blog

Intermediate and Long-Term Quality of Life after Hip Replacement

Hip osteoarthritis (OA) causes severe disability and pain. If hip OA is treated successfully with a total hip arthroplasty, patients will have significant improved quality of life.

Researchers conducted a follow-up study to assess the quality of life and functionality of 250 people an average of 16 years after total hip Hip painreplacement. The Harris Hip Score, WOMAC screening, Functional Comorbidity Index, and the SF-36 questionnaire were used to assess the participants. The questionnaire showed that the results compared positively with results from untreated persons with severe hip arthritis. In addition, patients reported a 96% post-operative satisfaction rate.

In this study, hip function and comorbidities were found to be the most important determinants of physical measures on the SF-36. Additionally, patients who had undergone total hip replacement had some long-term impaired quality of life and hip functionality, but they did perform significantly better than untreated patients.

What to Expect

During the recovery period, there are some things you can do to improve recovery outcomes and quality of life after the hip replacement. These include:

  • Wound care: During home recovery, you should keep the wound area dry and clean, and dress it according to doctor’s instructions.
  • Swelling: Mild to moderate swelling may occur up to 3 months post-surgery. To reduce selling, you must elevate your leg slightly and use ice packs. Wearing compression stockings can help to decrease leg swelling.
  • Medications: Take all medications as directed by your doctor. Use pain medicine before physical therapy sessions to improve participation during the exercises. In addition, avoid any over-the-counter drugs and supplements that could interfere with prescribed medicines.
  • Weight-bearing: Use a walker, crutches, or cane as recommended by your physical therapist. Full weight-bearing is often allowed right after surgery, but this depends on the doctor’s choice and your health status.
  • Driving: It is not safe to resume driving until you quit taking pain medication. In addition, you should wait until your strength and reflexes return to normal. Usually, you can resume driving after 3 weeks.
  • Sexual activity: Please consult your doctor about resuming sexual activities, as this varies for each patient. Depending on the type of surgery you have undergone, sexual activity is restricted for several weeks.
  • Return to work: If you have a sedentary job, you may be able to resume work activities within a few weeks. This decision will be made by the orthopedic surgeon depending on your progress in rehabilitation.

canstockphoto4842007

The Longevity of a New Hip

Total hip replacement is one of the most successful orthopedic surgeries done today. However, people are having hip replacements at a younger age, and wearing of the new joint surface can become a problem after 15-20 years. Revision surgery is becoming more common to maintain quality of life. This involves repeating the surgery, only this time, the artificial components are replaced with new ones.

If medication and physical therapy does not relieve pain and disability, or if the new hip shows damaged around the artificial components, the surgeon may consider revision surgery for you. This is done when bone loss, wearing of joint surfaces, or joint loosing occurs. Hip revision may be required after infection, fracture, or injury to the joint.

Resources

Galasso O, Costa GG, Recano P, & Cerbasi S (2011). Quality of life and functionality after total hip arthroplasty: a long-term follow-up study. BMC Musculoskel Dis, 12, 222.

Save

Physical Therapy for Chronic Orthopedic Problems

Chronic pain affects millions of Americans. Many orthopedic conditions are chronic, and they cause serious pain. Physical therapy is a good way to alleviate pain and improve quality of life.

Manual Therapies

Physical therapy involves manual therapies for pain relief, as well as exercises for strengthening and flexibility. Manual physical therapy is a specialized kind of treatment delivered with the therapist’s hands as opposed to a machine or device. Many patients come to their first physical therapy appointment expecting to get ultrasound and hot packs. However, the therapist first assesses your condition before canstockphoto47029630devising a treatment plan.

The physical therapist is interested in why a muscle or structure is not functioning properly, and see back exercises as more than the driving mode of recovery. Exercise is viewed as a complement treatment to manual therapy. With manual therapy, the therapist uses his/her hands to apply pressure on muscle tissue and to manipulate joints, which is used to decrease back pain caused by tension, spasm, or joint dysfunction.

Many physical therapists have the option to use manual therapy, but many do not spend the time to become efficient in this area of practice. Patients should request manual therapy, which is used to relieve pain. However, because this treatment is not standard, insurance reimbursement may be limited.

Manual therapy is used for joint pain. Joints that do not have adequate mobility or range of motion can benefit from physical therapy. Certain musculoskeletal conditions cause limitations, which in turn, creates discomfort, pain, and altered function. Manual physical therapy involves restoring motion to stiff joints and reducing muscle tension so the patient can regain a natural movement without pain.

