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Advancements in Joint Replacement

July 13, 2021 11:00 AM with Anand Srinivasan

Patient with joint issues

Today, people are living longer with optimistic expectations to remain active, productive and physically fit—at any age. Anand Srinivasan, MD, Orthopaedic Surgery Division, answers your questions about joint pain, knee and hip surgery, and advancements in joint replacement.

Ben (Moderator) - 10:50 AM:
Greetings and welcome to NorthShore University HealthSystem's latest chat: Advancements in Joint Replacement with Dr. Anand Srinivasan. The chat will begin in about 10 minutes, but please start submitting your questions now so we can get to all of them.

  Patti (Evanston, IL) - 11:04 AM:
Do you think it is better to go home after surgery or to a rehab excluding the obvious issues with covid? Also which rehabs do you recommend near Evanston and Skokie?
Anand Srinivasan
I think that it is safe and often more recommended to go home after surgery. This may even require an extra night in the hospital to feel ready and safe. The therapy and recovery process at home can be very similar to a rehab center. Therapists and nurses will often be able to see you multiple times a week and you are motivated to progress to outpatient therapy sooner. Finally, the comfort and knowledge that comes with being home often helps patients in their own recovery. NorthShore has a list of rehab centers that they partner with if a patient would be safer at a rehab center after surgery.

  Steve (Mundelein, IL) - 11:08 AM:
What are some of the best things you can do for knee pain? Right now I integrate walking backward into my exercise routine because I heard that's a good strategy. What else can I be doing?
Anand Srinivasan
First, making sure that one's weight is appropriate is the best thing that can be done to improve knee pain and studies would support that statement. Making sure that your muscles and core are strong through a weight training regimen would also help with reducing force across your knees. There is no one method of exercise that works for everyone but non - impact activities are probably better than impact activities such as running

  Mary (Naperville, IL) - 11:12 AM:
How frequently do you see bursitis in patients who have had knee replacement, and what can be done about it? I am struggling with it after a double knee replacement 10 years ago.
Anand Srinivasan
Bursitis can occur after knee replacement in a small but not insignificant portion of the population. This can be up to 10% of patients If you have not had a recent visit to make sure your knee replacements are functioning correctly, you should schedule a visit with your surgeon. Topical gels and even the occasional cortisone shot into the bursa may be helpful at reducing pain from bursitis.

  Mary (Evanston, IL) - 11:15 AM:
Are there any proactive measures you can take to delay knee surgery if you know you're predisposed by family traits?
Anand Srinivasan
Exercise to help your muscles stay strong can help delay knee surgery. Weight loss to reduce mechanical forces on the knee can help delay knee surgery as well. Sometimes, despite the above measures, the anatomy either that a patient has or "inherits" can predispose them to osteoarthritis of the hip and knee. Through the above actions, surgery can be delayed so that replacement surgery does not have to happen at an early age, but may not be avoidable.

  Marilyn (Grayslake, IL) - 11:19 AM:
I am 80yrs old, with a history of blood clots. I am considering total hip arthroplasty. A filter has been suggested. What are the risks?
Anand Srinivasan
There are risks associated with a filter including the need for two procedures (one to put the filter in and another to remove the filter). Also, the efficacy of IVC filters and whether they are better at stopping lung clots after surgery is not clear. There may be equal "protection" and risk through appropriate anticoagulation (blood-thinning). At NorthShore, we often send our surgical patients to our Vascular Medicine team who are aware of the most recent guidelines and recommendations. They often will tailor the plan based on a patient's individual history.

  Mary (Evanston, IL) - 11:24 AM:
How does the presence of arthritis affect the future success of a hip replacement?
Anand Srinivasan
Hip replacement is meant to address arthritis of the hip, including osteoarthritis and rheumatologic conditions. The success rate actually increases if someone has arthritis in their hip in that the patient feels relief after their surgery.

  Patti (Evanston, IL) - 11:28 AM:
Can you talk about what is done in an actual knee replacement?
Anand Srinivasan
Knee replacement is more of a "resurfacing" than a true replacement. The surgery involves removing a wafer of bone off the end of the thigh bone and top of the shin bone and putting a metal prosthesis (with a plastic in between) onto your bone. The undersurface of the knee cap also is shaved down and a plastic button is glued on. Knee replacement can be performed with technology such as robotics to fine-tune and measure an individual's anatomy. This helps a surgeon place the knee replacement in a manner that matches the bone and soft tissue of the patient accordingly.

  Sloan (Niles, IL) - 11:32 AM:
About robotic joint replacement...what parts of the surgery do the robots assist with?
Anand Srinivasan
The short answer is "it depends" but all robots measure the bone and anatomy closely, helping to fine-tune the position of the knee replacement. Some robots have arms that the surgeon holds and the surgeon guides the arm (with a saw attached) towards the patient in a controlled manner. Other robots show the surgeon where to place the blocks for a surgeon to machine the bone properly with a handheld saw. Each robot company is slightly different In the end, the surgeon has ultimate control and can supersede the robotic plan if necessary.

  Irene (Chicago, IL) - 11:37 AM:
ASSUMING the very best hip replacement surgery, therapy, and recovery scenarios, approximately how much time should a patient expect to pass before they feel reasonably stable walking without a medical device on uneven surfaces, such as soil, grass, etc.?
Anand Srinivasan
With that assumption, I would say that it would take 6 weeks for a patient to walk on uneven ground and surfaces without an assist device and equal fall risk as before.

  Judith (Evanston, IL) - 11:40 AM:
Can surgery correct a bowing leg caused by bone on bone arthritic knee?
Anand Srinivasan
Yes. Correcting a bow-legged deformity is one of the primary goals of a successful knee replacement. If this is an acquired deformity (happened later in life with arthritic change), then the chance of straightening the knee out completely is high. If this is a congenital or developmental deformity (childhood, bone shape from young age), then we often correct most but not all of the bow-legged deformity

  Debra (Northbrook, IL) - 11:43 AM:
When my husband was young, he tore his ACL doing hockey. He had knee surgery on it, completed physical therapy, but it's never really been the same. Recently, he's been watching YouTube videos like the "Knees Over Toes" guy which is basically a physical therapy program to help strengthen different parts of his knees. He does physical therapy every day but still experiences "tightness" in his joints and he still feels "weak" in parts of his knee. Is there something better he can be doing?
Anand Srinivasan
Having an old ligamentous injury such as an ACL, can start a slow process of arthritis in the knee. Usually, the mechanics of the knee are a little different and the knee may feel "weak" or unstable especially at a higher level of activity. The fact that your husband does a home exercise program consistently is a great start. As far as something better, it's hard to know but bracing could help in certain circumstances. Injections can be attempted as well if he has some evidence of degenerative change on x-ray.

  Nancy Gospo (Chicago, IL) - 11:48 AM:
What are the latest advancements in joint replacement, and do they enable patients to return to active sports like volleyball that require one to be able to pivot?
Anand Srinivasan
Both hip and knee replacement will allow some pivoting at a more recreational level. Traditionally, the concern with higher impact activities such as volleyball was that a patient may need a revision sooner as the hip or knee prosthesis wore down. With cementless knee technology and better plastics across the board, more sporting activities are allowed. However, volleyball and specifically jumping/spiking/digging are not typically allowed after a joint replacement

Ben (Moderator) - 11:53 AM:
That is all the questions we had submitted. Thank you, Dr. Srinivasan, for your time and expertise. You can view an archive of this chat anytime at www.northshore.org.
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