Hip/Knee
Hip Replacement
Most damaged hips are the result of osteoarthritis or “wear-and-tear” arthritis, a degenerative type of arthritis that causes the cartilage to wear away over time so the bone ends rub together. Other common causes of hip degeneration include rheumatoid arthritis, trauma, osteonecrosis (bone decay), prior surgeries, and tumors.
Joint replacement surgery removes the damaged, painful parts of the hip and replaces them with a prosthesis made of metal and plastic. The artificial joint can relieve pain and improve mobility when your natural hip can no longer do its job. An artificial ball and metal stem replaces the worn head of the thigh bone and a metal cup and artificial liner replaces the worn socket of the pelvis. The prosthesis allows the hip joint to move smoothly, so patients can enjoy a greater range of pain-free movement.
Treatment Options
Patients with arthritis of the hip may find relief in a number of non-surgical treatments before considering replacement surgery. The goals of these treatments are to relieve pain, to increase mobility and restore quality of life. Patients often try some combination of the following:
- Exercise and Life Changes
- Assistive Devices – Orthotics, Cane
- Physical Therapy
- Alternative Therapies such as Nutraceuticals and Dietary changes
- Medication
- Hip Arthroscopy
- Hip Replacement surgery
Hip Arthroscopy
In certain circumstances, the specific symptoms and presentation of a patient’s condition warrants arthroscopic evaluation and repair. In such instances our Sports medicine physicians can provide appropriate treatment through hip arthroscopy.
Hip Replacement
If the pain and stiffness of the hip joint is severe and other treatments have not brought sufficient relief, a hip replacement may be recommended. Our doctors will conduct a thorough examination that includes x-rays, strength and range-of-motion tests, a medical history and a series of questions to determine whether a total hip replacement is right for you.
Recent advances in surgical technology make it possible to perform minimally invasive joint replacements. Traditionally, an incision of 10-12 inches was needed for hip replacement surgery. Now, for patients who qualify, the same procedure can be performed with smaller incisions. There are other advantages to these techniques that may help make the surgery safer and allow patients to enjoy a potentially faster and less painful recovery. Our doctors will discuss with you whether you are a candidate for minimally invasive hip replacement surgery.
Modified, “direct Anterior” Hip replacement
Our Physicians have the most extensive experience with Direct anterior approach hip arthroplasty in the Tucson Area, and are amongst the first nationwide to adapt and perform this surgery in their practice. The direct anterior approach offers the patient a truly Mini-Incision hip replacement with the added benefit of minimal dissection, significantly decreased likelihood of dislocations and “no tendon or muscle resection”. Out typical Modified direct anterior patient has a faster rehabilitation course as well as shorter hospital stay (1-2 days).
Hip Resurfacing/ Resurfacing Arthroplasty
In patients with increased lifestyle demands and activity requirements, and those who are younger in age with good bone stock Hip Resurfacing offers a fantastic solution that will provide for minimal bone resection and maximal range of motion.
“Mini-Incision” Hip Replacement
Mini-Incision hip replacement offers several advantages over traditional joint replacement surgery, including a potential for faster rehabilitation, smaller incision and a shorter hospital stay (1-2 days).
2-Incision Hip Replacement
One of the major advantages of 2-Incision hip replacement is that the surgeon is able to separate or avoid many of the muscles, ligaments and tendons around the joint instead of cutting through them. This leads to less tissue damage and blood loss during surgery. Because the 2-Incision technique involves very small incisions as well (only 1.5-2 inches each), patients experience a faster and less painful rehabilitation and a shorter hospital stay (only one day) than is possible with traditional hip replacement surgery.
Revision – Hip
Total hip replacement is successful in over 95% of well-selected patients. On average, replacements last 15-20 years. Some patients enjoy full use of the prosthesis after 25 years or longer. Occasionally, an implanted prosthesis does not function as well as it was intended to. In this case revision surgery may be performed to adjust or replace the mechanism. All or only parts of the prostheses may require removal and replacement.
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Knee
Knee conditions vary in their presentations and severity of the symptoms, and may naturally require a stepwise approach to their treatment.