Types of Manual Physical Therapy Techniques

Manual physical therapy techniques are aimed at relaxing restricted joints and tense back muscles. The goal of therapy is to increase flexibility and decrease back pain. The types of movement include:

 

  • Soft tissue work – This involves application of pressure to the soft tissues, such as subcutaneous tissue and muscles. This massage maneuver and pressure relaxes the muscles, breaks up scar tissue, increases circulation, and eases soft tissue pain.

 

  • Mobilization and manipulation – This uses measured movements of varying speed (slow to fast), distances (called amplitude), and force (gentle to forceful) to pull, push, and/or twist bones and joints into position. This helps loosen tight tissues in and around the joint, helps with alignment and flexibility, and reduces pain in the joint and surrounding tissues.

Other Therapy Maneuvers

Some commonly used physical therapy maneuvers include:

 

  • Soft tissue mobilization – Muscle tension will decrease joint motion and cause muscle spasms. For these patients, the therapist will use soft tissue mobilization (STM), which breaks up inelastic or fibrous muscle tissue, such as scar tissue form a back injury, and moves tissue fluids. The therapist will localize the area with the most tissue restriction through assessment. Once this is identified, the restrictions are mobilized with STM.blog_shoulder-physical-therapy-hawkgrips-instrument-assisted-soft-tissue-mobilization-iastm

 

  • Strain-counterstrain – This technique focuses on correcting abnormal neuromuscular reflexes that cause postural and structural problems, resulting in tender points. The therapist finds these points and holds the muscle area down. Through mild stretching, this allows the body to reset its muscle to a normal tension level.

 

  • Joint mobilization – This involves loosening up a restricted joint and increasing the range of motion by providing speed (velocity) and increasing distance of movement (amplitude). These mobilizations move the bone surfaces on each other in ways the patient cannot move the joint himself.

 

  • Muscle energy techniques (METs) – These maneuvers are designed to mobilize restricted joints. METs utilize a voluntary contraction of the patient’s muscles against a controlled counterforce, which is applied by the therapist from a precise position and in a specific direction. The operator takes the joint to a new level where the patient them contracts the muscle.

OSPI offers top orthopedic services in the East Valley with Board Certified doctors. Physical Therapy is offered along with chiropractic and pain management too!

Basics of Hip Joint Replacement

Hip joint replacement, also called total hip arthroplasty, is a procedure used to replace a damaged or worn hip joint with artificial components (prostheses). This surgery is often performed following a hip fracture or for patients with severe and advanced arthritis.

What types of arthritis affect the hip joint?hip arthritis picture

Three main types of arthritis affect the hip joints. These include:

  • Osteoarthritis – Degenerative joint disease, or OA, affects older individuals. This type of arthritis may cause joint cartilage break down.
  • Rheumatoid arthritis – Severe, deforming type of arthritis that causes synovial lining inflammation and excessive synovial fluid.
  • Traumatic arthritis – This results from an injury or trauma, and it causes cartilage damage.

Will I have a big scar after the surgery?

The traditional approach to hip replacement involves a 6 to10 inch incision over the hip joint. Newer approaches, such as minimally invasive and the anterior approach, involve two smaller incisions. The doctor will tell you which approach is best for you.

How do I prepare for hip replacement surgery?

When you meet with the surgeon, he will discuss the procedure and review the risks and benefits. Because bleeding is a risk, you must hold all blood-thinners for a few days before the surgery. The doctor takes a detailed medical history, inquires about allergies, goes over your medications, and conducts a physical examination. If not available, routine hip x-rays are done. Because this is a major surgery, you will have some preliminary tests (urinalysis, bloodwork, and EKG).

canstockphoto38482995What happens the day of the surgery?

You must arrange to have someone drive you home from the hospital and help you for a few days. Because anesthesia is given, you must fast for 8 hours before the procedure. After you change into a gown, a nurse places an IV catheter in your arm to administer medications. You will be given a mild sedative before going to the surgical room.

What happens during hip replacement surgery?

When you are asleep from anesthesia, the medical workers will clean your hip region using an antiseptic. The surgeon makes incisions and uses special instruments to remove the diseased and damaged hip bones. The prosthesis is inserted into the thigh bone, and the cup is placed into the hip joint socket. After all changes are made, the incisions are closed using sutures. The doctor will place a small drain and bandage over the surgical site.

