According to the American Academy of Orthopaedic Surgeons, almost 1 million joint replacements are done each year in the United States. When is it time to consider a joint replacement? Do you have to wait until the pain is unbearable?
Listen in as Efrain Paz, DO explains that when knee or hip pain severely limits your ability to walk, work or perform even simple activities, it might be time to consider knee or hip replacement.
What To Expect With a Hip and Knee Replacement
From the Show: Lourdes Health Talk
Summary:
Air Date: 10/16/16
Duration: 10 Minutes
Transcription:
Melanie Cole (Host): According to the American Academy of Orthopedic Surgeons, almost one million joint replacements are done each year in the United States. My guest today is Dr. Efron Paz. He's an orthopedic surgeon with Lourdes Medical Associates. Welcome to the show, Dr. Paz. So, people hear about replacements, joint replacements, knees and hips. When would somebody even figure that it's time to come see you, when they've had pain in either their hip or knee?
Dr. Efron Paz (Guest): It's a good question, Melanie. I get asked that by patients. I look at x-rays with them and then they say to me, “Do I need a hip replacement?” or, “Do I need a knee replacement?” The answer to that is, it really depends on how much the condition is impacting patient's life, and their function, and their sleep, and their habit. I tell folks we don't operate on x-rays, we operate on people. There are conservative treatment, there are injections, there's therapy, there's exercises, and weight loss. When you've tried all those things and you still have pain and dysfunction that's dramatically impacting your life, then that's the time to consider. So, the patient makes that decision.
Melanie: What's changed in the world of joint replacement now? Speak about some of the materials that you show people or discuss with them for the replaced joint?
Dr. Paz: When I sit down and talk to someone about a hip or knee replacement. I have model components there and I let them feel exactly what a replacement material is. What's changed is what we call the “bearing surfaces”, the surfaces that actually rub together in a knee or hip. In particular, the plastic or the polyethylene is much improved and it's getting better and better in wear characteristics as it's developed. On the side of the hip, the ball part of the hip, ceramic has been revolutionary there as far as minimizing friction and improving wear. So, material-wise polyethylene and ceramic. And, really, what else is new is the way we're treating pain, and the size of our incisions, and all of this has, hopefully, made it less painful or quicker recovering and longer lasting in the knee replacement.
Melanie: There are a few myths that are out there that people hear that maybe you can bust up for us just a little bit, doctor. The first one is that people think that they're too young to get a joint replaced If they're young and they are experiencing some of those symptoms that you described.
Dr. Paz: It's a myth to some extent but, still, anytime I see someone who is young and, believe it or not, as far as joint replacement, anybody younger than 60 is considered young. We always tell folks and we're obligated to tell them that they could loosen or wear out a hip replacement or knee replacement in their lifetime and need a more complicated surgery thereafter. Now, that having been said, the materials that we have nowadays we're expecting them to last much longer but we don't know how long they will last because we've not have them that long. I've done knee and hip replacements on young folks, folks in their 30's even with severe degenerative disease or deformities after trauma. We do it for quality of life reasons but, again, at least I feel obligated to counsel these people and tell them, “You could wear it out or loosen it in your lifetime.”
Melanie: What’s life for them afterwards? Do they have range of motion? Are they going to develop a lot of scar tissue? Because that's another myth. People say, "Well, I'm not going to be able to move around as easily as I did."
Dr. Paz: That's a good question because it is a prosthetic joint and, in particular, when it comes to knees many young folks that are active just don't have the same feel, the same mobility, with a knee replacement that they would with a native knee. Curiously enough, the hip is the opposite. Hip mobility is remarkably improved after hip replacement, and so much so that one of the worries with a young active person is that they could pop the hip out of place. But, in particular, this worry is early on, within the first few months after their hip replacement. So, knees are different than hips. In particular, a prosthetic knee joint doesn't feel exactly the same mechanical-wise as a native knee. It's important to also tell this to young folks that before hip replacement or knee replacement.
Melanie: And, they be active afterward, if they want to get back to their exercise or back to their weekend warrior sports? Can they still do that with the replacement?
Dr. Paz: They can be active. There are certain exercises that we try to dissuade people from. In particular, if you had a hip or knee replacement jogging or training for a marathon wouldn't be ideal. You could loosen or wear out your prosthetics quicker. Similarly, contact athletics, like playing football with hip replacement or knee replacement, or even soccer, is not ideal. Tennis, running with your grandchildren, running across the street, golf, low impact and non-contact athletics, absolutely. We encourage them to get back to that stuff--skiing as well.
Melanie: How soon after the procedure can they start physical therapy? If they've gotten a new knee or a new hip, how soon do you want them to get up and start walking around on it?