Treatment Options
Patients with repetitive use and over use injuries, as well as acute sports injuries and arthritis of the knee may find relief in a number of non-surgical treatments before considering surgery. The goals of these treatments, as are the goals of treatment for all our patients, are to relieve pain, to increase mobility and restore quality of life. Patients often try some combination of the following:
- Exercise and Life Style Changes
- Assistive Devices – Orthotics, Cane
- Physical Therapy
- Alternative Therapies such as Nutraceuticals and Dietary changes
- Medication
- Knee Arthroscopy, and arthroscopic surgeries
- Knee Replacement surgery
Knee Surgery
The knees are the strongest joint in the human body, allowing the legs to bend and straighten while carrying almost all of the weight of the individual when they are standing. The knees are a hinge joint, but still have substantial capacity for lateral (side-to-side) motion.
As an active, weight-bearing joint, the knee is a source of pain and problems for many people. This pain may be acute or chronic, and may be a result of injury, overuse or growth. It can stem from the tendons, ligaments, bones, cartilage or any other structure within the knee. Some of the most common knee conditions include:
- Arthritis
- Bursitis
- Dislocated kneecap
- Meniscal tear
- Ligament injuries
- Patellar tendonitis
Patella Injuries
The patella, commonly known as the kneecap, helps increase leverage and support within the knee joint. Pain may develop in the patella as a result of overuse or injury, and often causes a fracture. Patella fractures can involve a single crack across the kneecap or a break into several pieces, and usually causes severe pain and swelling.
Surgery may be required for more intense patella fractures, and aims to repair the patella by realigning the fractured ends and holding them in place with pins, screws and wires. Part of the bone may just be removed in smaller fractures. During the healing process, the knee must be kept straight, and patients will often undergo physical therapy to help restore movement to the joint.
ACL Injury
The anterior cruciate ligament (ACL) works together with the other ligaments in the knee to connect the femur to the tibia and support the knee joint. A tear in the ACL is one of the most common knee injuries, causing the joint to become unstable and slide forward too much. This injury occurs most often in athletes and causes pain, swelling, tenderness and limited motion.
ACL reconstruction is usually not performed until several weeks after the injury, when swelling and inflammation have been reduced. The torn ligament is completely removed and replaced with a new ACL. Simply reconnecting the torn ends will not repair the ACL. Part of another ligament, usually in the knee or hamstring is used to create a graft for the new ACL.
Arthroscopy
Arthroscopy offers patients many benefits over traditional surgery, including no need to cut muscles or tendons, less bleeding, smaller incisions and shorter recovery times. However, arthroscopy is not appropriate for all patients. Your doctor will decide whether or not arthroscopy is right for you.
Some knee conditions that can often be treated through arthroscopy include meniscal tears, ACL or PCL tears, synovitis, patellar misalignment, arthritis and more. During the arthroscopy procedure, a thin tube with a camera on the end (arthroscope) is inserted into the joint, along with several tiny surgical instruments so that your surgeon can adequately visualize the area while repairing any damage that is found.
Total Knee Replacement
A knee replacement is recommended for patients with arthritis and certain knee injuries or diseases that have not responded well to conservative treatments such as anti-inflammatory medications or cortisone injections. The replacement devices are designed to relieve pain caused by cartilage damage, and usually last up to 20 years in most patients.
During the knee replacement procedure, the entire joint is replaced with an artificial prosthesis. The end of the femur is replaced with a metal shell, while the end of the tibia is fitted with a plastic cup and metal stem that fit into the shell. The posterior cruciate ligament and kneecap may be replaced if needed or may be left in place. This procedure can take up to three hours to perform and usually provides immediate pain relief and a return to regular activities.
Shape Fitting technologies and computer assisted Navigation:
Alignment and anatomy are the most important considerations in any joint replacement surgery and specially so in Knee replacement surgery. The knee is comprised of 3 separate articulations, optimal replacement will have to move in unison and in concert to replicate the motion of the native articulation. In order to increase satisfaction in our patients, we strive to restore our patient’s native anatomy and biomechanics. The initial advance in knee arthroplasty utilized by our surgeons was through use of computer assisted navigation, now with the advent of MRI based native anatomical matching technology such as (OTIS-Med®) Custom-FIT®, and (Smith and Nephew®) Visionair®, our surgeons replace your native worn-out knee with a custom fitted knee replacement in your native alignment.