What happens after my hip surgery?

After your operation, you are taken to the recovery room. A nurse monitors your pulse, breathing, and blood pressure, and once you are alert, you are taken to the hospital room. A nurse helps you to bed and administers pain medication as necessary. The physical therapist will meet with you and discuss your exercise rehabilitation plan. Some patients are moved to a rehabilitation center for recovery, whereas others will go home.

What modifications will I need at home?

After your hip replacement surgery, you will need certain modifications. The physical therapist will do a home visit before you have surgery to ensure you have the right modifications. These include:

  • Safety handrails in the bath/shower
  • Proper handrails along the stairs
  • Raised toilet seat
  • Shower chair
  • Stable chair with firm back and knee rest
  • Sock aid
  • Dressing stick
  • Long-handled sponge
  • Shower hose
  • Reaching stick
  • Firm pillows
  • Removal of all loose carpets and cords

Orthopedic and Sports Performance Institute offers top hip replacement doctors in Gilbert AZ. Most insurance is accepted, call us today!

How does Surgical Approach to Hip Replacement affect Recovery?

Anterior hip replacement is an approach to surgery used to improved patient outcomes. Thousands of hip replacement surgeries are performed each year, but only 20% of surgeries in the United States are done using the anterior approach. The other 80% of surgeries are performed using the posterior or lateral approach.

Advantages of the Anterior Hip Replacement

Supporters of the anterior hip replacement approach believe it offers the following canstockphoto10503438advantages:

  • Less damage to major muscles – The orthopedic surgeon avoids cutting and manipulating major muscles during the anterior hip replacement. The surgeon works between the front muscles rather than severing muscle fibers or detaching muscle from bone.

 

  • Less post-operative pain – Because anterior approach does not require manipulation and cutting of muscles, the patient has less post-surgical pain and requires less medication.

 

  • Faster recovery – After surgery, the patient can bend at the hip and bear weight sooner. Most anterior hip replacement patients use walker or crutches soon after surgery. In a recent study researchers found that anterior hip patients walked unaided 6 days earlier than those who had the posterior surgery.

 

  • Decreased risk for dislocation – With the anterior surgery, the hip is not at risk for dislocation because soft tissue structures are not moved.

 

  • Improved range of motion – Patients can bend over, sit with legs crossed, and perform other movements without risking hip dislocation.

 

  • Shorter hospital stay – A patient who undergoes anterior surgery will not stay in the hospital as long as with the traditional approach.

 

Advantages of the Posterior-Lateral Hip Replacement

In a recent study comparing posterior and anterior approaches to hip replacement, researchers found that both groups had improvements in pain and range of motion, with no observable differences in gait or dislocation. Advantages to the posterior approach can include:

 

  • Less technically demanding – The posterior approach to hip replacement is easier to canstockphoto24182699perform. Anterior approach requires considerable training, skill, and experience by the orthopedic surgeon.

 

  • Simpler and easier – Many Gilbert orthopedic surgeons believe the posterior approach is the simplest and easiest, therefore providing the greatest safety margin for patients.

 

  • Minimal risk of femoral fracture or implant problems – Due to ease of this surgery, there is less risk to the patient for femoral fracture or poor positioning of the prosthetic component.

 

  • No special surgical equipment required – This procedure does not require the use of high-tech, specialized surgical equipment.

 

Disadvantages of the Anterior Hip Replacement

There are a few limitations associated with anterior hip replacement. These include:

  • Not suitable for obese or large patients – Muscular, overweight, or obese people are not good candidates for the anterior procedure.

 

  • More technically demanding – The Arizona orthopedic surgeon must be very experienced in performing the anterior hip replacement. This surgery is known to be quite technically demanding.

 

  • Potential for nerve damage – The lateral cutaneous femoral nerve runs down the front of the pelvis and past the hip to supply the thigh. There is more potential for damage to this nerve with the anterior approach.

 

  • Delayed wound healing – Some studies show that wound healing is delayed using the anterior approach, with 1.4% of patients having a wound complication compared to 0.2% with the posterior approach.

 

Disadvantages of the Posterior-Lateral Hip Replacement

  • Higher post-operative dislocation rates – Some studies show higher rates of dislocation with the posterior approach. However, with improved technology, these rates have declined.
  • Longer recovery – The posterior approach to hip replacement is associated with longer hospital stays and recovery. However, with full participation in physical therapy and rehabilitation, the recovery time has shortened.

