Groucho Marx famously said, “Getting old is no problem. You just have to live long enough.” But living longer does not come without its challenges.
Conditions like arthritis, which leave many looking for ways to alleviate the condition, is a case in point. With minimal treatments outside of medication, total joint replacements have become a viable option when arthritis takes over.
The procedure itself has evolved — it’s no longer your mother’s or father’s total joint replacement — to where we can effectively replace the entire joint and return people to their normal activities.
This is a positive trend for more than 50 million adults and 300,000 children living in the US with some type of arthritis. Most commonly found among women, arthritis increases in incidence with age. And the upward movement should be critical as the population greys and Baby Boomers fulfill their senior years.
The surgical implants themselves are not much different than previous iterations. What’s really influencing positive outcomes are post-operation pain management and rehabilitation. Both have significantly minimized the time a person is off their feet, and hospital readmissions.
Years ago, a four- or five-day hospital stay and subsequent week or two in a rehab facility was required after surgery. Now, 85 percent of patients go home in about two days. Some are even on their feet the same day of the procedure.
What are my options to minimize pain?
This is a frequent question, especially as opioids have ravaged Long Island’s communities.
Femoral nerve blocks and periarticular injections have significantly decreased our use of opioids in the post-operative setting. These blocks blunt the pain and have opened avenues to accelerating recovery.
For example, if someone had a total knee replacement, they would have a prolonged hospitalization and rehabilitation. They didn’t have confidence walking with pain so they utilized a knee immobilizer, which can cause weakness in supporting muscles, specifically the quadriceps.
Periarticular injections have removed the need for knee immobilizers and can help patients go home the same day. They also result in fewer side effects, less medication and walking sooner.
It’s a big plus.
The American Association of Hip and Knee Surgeons expects the number of hip replacements performed each year to balloon to 500,000 by 2030.
For both total hip and knee replacements, imaging and computer assist have helped to improve the accuracy of implanting the hardware and preserving limb alignment. Also, medical device companies have advanced their technology, making them more customizable to the patient.
The ability for people to recover from home is a clear indication of the dramatic changes in health care. We now encourage jumping (er, walking) into recovery as immediately after surgery as possible.
While at home, visiting nurses can assist with physical therapy. There are also a growing number of digital options to deliver rehabilitation plans via mobile devices and apps.
Northwell Health, for example, is working with Force Therapeutics to test software that provides total joint replacement patients with online regimens. Their data is fed back to our offices. Patients can also ask questions in real time. Several individuals are already taking advantage of this option and the health system is enrolling others.
William Healy, MD, is an orthopedic surgeon within the Orthopaedic Institute at Northwell Health specializing in total joint replacement and sports medicine. He is also an assistant professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.