Re: Re: Marla- How much weight? FYI

[Guest guest]

General Questions

* _Will this surgery get rid of all my pain?_

(http://ortho.muhealth.org/hipandknee/generalquestions.html#pain)

* _Do knee replacements hurt more than hip replacements?_

(http://ortho.muhealth.org/hipandknee/generalquestions.html#hurt)

* _If my hip is arthritic, why does my knee hurt?_

(http://ortho.muhealth.org/hipandknee/generalquestions.html#arthritic)

* _How much pain can I expect with a hip or knee replacement?_

(http://ortho.muhealth.org/hipandknee/generalquestions.html#expect)

* _How much physical therapy will I need after surgery on my hip or

knee?_ (http://ortho.muhealth.org/hipandknee/generalquestions.html#pt)

* _H_

(http://ortho.muhealth.org/hipandknee/generalquestions.html#howlong) _ow long do

artificial hip and knee joints last?_

(http://ortho.muhealth.org/hipandknee/generalquestions.html#howlong)

* _My knee is degenerative and I am not ready for a replacement. Will

arthroscopic surgery help?_

(http://ortho.muhealth.org/hipandknee/generalquestions.html#arthroscopy)

* _Will I gain or lose any leg length as a result of my surgery?_

(http://ortho.muhealth.org/hipandknee/generalquestions.html#length)

* _H_

(http://ortho.muhealth.org/hipandknee/generalquestions.html#howmany) _ow may

joints can one have replaced?_

(http://ortho.muhealth.org/hipandknee/generalquestions.html#howmany)

* _H_ (http://ortho.muhealth.org/hipandknee/generalquestions.html#scar)

_ow big will my scar be?_

(http://ortho.muhealth.org/hipandknee/generalquestions.html#scar)

* _I have arthritis of the hip or knee joint. The joint surfaces are

rough instead of being smooth; so won’t therapy and exercise before surgery

hurt the joint?_

(http://ortho.muhealth.org/hipandknee/generalquestions.html#rough)

* _With the new, minimally invasive surgery methods, should I not go

ahead and have my joint replaced, or should I wait longer?_

(http://ortho.muhealth.org/hipandknee/generalquestions.html#wait)

* _Another orthopaedic surgeon looked at my knee or hip x-rays and

said that the arthritis is really bad. I was advised to have surgery done

quickly, because waiting will only make things worse. Can I safely wait in

such a

situation?_

(http://ortho.muhealth.org/hipandknee/generalquestions.html#another)

* _How much do the implants weigh? What are they made of?_

(http://ortho.muhealth.org/hipandknee/generalquestions.html#weight)

Will this surgery get rid of all of my pain?

This question goes to the very heart of expectations and disappointments

after surgery. If you have pain that is coming from elsewhere, i.e., another

source besides the replaced joint, that pain will continue after surgery. Such

pain may be caused by osteoarthritis, rheumatoid arthritis, fibromyalgia, back

disease, poor circulation or damaged nerves. Such pre-existing conditions

continue after surgery and may compromise the result of joint replacement

surgery.

An artificial joint made of metal and plastic is no match for the real

thing. It takes time and re-education of muscle, ligaments, tendons, nerves and

the brain to get accustomed to an artificial joint. In some instances, a

low-grade, mild pain may persist for several years despite an otherwise

successful

result.

Artificial joint replacement of the hip and knee should therefore be

considered if, and only if:

* All other methods of treatment have failed to help you.

* You have debilitating and severe pain with loss of function.

* You are emotionally and psychologically prepared for surgery.

* You have a thorough and comprehensive understanding of the operation

and the potential outcomes.

Experience shows that motivated patients who satisfy these criteria and keep

a positive outlook typically have the best results.

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(http://ortho.muhealth.org/hipandknee/generalquestions.html#top)

Do knee replacements hurt more than hip replacements?

People perceive pain in highly individual ways. Generally, knee replacements

tend to be more painful. Why? Heavy muscles cover and support the hip joint,

whereas the knee joint is close to the skin. The nerves that carry pain

sensations from the hip and knee joints differ. After knee replacement, the

physical therapist pushes you to move the knee and regain mobility, whereas

with a

hip replacement, the therapist has less of a role, other than teaching you

how to walk with assistive devices.