Dr. Paz: We get our patients or I get my patients up that night. I want them to, immediately after the surgery, as soon as they are medically stable, which is quickly, to start to embark on their pain-free life and improving their functions. I try to get them out of bed the day or the night of their surgery, get them standing, get them walking, almost always with a walker and with assistance naturally, but right away. The rehab starts the day of the surgery.
Melanie: Which one is easier for you doctors: a hip or a knee to replace? Or, for the patients for that matter?
Dr. Paz: That's an interesting question. Some doctors prefer doing hip replacements. Some prefer the mechanics of a knee replacement. It's hard for me to answer. I can tell you from the patient perspectives, far and away, hip replacement is much easier to recover from less pain, less dysfunction, less work on the part of the patient. I have plenty of folks that I do hip replacements on and, other than the immediate few weeks of therapy, never even need therapy. Knee replacements are different. It takes great work on the part of the patient and, quite often, physical therapy to get range of motion back, and to take these tight and inflamed tissues and not let them scar up. So, far and away for the patient, the knee replacement is harder to recover from than hip replacement from the pain standpoint, and from a motion and rehab standpoint.
Melanie: In the last few minutes, give us your best advice. Is there any way to prevent the need for a joint replacement? What do you tell people every day about keeping healthy joints?
Dr. Paz: That’s another good question because it is a discussion I have every day with patients. Activity modification, when you have an arthritic knee, is one of the things we do. We avoid high impact exercises and training. Weight loss, keeping our weight down. If we diminish the weight through a weight-bearing joint, naturally it will preserve it. Also, really important thing is exercise. If an arthritic joint is kept supple and exercised on a regular basis, provided that it's not painful exercise, generally feels better and lasts longer, functions better. Weight loss, activity modification, and exercise are really important.
Melanie: Why should they come to Lourdes Health System for their care?
Dr. Paz: Naturally, I'm biased but I like to think I provide an individualized and personalized care. I talk to my patients. I see my patients each day they're in the hospital after the surgery. I see my patients personally. Each time they have a follow up visit and I see them ten days after the surgery, six weeks after the surgery, three months after the surgery, six months after surgery, one year after the surgery, and then, usually yearly thereafter. So, I like think I give a personalized care. We've recently renovated our 35th floor to accept our joint patients with a private room, flat screen TV, a little nicer surrounding, even though we are a community hospital. Those are the reasons I'd like to think folks should come to me.
Melanie: Thank you so much for being with us today. It’s great information. You're listening to Lourdes Health Talk. For more information, you can go to www.lourdesnet.org. That's www.lourdesnet.org. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): According to the American Academy of Orthopedic Surgeons, almost one million joint replacements are done each year in the United States. My guest today is Dr. Efron Paz. He's an orthopedic surgeon with Lourdes Medical Associates. Welcome to the show, Dr. Paz. So, people hear about replacements, joint replacements, knees and hips. When would somebody even figure that it's time to come see you, when they've had pain in either their hip or knee?
Dr. Efron Paz (Guest): It's a good question, Melanie. I get asked that by patients. I look at x-rays with them and then they say to me, “Do I need a hip replacement?” or, “Do I need a knee replacement?” The answer to that is, it really depends on how much the condition is impacting patient's life, and their function, and their sleep, and their habit. I tell folks we don't operate on x-rays, we operate on people. There are conservative treatment, there are injections, there's therapy, there's exercises, and weight loss. When you've tried all those things and you still have pain and dysfunction that's dramatically impacting your life, then that's the time to consider. So, the patient makes that decision.
Melanie: What's changed in the world of joint replacement now? Speak about some of the materials that you show people or discuss with them for the replaced joint?
Dr. Paz: When I sit down and talk to someone about a hip or knee replacement. I have model components there and I let them feel exactly what a replacement material is. What's changed is what we call the “bearing surfaces”, the surfaces that actually rub together in a knee or hip. In particular, the plastic or the polyethylene is much improved and it's getting better and better in wear characteristics as it's developed. On the side of the hip, the ball part of the hip, ceramic has been revolutionary there as far as minimizing friction and improving wear. So, material-wise polyethylene and ceramic. And, really, what else is new is the way we're treating pain, and the size of our incisions, and all of this has, hopefully, made it less painful or quicker recovering and longer lasting in the knee replacement.
Melanie: There are a few myths that are out there that people hear that maybe you can bust up for us just a little bit, doctor. The first one is that people think that they're too young to get a joint replaced If they're young and they are experiencing some of those symptoms that you described.
