Arthritic Hips and Knees

Getting you back to your active life is our goal.

Osteoarthritis, tendonitis, ligament and cartilage injuries, along with wear and tear over time on the joint can compromise a hip or knee, causing pain that interferes with the activities of daily living. If you are having difficulty getting in and out of a car or even walking to the mailbox without pain, it’s time to consider a joint replacement. In fact, many patients experience such a quick recovery, they frequently comment on how they wish they had had the surgery sooner. During the procedure, the surgeon will remove the damaged portion of your hip or knee joint and replace it with a prosthesis that is right for you. You will have a full team of rehabilitation experts to help you recover your activity level and return to your life.

Preoperative Education

Total Joint Class

All patients undergoing joint replacement surgery are encouraged to attend our preoperative total joint class where many of their questions can be addressed. This patient education is designed to alleviate any anxiety patients may feel prior to their surgery. At the class patients are screened, and if necessary, treated for methicillin-resistant Staph aureus (MRSA) bacteria colonization. Patients colonized with MRSA have been shown in studies to be at higher risk for postoperative infection. Identification and treatment to eliminate it prior to the surgery minimizes the risk of this complication. Patients are also screened for anemia and, if found to have low hemoglobin levels, are referred to our hematology department for treatment prior to the surgery. This process dramatically lowers a joint replacement blood transfusion which is important since they can slow rehabilitation, lengthen hospital stay and increase the risk of wound infection.

Procedures

Hip resurfacing

When there is a relatively healthy “ball” (also called the femoral head) of the hip joint, that upper end of the femur is capped rather than replaced.

Anterior total hip replacement

One of the most innovative methods, the anterior approach to hip replacement involves making an incision from the side using a special table—called a Hana table. Since there is less trauma, there is less residual pain, resulting in a quick recovery. There are limited surgeons that are able to perform this procedure. Bayhealth has two fellowship trained surgeons that specializes in this approach.

Total hip replacement

If both the “ball” or femoral head and the femoral stem of the hip, along with the hip socket itself, are damaged, surgeons remove them and replace them with an artificial stem and socket. These typically consist of a metal or ceramic head and metal cup with a plastic liner. The surgery may be performed using a minimally invasive technique, which involves a shorter incision and typically a faster recovery.

Partial knee replacement

If you suffer from arthritis in only one compartment of your knee, you may be a candidate for a partial knee replacement. During this procedure, a small incision is made to access the affected area. The cartilage and bone tissue that are affected are removed and replaced with prosthesis components.

Total knee replacement

During a total knee replacement, all of the cartilage surfaces of the knee are replaced with metal implants and a plastic liner. The surrounding ligaments and muscles are preserved to maintain stability. A minimally invasive technique is used for most total knee replacements during which the quadriceps muscle is not violated or “cut”. This results in less pain and quicker functional recovery.
 

Rehabilitation and education

As soon as the patient is stable, our physical and occupational therapy team will begin the rehabilitation process.  The team instructs patients and their families on the goals of rehabilitation and gives them exercises and guidelines for activity. The team also educates them on how to prepare the home for the patient’s return and explains precautions they should take to avoid falls both during the rehabilitation phase and in the future.
 

Pain management protocols

Managing and minimizing pain after joint replacement surgery is important to enhance both patient comfort and recovery goals of improving range of motion and early ambulation. One option for patients undergoing total knee replacement is to receive a nerve catheter placed by the anesthesiologist.  This is done prior to surgery which provides a continuous anesthetic to the major nerve in the thigh resulting in improved pain control and a reduction in the need for oral and intravenous narcotic drugs. This in turn decreases the incidence of narcotic-related side-effects such as delirium, nausea and constipation, which can slow the rehabilitation process.  Another option offered is a consult with an in-house pain management specialist who will work with the surgeon to best manage the patient’s pain.