What Patients Should Know About Joint Replacement Surgery

Joint replacement may be considered only after other treatment options have failed to provide adequate relief from pain and/or disability. Dr. Linda Suleiman discusses signs that it might be time for someone to consider a joint replacement and what to expect from this type of surgery.
What Patients Should Know About Joint Replacement Surgery
Linda Suleiman, MD
Linda Suleiman, MD is the the first African-American orthopaedic surgeon at Northwestern Memorial Hospital. She specializes in hip and knee reconstruction, an area considered to be the most male-dominated subspecialty of orthopaedics. Her research addresses the lack of women in orthopaedic surgery. She is the director of diversity and inclusion at the McGaw Medical Center of Northwestern University. She is also a health policy fellow of the American Association of Hip and Knee Surgeons, which is actively working to recruit more women to the field through early exposure of medical students and residents. She attended medical school at Howard University and an orthopaedic surgery residency at Northwestern Medicine. She also completed a fellowship in Adult Hip and Knee Reconstruction and Replacement at Rush University Medical Center.

Learn more about Linda Suleiman, MD

Melanie Cole (Host): If you’ve suffered from knee or hip pain you know how debilitating it can be and it can keep you from taking part in the activities that you enjoy, but when this type of pain begins to really interfere with your daily life, it might be time to see a physician to assess the situation to see what can be done about it. My guest today, is Dr. Linda Suleiman. She’s an orthopedic surgeon at Northwestern Memorial Hospital. Dr. Suleiman, what types of conditions are we talking about here today that would cause the knee or hip joint to break down and cause pain?

Dr. Linda Suleiman(Guest): The type of condition we are talking about is the most common condition to affect the hip and knee, which is osteoarthritis. Other conditions that affect the hip and knee that can cause it to break down or cause degenerative changes to the hip and knee are some inflammatory arthritis like rheumatoid arthritis, lupus, but mainly the most common cause is osteoarthritis.

Host: So when somebody comes to you, what’s diagnosis look like?

Dr. Suleiman: So when someone comes to me, they likely have had ongoing knee or hip pain. The age population, you know most patients – or most people assume that arthritis only affects the older generation but I believe because we’re such an active younger generation with prior knee surgeries as kids like ACL reconstructions, we’re seeing arthritis a lot earlier in patients who are between 40 and 50 and above.

Host: And if someone does have arthritis, maybe they were a young child who had ACL issues playing soccer or something, and in their 20s and 30s they’ve now got pain. What’s the first line of defense that you’d like them to try before surgery is the discussion?

Dr. Suleiman: So we always attempt all forms of nonoperative management, meaning physical therapy, which I’m a huge advocate of. Sometimes patients have knee pain due to the imbalance of the joint itself, so strengthening the muscles around the knee, strengthening the muscles around the hip is really important in rehabilitation. If they fail physical therapy, which we usually do for about 6 to 8 weeks, and they’re still having ongoing pain, the next line of defense is really an injection, and I typically use a corticosteroid injection.

Host: How many can people have? It’s a very common question, and Dr. Suleiman, I’m an exercise physiologist and I work with so many people that get a cortisone injection in their knee, and how many is always the question.

Dr. Suleiman: Sure, I think every physician differs as far as the number that they allow. Personally I think on average, we typically quote about three injections a year, and injections are not without risk. We’re putting a needle into the knee, so there’s always risk of actually causing an infection, although very, very low risk of that.

Host: And then if they’ve tried exercise and maybe arthritis medications, physical therapy, injection procedures, then what does the discussion look like when you’re discussing knee replacement?

Dr. Suleiman: So when we’re discussing having a joint replacement, the buzz words I look for when patients talk to me what are the next steps are. You know, my life is now debilitated, I can’t exercise in the way I want to exercise, I can’t walk for long distances and I used to walk two to three miles a day as part of my exercise. When it comes to the point where the pain and limited range of motion and the functional debilitations occur is the time where we discuss a joint replacement where we replace the arthritic portions of the knee, and this can be a total joint replacement or sometimes it may only affect one component of the knee, which would be a partial knee replacement.

Host: Tell us the difference between total and partial knee replacement as far as the procedure, recovery time, what can the patient expect?

Dr. Suleiman: So a partial knee replacement is a quicker recovery and you can imagine it’s less invasive compared to a total knee replacement. So a partial really means we’re replacing one portion of the knee. So this could be the medial portion or the inside portion of the knee. It could be the lateral portion of the knee, which is the outside portion of your knee or the patellofemoral, which is where your kneecap meets your femur, and so all of those in insolation would be a partial knee replacement, compared to a knee that has all – the entire knee is affected by the degenerative changes, so that’s a total knee, meaning the entire knee is resurfaced. So you can imagine if you only do one portion of the knee, it’s a quicker recovery as far as getting back to work, but as far as the actual postoperative routine, it’s the same for both.