OSPI offers state of the art approaches for hip replacement which minimize hospital stay and complications, while improving outcomes. Most insurance is accepted by the Gilbert and Mesa orthopedic surgeons, call today!

Resources

Kennon RE, Keggi JM, et al. (2013). Total hip arthroplasty through a minimally invasive anterior surgical approach. Journal of Bone and Joint Surgery, 85-A:39-48.

Petis S, Howard JL, Lanting BL, & Vasarhelyi EM (2015). Surgical approach in primary total hip arthroplasty: anatomy, technique and clinical outcomes. Can J Surg, 58(2), 128-139.

Post, ZD, Orozco F, Diaz-Ledezma C, Hozack WJ, & Ong A (2014). Direct anterior approach for total hip arthroplasty: indications, technique, and results. Journal of the American Academy of Orthopaedic Surgeons, 22:595-603.

Taunton MJ, Mason JB, Odum SM, & Springer BD (2014). Direct Anterior Total Hip Arthroplasty Yields More Rapid Voluntary Cessation of All Walking Aids: A Prospective, Randomized Clinical Trial. J Arthroplasty. pii: S0883-5403(14)00340-4. doi: 10.1016/j.arth.2014.03.051.

 

Save

Recovery after Total Knee Replacement in Arizona

canstockphoto10845760

Each year, thousands of people undergo total knee replacement (TKR) surgery. This procedure is done to replace damaged portions of the knee, including cartilage and bone ends. The most important part of surgery is the recovery.

Hospital Recovery

  • Bandages/drains – The knee will have a bulky elastic bandage dressing on it. Depending on the situation, some patients have a small drain inserted at the surgical site to remove excess blood and fluid that accumulates. The bandage is removed 1-2 days after surgery, and the drain is usually removed within 3 days of surgery.

 

  • Incisions – The incisions must be kept clean and dry. Sutures or staples are removed in 7-14 days.

 

  • Continuous passive motion (CPM) – A CPM machine is used to move the knee in physical therapy1regular motion. This helps the knee regain flexion.

 

  • Activities – Nurses will help you get out of bed and back in bed while in the hospital. You are encouraged to walk to the bathroom using a walker, crutches, or cane.

 

  • Deep breathing – After surgery, you must perform deep breathing exercises to rid your airway and lungs of mucus. This involves taking several deep breaths every hour.

 

  • Physical therapy – The physical therapist works with you to improve range of motion and strengthen muscles. The therapist assists with sitting at bedside, transferring in and out of bed safely, climbing stairs, walking with a cane or walker, and performing exercises without the CPM.

 

  • Pain management – The nurses will administer pain medicine to keep you comfortable.

 

Home Recovery

  • Preparation – Before going home, you need to arrange for a ride home, and have someone available to help you for a few days. It is a good idea to have plenty of gauze and tape ready, as well as pre-made meals, ice, and water. You will need to have a recliner or an ottoman so you can elevate your leg. In addition, you should remove all loose cords and rugs from walkways.

 

  • Physical therapy – The therapist continues to work with you after you go home. As the days progress, you will increase your frequency and distance of walking. Most patients are on a straight cane within 3-5 days of surgery.

 

  • Pain management – To control pain, take prescribed medications before pain gets too severe. In addition, avoid any alcoholic beverages while you are taking these medicines. We recommend taking pain medicine at least 45 minutes before physical therapy sessions, so the medicine will take effect.

 

Dos and Don’ts after Knee Replacement Surgery

 

  • Do position the knee comfortably as you perform daily activities.
  • Do use an ice pack if swelling occurs.
  • Do walk and perform range of motion exercises each day.
  • Do elevate the leg often to reduce swelling.
  • Don’t twist the knee.
  • Don’t jump or put any sudden stress on the knee.
  • Don’t put a pillow under the knee.

 

Fast-Track Recovery Protocol

 

During the last decade, many medical facilities have implemented fast-track protocols for total knee replacement. A fast-track protocol will reduce the length of hospital stay.

 

In a recent study involving fast-track recovery, researchers evaluated patients during the first 6 weeks after total knee replacement. They found that 28 of the 30 study participants were satisfied with a short hospital stay. It was determined that quality of life at 6 weeks discharge was the same for fast-track patients as those who stayed longer at the hospital.

OSPI in Gilbert AZ offers top knee replacement surgeons providing rapid recovery procedures. Most insurance is accepted, call today!

