with a ceramic ball and plastic liner; knee surgery essentially resurfaces the joint with metal and plastic.  

Our goal is to have you up and walking a few hours after your operation. During your hospital stay, you will work with physical occupational therapists twice a day. Our skilled team of therapists will help you learn how to get about and walk on your new joint, emphasize the home exercise program and even show you tips and tricks you will need once you are back home.

As for your arthritic pain, it gets traded for surgical pain. Fortunately, the surgical pain typically resolves after a few weeks.

How we control your pain

Among the latest advancement in joint replacement is multimodal pain control. Traditionally, patients were given only narcotic pain medications, but those have potential side effects such as altered mental state, reduced bowel function, decreased respiratory rate and sometimes more serious issues.

Now, we offer a better mix of medications including anti-inflammatories, nerve pain medication and Tylenol. These medications are started before surgery in order to more quickly achieve a therapeutic level.

Regional anesthesia is also used more commonly. Our anesthesia partners inject numbing medication around nerves going to the knee, providing eight to 12 hours of pain relief immediately after surgery. Additionally, local anesthetic is applied by the surgeon at the time of surgery to exposed soft tissues for even greater pain control. How we control pain with a pleasant tingling sensation ›

All of these advancements have resulted in improved patient comfort and in hospital stays that are now two or three days instead of four to five days, which used to be commonplace.

Recovering from surgery at home

With the home exercise regimen taught before and during hospitalization, most patients regain strength, function and range of motion without having to go to outpatient physical therapy. Patients often get to 80 percent strength within two to three months, though up to a year may be required for total recovery.

Replacement joints typically last about 15 to 20 years for both hips and knees before any sort of revision surgery may be needed.

Of course, there is always a risk your joint replacement may fail sooner than that. This can be due to infections, loosening of the components or joint instability.

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