Host: And as you’re talking about the difference between total and partial knee replacement and we hear about all the different types about joint replacements available today, anterior hip and all of these things, how has joint replacement surgeries advanced in recent years? Tell us a little bit about what’s different now than say 20 years ago?

Dr. Suleiman: I think the main difference now are actually things not specifically related to the surgical technique. I think we’ve gotten a lot better on the other aspects of the surgery. So surgeries involve disciplinary teams. So our anesthetics, we’re doing spinal anesthetics instead of general anesthetics when we do join replacements, so you can imagine that allows for patients not to be as groggy postoperatively because they’re essentially not entirely asleep and so they’re able to get up and move faster, less complications related to just doing a spinal anesthetic versus a general anesthetic, and then our pain management protocols, our pain management postoperatively with local injections and canal blocks where we have regional anesthetic blocks, all have allowed us to control patient’s pain better in order for them to get back to their day to day activities and fully rehab joint replacement and you can imagine we’re an implant driven subspecialty with having hip and knee replacements, we use different types of implants and over the last 20 years, the longevity of our implants have improved by manufacturing techniques with our polyethylene liners and different portions of the actual implants have just gotten much better over the last 20 years.

Host: That would’ve been my next question, so thank you for answering that about the implants. People wonder about those in airports and things and how long they’ll last, so that was a great answer doctor. Now what would you like patients to do before surgery to prepare so that it will be a more successful outcome and that includes exercise, maybe weight loss, or things they can prepare in their home before surgery so they go back home to a safer environment?

Dr. Suleiman: Sure, so we typically send our patients home after surgery. It’s very rare to go to a skilled rehab facility anymore. It’s actually safer to go home compared to going to a rehab facility. To prepare for surgery, I actually prefer my patients to have dental cleanings done several weeks before surgery. It sounds kind of like a weird thing but it decreases risk of infection when you’ve had your dental cleaning done beforehand as well as physical therapy and home exercises. So every one of my patients gets home exercises to strengthen their quadriceps muscles or hip flexors muscles or abductors muscles in order to prepare themselves physically for the surgery and the when they come for their preoperative visit with me, it’s always important to have a family member or a friend who’s going to be with you at your home for the first two weeks because it’s important that your family or your friend who’s at home with you really understands what you’re about to go through because surgery’s not just the physical component, it’s a lot of the mental well-being, family support that makes for a successful surgery.

Host: That’s really important points to make, and then when can they get back generally to their activities. 

Dr. Suleiman: So I typically see most of my patients back at their full functional capabilities at six weeks, although recovery occurs throughout your entire first year after surgery. But as far as being able to get back to your exercises that you were doing beforehand really that’s six weeks. So you start physical therapy on day one of your surgery, and you have physical therapy for those first six weeks which allows for rapid recovery.

Host: What else would you like patients to know when that discussion comes up. What questions, Dr. Suleiman, would you like them to ask you about when they’re considering a joint replacement, whether it’s the knee or the hip, what do you want them to ask you?

Dr. Suleiman: I typically like patients to ask me what type of activities can I do after surgery and which ones can I not do after surgery? The thing that’s really important to understand what type of activities you want to get back towards; that’s one of the first questions I even ask the patient is what do you hope to do after surgery? If you’re someone who is a marathon runner and you want to get back to doing marathons, you likely won’t be doing that after a knee replacement, although you physically can do a marathon, the impact of running is detrimental to the longevity of the implant, so it’s important to ask and have realistic expectations of what can I get back to doing. The other question you want to ask is what type of rehab protocols will you be participating in? It’s always good to know what the expectation is for you after surgery if you know beforehand what types of exercises I should know how to do, and those are the two main aspects, as well as whether you do minimally invasive techniques, which is the newest thing with joint replacements over the last five to ten years. Doing minimally invasive joint replacements allows for a speedy recovery.

Host: Then wrap it up for us. It’s really important, as so many people suffer from pain in their hips and their knees, Dr. Suleiman, give us your best advice about keeping healthy hips and joints and knees in the first place so that maybe we don’t have to consider a replacement.

Dr. Suleiman: The best you can do for yourself is actually weight loss when it comes to knee and hip osteoarthritis. The less you weight, it’s the one piece of information we know with how to prevent osteoarthritis is keeping your weight down and keeping a healthy lifestyle and decreasing impact activities. So those are the two things as far as preventative ways of trying to decrease your risk of developing arthritis is weight loss as well as keeping a healthy, active lifestyle with nonimpact activities.

Host: Thank you so much, and thank you for joining us today and sharing your expertise in explaining what patients can expect when they are considering joint replacement surgery. Thank you again. You’re listening to Northwestern Medicine Podtalk. For more information on the latest advances in medicine, please visit nm.org, that’s nm.org. This is Melanie Cole, thanks so much for listening.