Resources

Van Egmond JC, Verburg H, & Mathissen, NMC (2015). The first 6 weeks of recovery after total knee arthroplasty with fast track. Acta Orthop, 86(6), 708-713.

Save

Overview of Partial Hip Replacement

Partial Hip Replacement in Gilbert AZ

 

With a partial hip replacement, also called a hemiarthroplasty, only the patients femoral head (top of thigh bone) is replaced. The prosthetic component will rotate in the natural hip socket. This procedure is used for patients who do not need replacement of the joint ModularEndoprosthesissocket (acetabulum).

How is the partial hip replacement different from total hip replacement?

The partial hip replacement surgery is less invasive than total hip replacement. With the partial procedure, only the ball of the femur must be replaced, and the joint socket is left alone. This surgery is used for patients who require replacement of the femoral head.

What are the reasons for a partial hip replacement?

Breaking or fracturing a hip can lead to breaks through the femur, which often displaces the femoral head. When the fracture occurs within the hip joint, it is called a femoral neck fracture. The upper portion of the femur is surrounded by muscle, and it has better blood supply than the neck. The partial hip replacement is used to repair damage that occurs after these injuries. A fracture of the femoral head or neck can lead to significant pain and loss of normal function.

Usually, patients who are good candidates for a partial hip replacement are those who have no significant underlying arthritis and people with healthy cartilage. A partial hip replacement is seldom used for patients with serious hip damage. Another use of a partial hip procedure is to repair damage in patients who already have a total hip replacement.

Can elderly people have this procedure?

uncemented-bipolarIntracapsular fractures of the femur account for the majority of fractures in older patients. The goal of surgery is to return the patient to his/her pre-fracture functional state. Partial hip replacement was studied in older people in a recent clinical study. Researchers found that all study participants returned to their pre-fracture level of activity after the procedure. In addition, they found that hemiarthropasty was a viable option for people age 70 years and older.

How do I prepare for surgery?

Before hip surgery, you need to arrange someone to drive you home from the hospital, and have someone ready to stay with you for a few days. You will need to prepare your home for discharge. Some things to do include:

  • Remove all loose cords and rugs from walking areas.
  • Secure safety handrails in bath/shower and along stairways.
  • Have pre-made meals and drinks available.
  • Have a firm recliner chair or chair with ottoman.
  • Purchase a raised toilet seat.

What can I expect during recovery?

After a partial hip replacement, a nurse monitors you in the recovery room for 45-75 minutes. Once you are stable and awake, you will be moved to a room or discharged home. Discharge depends on your unique situation, your health status, and the surgeon’s preference. You may need to stay in the hospital for 1-2 nights. You will begin passive range of motion exercises with the help of a physical therapist, and nurses administer pain medications to ease postoperative pain.

Once you are home, you must keep the incisions clean and dry, and avoid soaking in a tub or pool until wounds are healed. Expect to use a walker or crutches for a few days. Physical therapy is used to improve hip strength, flexibility, and range of motion. The Mesa orthopedic surgeon encourages frequent movement to prevent blood clots and improve recovery.

The top orthopedic surgeons in Arizona are at OSPI, serving Mesa, Gilbert, Chandler, Tempe, Queen Creek and surrounding areas. Call today!

Resources

Marya SKS, Thurkral R, & Singh C (2008). Prosthetic replacement in femoral neck fracture in the elderly: Results and review of the literature. Ind J Orthop, 42(1), 61-67.

FAQs on Total Hip Replacement

If you suffer from hip pain, stiffness, and limited physical activities, you may need a total hip replacement. When the hip is damaged from a fracture, long-standing arthritis, or other conditions, the cartilage wears away and pain occurs. Hip replacement surgery is a successful surgery for improving functionality.

What are the reasons for getting a hip replacement?

The decision to have a total hip replacement (THR), also called total hip arthroplasty (THA), is made by you in conjunction with your primary care doctor, your family members, and your orthopedic surgeon. There is no age or weight restrictions for canstockphoto13092914this procedure, and most patients are 50-80 years old. This surgery may be for you if you have:

  • Hip pain that affects everyday activities, such as bending or walking.
  • Hip pain that occurs at rest, and often interferes with sleep.
  • Hip stiffness that affects the ability to move or lift the leg.
  • Pain that continues in spite of usual therapies (medicines, physical therapy, and injections).

What causes hip pain?

