Joint replacement surgery gets patients moving again
From SJ Magazine (October 2012 edition)
When Westampton's David Hsula was told he would need hip replacement surgery, the active 44-year-old went into denial.
"I ride my bike to work every day - six miles each way - and I compete in triathlons. I have a passion for fitness, and being active is part of my daily routine," he says. "When you exercise as much as I do, aches and pains come with the territory, so I initially thought I could just tough out the pain and avoid surgery. I didn't want to undergo a surgery that would force me to limit my activity."
Hsula initially ignored the advice of his physician and spent several months walking with a pronounced limp. He battled constant pain. "The pain wasn't confined to my hip. Since I could barely walk, I felt the effects in my ankles, knees and back," he says. "I finally got to the point where I couldn't take it anymore, so I went back to the doctor.
"The first question I asked was, 'How debilitating is this going to be?' Before undergoing surgery, I wanted to be sure I would still be able to lead an active life."
Hsula's concerns are not uncommon, says Scott Schoifet, MD, medical director of the Virtua Joint Replacement Institute in Voorhees. "Patients want to know that they will be able to do everything they need to do - and love to do - once they're back home."
Hsula was able to have his surgery through a minimally invasive technique. "We use what's called the 'quad-sparing' technique for total knee replacements," says Schoifet, "which eliminates the need to cut the quadriceps tendon and allows patients to return to normal activities faster."
The procedure only requires a three- to four-inch incision, which allows patients to quickly walk with more stability and support compared to more invasive methods. "This means that many patients can undergo same-day total knee replacement surgery. Most people can't believe they can go home the same day," says Schoifet.
Smaller incisions are also used in hip replacement surgeries, and because the surgeon is often able to cut through less tissue, muscle and nerves, there is less trauma to the body, explains Schoifet.
In Hsula's case, this meant he was out of bed the same day as his hip replacement surgery. "I was getting around with a walker the next day, and felt a little better every day," he says. "In two weeks, I was walking with a cane, and I was back on my bike within eight weeks."
Doctors also credit Hsula's speedy recovery to the education before surgery. "Before any procedures are performed, patients undergo a pre-surgery class so they understand the process, and everyone is on the same page," says surgeon Rajesh Jain, MD.
"This approach helps the team and the patient stay on top of any pain. It's helpful in reducing potential complications like blood clots and infection, motivates patients to get moving as quickly as possible in physical therapy and is more cost effective," adds Jain.
Patients also begin physical therapy as soon as possible after surgery. "The faster a patient can get up on his feet," says Schoifet, "the easier it will be to recover, complete rehab and get back to everyday activities."
The therapy process actually begins before surgery, says Jain. "During the pre-surgery class, we make sure patients understand it's mandatory that they be seen by a physical therapist the day of surgery. Even if it's 7 or 8 pm before the patient is out of recovery, the therapists will still see the patient. If they're not able to get out of bed at that point, the therapists are at least showing them the exercises they'll be doing the next day."
The therapists also encourage patients to set lofty goals for each therapy session. "Some post-op therapy says the patient should get up and walk 20 feet. If they are able to do that, they've hit their goal and therapy is done for the day," says Jain. "Here, if the patient walks 20 feet, great. But instead of calling it quits, we ask, 'What else can you do? Can you walk another 20 feet?' We want them to keep trying - within reason, of course - because the more they move, the better their outcomes."
"Right now, the fastest growing age group for joint replacements is patients between ages 45 to 55," says Schoifet. "As that population continues to age and their joints wear out, we expect to see the need for joint replacement surgery to increase six-fold over the next 20 years."