Dr. Paz: It's a myth to some extent but, still, anytime I see someone who is young and, believe it or not, as far as joint replacement, anybody younger than 60 is considered young. We always tell folks and we're obligated to tell them that they could loosen or wear out a hip replacement or knee replacement in their lifetime and need a more complicated surgery thereafter. Now, that having been said, the materials that we have nowadays we're expecting them to last much longer but we don't know how long they will last because we've not have them that long. I've done knee and hip replacements on young folks, folks in their 30's even with severe degenerative disease or deformities after trauma. We do it for quality of life reasons but, again, at least I feel obligated to counsel these people and tell them, “You could wear it out or loosen it in your lifetime.”
Melanie: What’s life for them afterwards? Do they have range of motion? Are they going to develop a lot of scar tissue? Because that's another myth. People say, "Well, I'm not going to be able to move around as easily as I did."
Dr. Paz: That's a good question because it is a prosthetic joint and, in particular, when it comes to knees many young folks that are active just don't have the same feel, the same mobility, with a knee replacement that they would with a native knee. Curiously enough, the hip is the opposite. Hip mobility is remarkably improved after hip replacement, and so much so that one of the worries with a young active person is that they could pop the hip out of place. But, in particular, this worry is early on, within the first few months after their hip replacement. So, knees are different than hips. In particular, a prosthetic knee joint doesn't feel exactly the same mechanical-wise as a native knee. It's important to also tell this to young folks that before hip replacement or knee replacement.
Melanie: And, they be active afterward, if they want to get back to their exercise or back to their weekend warrior sports? Can they still do that with the replacement?
Dr. Paz: They can be active. There are certain exercises that we try to dissuade people from. In particular, if you had a hip or knee replacement jogging or training for a marathon wouldn't be ideal. You could loosen or wear out your prosthetics quicker. Similarly, contact athletics, like playing football with hip replacement or knee replacement, or even soccer, is not ideal. Tennis, running with your grandchildren, running across the street, golf, low impact and non-contact athletics, absolutely. We encourage them to get back to that stuff--skiing as well.
Melanie: How soon after the procedure can they start physical therapy? If they've gotten a new knee or a new hip, how soon do you want them to get up and start walking around on it?
Dr. Paz: We get our patients or I get my patients up that night. I want them to, immediately after the surgery, as soon as they are medically stable, which is quickly, to start to embark on their pain-free life and improving their functions. I try to get them out of bed the day or the night of their surgery, get them standing, get them walking, almost always with a walker and with assistance naturally, but right away. The rehab starts the day of the surgery.
Melanie: Which one is easier for you doctors: a hip or a knee to replace? Or, for the patients for that matter?
Dr. Paz: That's an interesting question. Some doctors prefer doing hip replacements. Some prefer the mechanics of a knee replacement. It's hard for me to answer. I can tell you from the patient perspectives, far and away, hip replacement is much easier to recover from less pain, less dysfunction, less work on the part of the patient. I have plenty of folks that I do hip replacements on and, other than the immediate few weeks of therapy, never even need therapy. Knee replacements are different. It takes great work on the part of the patient and, quite often, physical therapy to get range of motion back, and to take these tight and inflamed tissues and not let them scar up. So, far and away for the patient, the knee replacement is harder to recover from than hip replacement from the pain standpoint, and from a motion and rehab standpoint.
Melanie: In the last few minutes, give us your best advice. Is there any way to prevent the need for a joint replacement? What do you tell people every day about keeping healthy joints?
Dr. Paz: That’s another good question because it is a discussion I have every day with patients. Activity modification, when you have an arthritic knee, is one of the things we do. We avoid high impact exercises and training. Weight loss, keeping our weight down. If we diminish the weight through a weight-bearing joint, naturally it will preserve it. Also, really important thing is exercise. If an arthritic joint is kept supple and exercised on a regular basis, provided that it's not painful exercise, generally feels better and lasts longer, functions better. Weight loss, activity modification, and exercise are really important.
Melanie: Why should they come to Lourdes Health System for their care?
Dr. Paz: Naturally, I'm biased but I like to think I provide an individualized and personalized care. I talk to my patients. I see my patients each day they're in the hospital after the surgery. I see my patients personally. Each time they have a follow up visit and I see them ten days after the surgery, six weeks after the surgery, three months after the surgery, six months after surgery, one year after the surgery, and then, usually yearly thereafter. So, I like think I give a personalized care. We've recently renovated our 35th floor to accept our joint patients with a private room, flat screen TV, a little nicer surrounding, even though we are a community hospital. Those are the reasons I'd like to think folks should come to me.
Melanie: Thank you so much for being with us today. It’s great information. You're listening to Lourdes Health Talk. For more information, you can go to www.lourdesnet.org. That's www.lourdesnet.org. This is Melanie Cole. Thanks so much for listening.