The most common causes of chronic hip pain and disability are:

  • Osteoarthritis – This involves wearing away of protective cartilage that covers the bone ends. Without adequate cartilage, the bones rub against one another, which leads to stiffness and pain.
  • Rheumatoid arthritis – This autoimmune disease causes synovial membrane (joint lining) inflammation and damage to the cartilage. The recurrent inflammation permanently damaged the joint.
  • Post-traumatic arthritis – After a hip fracture or injury, the cartilage is damaged, which leads to chronic hip pain.
  • Avascular necrosis – Any injury to the hip can limit blood flow to the head of the femur (thigh bone). A dislocation or fracture can lead to avascular necrosis, where the lack of blood causes the bone to collapse.
  • Childhood hip disease – Some infants are born with hip problems. While the hip conditions are treated during childhood, they may cause arthritis later in life.

What happens during the total hip arthroplasty?

During the hip replacement procedure, the damaged cartilage and bone are removed and replaced with artificial components (called prostheses). The steps include:

  • Replacing the femoral head – The damaged upper portion of the femur is removed and replaced with a metal stem. The prosthesis is placed into the center of the femur and either “press-fit” into the bone or cemented there. A metal or ceramic ball is used to replace the femoral head.
  • Replacing cartilage surface of socket – The hip socket is called the acetabulum, and it is removed and replaced with a metal socket. Screws or cement is used to hold this component in place.
  • Inserting the spacer – A ceramic, metal, or plastic spacer is positioned between the new femoral head (ball) ad socket. This allows for a smooth gliding motion.

What home planning should I do?

Before having a total hip replacement, you should arrange to have someone drive you home from the hospital. In addition, you may need someone to stay with you for a few days. The following items can help you with activities after surgery:

  • A raised toilet seat
  • Securely fastened handrails in bath or shower
  • Handrails along stairs.
  • Reclining chair or stable chair with ottoman
  • Long-handled sponge
  • Shower hose
  • Shower chair
  • A “reacher” that lets you grab objects
  • Firm pillows

What can I expect during recovery?

You may need to stay in the hospital 1-3 nights. The nurses will work with you to control pain, and a physical therapist starts to work with you to help you learn exercise to improve hip flexibility and mobility. The orthopedic surgeon wants you to get up and walk around (with help) as soon as possible. You should be able to resume normal activities within 3-6 weeks after surgery. Sutures or staples will be removed 7-14 days after your surgery. You must avoid getting wounds wet, and use bandages to prevent irritation to the wounds.

Do THA procedures work?

Total hip arthroplasty has been proven to decrease pain and increase function in persons with severe hip arthritis. In one clinical study, researchers evaluated THA in people who are in their 80s. They found that 80% of study participants were pain-free after recovering from surgery, and could walk without assistance at the follow-up. They concluded that total hip replacement was safe and effective for elderly people.

The top hip replacement doctors in Arizona are with OSPI. They offer anterior approach procedures that are available outpatient or next day going home. Call us today!

 

Recovery after Carpal Tunnel Surgery

carpal tunnel syndrome2

One of the most common operations done today is carpal tunnel surgery. The goal of surgery is to relieve pressure on the median nerve. For many patients, improvement is noticed right away. For other patients, the pain stops, but full recovery of sensation is not always possible.

What will my sensation and strength be like after surgery?

Most patients describe a tingling or numbness after the carpal tunnel procedure. The return of sensation depends on severity of nerve compression, duration of symptoms, general health, age, and circulation. In severe cases, decompressing the nerve may not help gain full recovery of sensation. There are many reasons why the hand with carpal tunnel does not feel as strong as the other hand. This is often related to decreased sensation, which improves after carpal tunnel release. While some muscle recovery is likely after surgery, it is not always possible to regain full function.

What can I expect immediately after surgery?

After carpal tunnel surgery, you will be in a small surgical dressing with a piece of plaster splint in place along the wrist. Most of the palm and fingers are free, however. A nurse monitors you in the recovery room before you are discharged home. You will feel some soreness and numbness of the affected region. You will return to the doctor’s office in 4-7 days to have the surgical dressing removed. If sutures are present, they are also removed.

What happens to the cut ligament after surgery?

After carpal tunnel surgery, the cut ligament heals, filing in the gap with new tissue. By preserving normal palmar tissue, less new growth of tissue fills in, which makes your palm feel normal.

Can I use my hand right away?

After your carpal tunnel surgery, you are encouraged to use your hand immediately, especially your fingers. You will have a dressing on the area, which must be kept clean and dry. For showers, you should cover the area with a plastic bag.

