New techniques shorten recovery time in hip, knee replacements

2013-09-06T14:00:00Z 2013-09-06T14:59:07Z New techniques shorten recovery time in hip, knee replacementsChristine Bryant nwitimes.com
September 06, 2013 2:00 pm  • 

It wasn't too long ago that patients who underwent a hip replacement or knee surgery spent nearly a week in the hospital and months in rehab.

Today, more patients find themselves at home just days after surgery and back at work within weeks.

Dr. Ram Aribindi, an orthopedic surgeon with Southland Orthopedics, says one of the largest innovations in the medical field of reconstruction is the shortened recovery time many patients are experiencing.

"In the old days, people thought they would have to take it easy, but that actually delays the rehab process," said Aribindi, who performs surgeries at Advocate South Suburban Hospital. "It turns out they end up having more pain."

While surgeries have become less invasive, Aribindi said a number of factors have played into hip and knee replacement becoming a more comfortable surgery for patients.

Better pain management, advances in rehabilitation and changes in anesthesia procedures have all played a role, he said.

"The vast majority of patients after knee and hip surgery are going home the next day or the following day, versus three to five days post op," Aribindi said.

The anterior approach

Dr. David Musgrave, an orthopedic surgeon with Lakeshore Bone and Joint Institute, said a particular type of hip replacement is gaining popularity because it can be performed as an outpatient procedure.

The anterior approach for hip replacement surgery allows doctors to spare the patient's muscle tissues around the hip - providing less pain, faster recovery and improved mobility.

"What that means is we don't incise muscle," he said. "We simply separate them and move them out of the way."

Musgrave, who performs surgeries at Porter Regional Hospital, said what used to be three to four months of rehab for a patient who undergoes traditional hip replacement surgery is now just three weeks for someone whose doctor uses the anterior approach.

During the approach, the surgeon cuts one small incision on the front - or anterior - of the hip, rather than the side or back. The hip is exposed in a way where surgeons do not have to detach muscles or tendons from the bone.

Studies have show this approach also may help prevent dislocations down the road because muscles are kept intact, Musgrave said.

Liner advancements

Those who experience traditional hip implants as well are more likely to avoid the need for follow-up surgeries for several decades, Aribindi said.

Hip implants typically have a plastic liner located between the cup of the implant - in the pelvis or socket side - and the metal ball. The liner serves as the cushion between the metal cup and metal ball - allowing painless motion of the joint when walking.

Recent advancements have improved the sustainability of the liner - allowing patients to go longer without replacing it.

"There is data that shows the newer plastic liner that we're using now is lasting longer," Aribindi said. "The liner has undergone so many changes, so now you can get a 25- to 30-year hip."

Zeroing in on the knee

Patients who require knee replacement surgery also have seen a change in technique - allowing them to keep ligaments intact.

The goal of knee replacement surgery is to restore function of the knee. Usually, those who undergo knee surgery have either experienced an injury or have suffered from wear and tear, such as from arthritis.

Rather than reconstructing the entire knee, orthopedic surgeons now look at the possibility of reconstructing just the side of the knee that is diseased, Musgrave said.

"If you just replace part of the knee, all of the ligaments remain intact, and it therefore functions more like a normal knee," he said.

Called unicompartmental knee replacement, the procedure allows doctors to perform surgery if damage is confined to a single compartment of the knee. Only the damaged part is replaced with metal and plastic, and surgery can be performed while leaving healthy cartilage and the rest of the knee alone.

"All of their ligaments would still need to be intact for unicompartmental knee replacement," Musgrave said.

Total knee replacement procedures usually warrant a three- to four-month rehabilitation. Patients who undergo unicompartmental often finish rehab in just four to six weeks, he said.

The procedure also offers less pain after surgery and less blood loss, he said.

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