Joint Replacement Surgery: Getting the Timing Right
Mark Adshead Managing Director of Physio2go Ltd. St. Albans joins Mr. Neil Davies Consultant Orthopaedic Surgeon of St. Albans City Hospital and Spire Hospital Harpenden exploring factors which may impact on the decision as to when surgery is advisable.
Many of us may remember smiling when Terry Wogan defined a TOG (Terry’s old geezer) as someone who bends down to tie his shoes and wonders what else he could do while he is down there. This picture, however, may not be far from the truth when you think of that first early morning stretch following your last tennis match or golf day!
Osteoarthritis, which is sometimes referred to as degenerative or “wear-and-tear” arthritis is the most common type of arthritis. This differs from the extensive joint damage of rheumatoid arthritis, which occurs as a result of the body’s own immune system attacking joints and surrounding tissues. Osteoarthritis can result from repeated over-use of a joint in specific sports; it can be related to an old bone injury resulting from a fall or road traffic accident. The bone ends of a normal joint are covered with cartilage and enclosed by a fibrous tissue envelope or sac which produces a lubricant to prevent friction and subsequent wear and tear of that joint. The stiffness, pain, lack of mobility and subsequent muscle weakness of the affected area are due to the wearing down of the joint protecting cartilage and the surrounding tissue. Any joint can be affected, but the weight bearing joints of the hips and knees are often the most painful and debilitating.
How is joint damage treated?
The treatment of osteoarthritis is aimed at managing the pain through the use of analgesics and non-steroidal anti-inflammatory drugs. Steroid injections into the inflamed joint are often an option for an acute exacerbation of symptoms. Physiotherapy to maintain joint mobility, healthy diet and weight loss if advisable may all help to alleviate symptoms.
What is joint replacement surgery?
When the above-mentioned treatments no longer control pain, and the loss of mobility interferes with your daily activities, you may be a candidate for joint replacement surgery. Over 80,000 total hip replacements, 84,000 knee replacements, and over 5,000 shoulder replacements were carried out in England and Wales in 2011 (Ref: National Joint Registry).
A total joint replacement is the removal of a damaged or diseased joint, such as the knee, hip or shoulder, replacing it with an artificial joint or prosthesis. When the entire joint is replaced, such as the knee, the term used is a total knee arthroplasty. If only part of the joint is replaced, the term is a partial arthroplasty. In a total knee arthroplasty for instance, the patient is given an anaesthetic, the surgeon removes the damaged ends of bone and cartilage, and replaces these with metal and plastic surfaces shaped to restore knee movement and function. There are a number of different surgical techniques now being offered to patients in the UK, including mini-incision surgery (MIS) for knee replacement patients, and a minimally invasive “2-incision technique” for a total hip replacement.
The most appropriate of the available procedures will be discussed with you when you meet with your orthopaedic surgeon. Surgeons, specialist nurses and physiotherapists will be able to discuss specifics of any planned surgery, what you can expect during your hospitalisation and any issues of particular importance to your individual case.
Could earlier surgery be a better option?
The typical patient for joint replacement surgery is evolving. Historically, joint replacement surgery was perceived as the last resort, with patients being advised “to wait as long as possible before undergoing surgery.” The rationale being that the artificial joints would not have to be replaced. There have been many changes in patient expectation, surgical technique and artificial joints that have challenged this. Mr. Neil Davies, Consultant Orthopaedic Surgeon practicing at St. Albans City Hospital and Spire Hospital Harpenden adds…
“There is significant evidence to suggest it is far better to undergo surgery before one has lost a significant amount of mobility, muscle function and bone stock. Advances in the design and materials used in the latest generation hip and knee prostheses support an earlier surgical intervention in the patient’s disease process.
“They also have an improved range of movement, and stability so as to allow the patients to return to participation in sports and activities that would have been unheard of 10 years ago. The aim of joint replacement surgery is to preserve the quality of professional, domestic and sporting life enjoyed by the patient.”
Optimising your recovery: an expanding role for physiotherapy
Be prepared! – The benefit of being able to plan for your surgery is that you can be in the best possible condition in preparation for the anaesthetic, the surgery, and the post operative exercise regime. Pre-operative advice on the benefits of quitting smoking and weight reduction, if necessary, should be taken seriously. When you have surgery on a hip, knee or shoulder, you will rely heavily on your good side when you begin to mobilise; you will therefore benefit from some instruction and demonstration aimed at pre-operative strength training of those muscles. My experience also points to the benefits of being oriented to your post-operative exercise plan and equipment before your surgery, at a time when you will undoubtedly prove to be a faster learner!
You will be returning home following your surgery; be sure to get advice on how to prepare that environment to ensure your safety when you are least mobile. Things like safety rails in showers may in some cases be necessary; the removal of loose rugs that can trip you up if you are using a walking aid for a few weeks can prevent unnecessary challenges to your recovery.
The good news/bad news of the shorter hospital stay!
Anyone that has been a patient or has visited friends or relatives in hospital knows how much discharge home is anticipated. Frequent horror stories in the Press of hospital acquired infection also lead one to believe that the shorter the hospital stay the better!
Undoubtedly, more experience with the joint replacement procedures and their post-operative management, coupled with less invasive surgical techniques has led to shorter hospital stays. In-hospital stay for elective (planned) joint replacement continues to decrease in the private sector and NHS hospitals. A shorter hospital stay however limits the number of physiotherapy sessions you can receive as an in-patient following your surgery, and you may leave hospital with limited mobility of the affected joint. The first 2-3 weeks after surgery, when you would most benefit from active rehabilitation and physiotherapy is often the time when you are least mobile and unable to drive. Once you are discharged home you may also feel unsure as to the expected timelines of your recovery. Home-based physiotherapy is now an option you may wish to consider. In addition to our extended clinic hours, Physio2go offers a home-based physiotherapy service. Our specialist physiotherapists offer advice and treatment to patients before and after surgery.
Shorter hospital stays are a fact of life, and with the appropriate follow-up are undoubtedly the right way ahead. Three-way communication between the surgeon, the patient, and the physiotherapist is of prime importance to the overall success of your operation. Be an active participant in your recovery!
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