How long does it take to heal?

The time of healing varies from patient to patient, as no two people are alike. However, most people can perform light activities in 1-2 weeks, and heavy activities within 4-6 weeks. Most people only are off from work for 5-10 days. While you may feel better early on, it is advisable not to overdo it, as this may delay a full recovery.

Will I be in a lot of pain?

Many people report that recovery from carpal tunnel surgery is not painful, and they get by taking only over-the-counter pain medicine, such as Advil or Aleve. However, the surgeon will give you a prescription for pain medicine to ease your discomfort. If you take care of your hand and wrist, your pain will be minimal.

Will I need physical therapy?

Physical therapy is used to relieve palm stiffness and discomfort. The therapist works with you through range of motion exercises and helps you perform flexibility and strengthening activities.

What can I expect immediately after surgery?

After carpal tunnel surgery, you will be in a small surgical dressing with a piece of plaster splint in place along the wrist. Most of the palm and fingers are free, however. A nurse monitors you in the recovery room before you are discharged home. You will feel some soreness and numbness of the affected region. You will return to the doctor’s office in 4-7 days to have the surgical dressing removed. If sutures are present, they are also removed.

What can I do to relieve pain and recover sooner?

Hand exercises with a stress ball are important in the first few days after surgery. Be careful to not overdo this, however. Gradually increase your tolerance for squeezing and gripping, and move your finger often to avoid stiffness and tendonitis. You may benefit from use of a cool splint, which protects the area while providing reduction of swelling.

OSPI offers top orthopedic surgeons in Gilbert AZ who offer all types of general orthopedics, carpal tunnel release, joint replacement and more. Call us today!

What you need to Know about a Total Knee Replacement

A total knee replacement, also called a knee arthroplasty, involves resurfacing and replacing portions of the bones. The decision to have a total knee replacement is made between you, your family, and your orthopedic surgeon.

The Four Steps of a Total Knee Replacement

There are four basic steps to a total knee replacement procedure. These are:

[ File # csp9997688, License # 2179057 ] Licensed through http://www.canstockphoto.com in accordance with the End User License Agreement (http://www.canstockphoto.com/legal.php) (c) Can Stock Photo Inc. / Andreus

  • Prepare the bone – The damaged cartilage surfaces at the ends of the tibia and femur are removed along with a small amount of underlying bone tissue.
  • Position the implants – The removed bone and cartilage are replaced with prosthetic components that recreate joint’s surface. These parts are cemented, or press-fit components are used that grow into the bone.
  • Resurface the patella – The undersurface of the kneecap is cut and resurfaced with a plastic button.
  • Insert a spacer – A medical-grade plastic spacer is inserted between the prosthetic components to create a smooth gliding surface.

Candidates for a Total Knee Replacement

People who will benefit from a total knee replacement include those with:

  • Severe knee pain and stiffness that affects mobility and everyday activities, such as climbing stairs, walking, and risking out of chairs.
  • Moderate to severe knee discomfort with resting.
  • Chronic knee swelling and inflammation that doesn’t improve with medications or rest.
  • Knee deformity, such as bowing out or in of the knee.
  • Inability to improve after conventional treatments (physical therapy, medications, and cortisone injections).
  • Age of 50-80 years.

Orthopedic Evaluation

When you visit the orthopedic surgeon, an evaluation is done. This involves:

  • A medical history – The surgeon gathers information about your past and present conditions and surgeries.
  • Physical examination – This involves assessing the knee motion, strength, stability, and overall leg alignment.
  • X-rays – These images determine the extent of damage and deformity in the knee.
  • Other tests – Includes blood tests, MRI scans, and CT scans.

Preparing for Surgery

The orthopedic surgeon and you will schedule your total knee replacement after reviewing the procedure risks and benefits with you. Several tests are used to determine surgical fitness, including an electrocardiogram, laboratory tests, and urine evaluation. You need to notify the doctor of all your medications, as certain agents that thin the blood must be held for several days.

 

If you live alone, you need to make arrangements to have someone assist you when you come home from surgery. In addition, you should make some modifications to your home. The following items may help with daily activities:

 

  • Secure handrails on stairways
  • Safety bars in the bath/shower
  • A raised toilet seat
  • A stable shower chair
  • A stable chair with a firm seat cushion, a footstool, and a firm back
  • Removing all loose rugs, carpets, and cords

 

The Surgery

 

You will be given general anesthesia, which means you will be asleep and in no pain. After numbing the knee structures to help with post-operative pain, the surgeon makes incisions around the knee. If an arthroscope is used, a small camera and surgical tools are inserted into the incisions. The damaged bone and cartilage are removed, and then new metal and/or plastic implants are positioned. After making all resurfacing changes, the incisions are closed with sutures.

 

After Surgery

 

After the total knee replacement procedure, you are monitored in the recovery room for several hours. Once you wake up, you are moved to a hospital room. Most patients only stay overnight at the hospital, but this depends on your health status, the procedure, and the surgeon’s preference. Rehabilitation begins while you are in the hospital. A physical therapist works with you to help move the nee, and teaches you exercises to restore knee movement, flexibility, and strength.

 

Exercise is an important aspect of home care, especially during the first couple of weeks after total knee replacement. You gradually are able to resume normal activities of daily living, and advance to more rigorous activities after 3-6 weeks.

FAQs on Outpatient Knee Replacement (Rapid Recovery)

Outpatient joint replacement surgery does not require an overnight stay at the hospital. This procedure is known as a rapid recovery surgery, which means the patient is back to usual activities soon after the surgery.

What is knee replacement surgery?

Outpatient knee replacement surgery is a surgical procedure in which the damaged, worn joint surfaces are removed and replaced with artificial components (prosthesis). This rapid recovery procedure is done on an outpatient basis, allowing the patient to go home soon after the surgery.

Who is a candidate for rapid recovery knee replacement surgery?

Your doctor may consider this knee replacement procedure if you:

  • Have severe pain that limits your daily activities
  • Suffer pain that is not relieved with physical therapy, medications, and knee injections
  • Have an active lifestyle that requires you to be on your feet
  • Are in relatively good health otherwise
  • Have a high level of motivation during the rehabilitation process
  • Good family support

What are the benefits of rapid recover knee replacement surgery?

The benefits of outpatient knee joint replacement surgery include:

  • No overnight hospital stay
  • Earlier mobilization
  • Rapid recovery
  • Fewer complications
  • Improved pain scores
  • Increased patient satisfaction

How do I prepare for the rapid recover knee replacement procedure?

Before surgery, the doctor will do some preliminary tests and have you hold certain blood-thinning agents for several days. You should arrange to have someone drive you home, and leave all valuables at home. When you arrive at the surgical center, a nurse explains the procedure, and you must sign a consent form. After changing into a procedure gown, the nurse places an IV catheter in your arm.

How is the rapid recovery joint procedure performed?

The rapid recovery knee replacement procedure is performed almost the same as traditional joint replacement surgery. Smaller incisions and less tissue manipulation allows the patient to recover at home instead of in the hospital. The procedure is done under general anesthesia. The surgeon makes 1-2 small incisions, removes damaged joint components, and inserts the prosthesis. After making necessary repairs, the incisions are closed with sutures.

What can I expect after the procedure?

You will be monitored in the recovery area for around 1 hour. After being discharged, a nurse comes to the patient’s home to monitor the condition, and a physical therapy visits several days a week to instruct the patient on flexibility and range of motion exercises. We emphasize ambulating and weight-bearing as tolerated with a cane or single crutch. Pain medications are only to be used as needed, and we stress the use of short-term anti-inflammatory drugs.

What do the research studies show?

A group of researchers studied the safety and feasibility of outpatient knee replacement surgery in a group of individuals with unicompartmental knee osteoarthritis. All 105 patients (100%) were discharged on the same day of surgery, and none of them required readmission to the hospital. The researchers concluded that rapid recovery knee replacement was a feasible, safe procedure for the majority of patients.

In a review of 4,500 total hip and knee replacements, researchers found that following a strict multimodal enhanced recovery protocol reduced the 30-day death rate, length of hospital stay, requirements for blood transfusion, and chance of heart attack, stroke, and pulmonary embolism. The protocol involved behavioral, procedural, and pharmacological modifications, such as use of certain medications before surgery and physical therapy after surgery.

Resources

Cross MB & Berger R (2013). Feasibility and safety of performing outpatient unicompartmental knee arthroplasty. Int Orthop, 38(2), 443-447.

Malviya A, Martin K, Harper, I, et al. (2011). Enhanced recovery program for hip and knee replacement reduces death rate: A study of 4,500 consecutive primary hip and knee replacements. Acta Orthop, 82(5), 577-581.

JOIN OUR E-MAIL LIST!