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(http://ortho.muhealth.org/hipandknee/generalquestions.html#top)

If my hip is arthritic, why does my knee hurt?

Pain refers from the arthritic hip to the knee. This happens in other places

in the body. For example, a heart attack can manifest as shoulder and arm

pain that goes up the neck. The nerves that supply the hip joint also supply

the knee joint. Even though you may feel pain in your knee, it might actually

come from your hip joint. Addressing the hip problem will lead to pain relief

in the knee in such situations.

With one major arthritic joint, it is not uncommon for people to limp,

compensate or alter their gait. Even subtle compensation can cause pain

developing

in adjacent joints. People with a diseased hip may develop back and knee

pain, or pain in the opposite hip and knee. People with major arthritis in one

joint sometimes have arthritis in other joints. When you protect a diseased

and worn-out joint during load bearing, other joints bear the weight and that

can lead cause them to hurt. Taking care of the worn-out joint usually

relieves some, or all, of the pain radiating to other locations.

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(http://ortho.muhealth.org/hipandknee/generalquestions.html#top)

How much pain can I expect with a hip or knee replacement?

These days, not very much at all. Most patients are pleasantly surprised at

how little pain is present early on. Later, as sore muscles start moving, and

muscles weakened by long standing arthritis start to gain strength, some

aches and pains are inevitable.

Many reasons explain the decreased after first-time hip or knee joint

replacement surgery. One, the anesthesia techniques have advanced. We were

using

_femoral nerve blocks and spinal anesthesia_

(http://www.reddinganesthesia.com/spinal.htm) which greatly reduce or eliminate

pain after surgery. Since the

femoral nerve blocks also make it difficult for the patient to move the leg

during therapy, we recently switched to a continuously infusing “pain

busterâ€

pump that drips an anesthetic drug directly into the joint via a thin

catheter for 24-48 hours after surgery; with this modality, we have been able

to

eliminate the need for any nerve block since patients do not hurt. (Find more

information at _http://.askyoursurgeon.com/howitworks.php_

(http://askyoursurgeon.com/howitworks.php) and _http://www.iflo.com_

(http://www.iflo.com/) )

The anesthetic infusion serves to block the pain fibers right at the surgical

site.

In addition to the above, we also inject a mixture of anesthetic and

anti-inflammatory drugs directly into the knee tissues during total knee

replacement. This helps with post-surgical pain relief considerably.

Finally, we begin anti-inflammatory, anti-nausea, anti-constipation, and

narcotic pain medications before the surgery, right when you are in the

pre-surgical area getting prepared for surgery. By pre-empting nausea, pain,

constipation, and the other unpleasant side-effects of surgery, the overall

experience is improved considerably, compared to what we did just a few years

ago.

None of this changes the fact that ANY surgery is still a serious

undertaking, and is associated with certain risks and side-effects that you

need to

know about, no matter how rare their occurrence. For a description of things

that can go wrong in surgery, please click _here_

(http://ortho.muhealth.org/hipandknee/13things.htm) .

_Back to the top_

(http://ortho.muhealth.org/hipandknee/generalquestions.html#top)

How much physical therapy will I need after surgery on my hip or knee?

With the two-incision hip replacement, physical therapy is needed only to

help you learn to use a walker or crutches, and instruct you on partial weight

bearing. For a month after surgery, usually home health will help you with

therapy and exercises at home. Few, if any total hip patients now need

extensive therapy because the muscles are not cut as they used to be with our

latest surgical methods. An occasional patient may need therapy after the one

month interval, and this can be addressed on an individual basis.

With the new minimally invasive knee techniques, about half of our patients

do not need any physical therapy beyond one month. During the first month,

the therapy is at home anyway. The rest of the patients need outpatient

physical therapy that we can arrange on an individual basis.

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(http://ortho.muhealth.org/hipandknee/generalquestions.html#top)

How long do artificial hip and knee joints last?

For most patients who undergo an expertly-executed hip or knee replacement

procedure, the implants should last the rest of the life of the patient.The

15-20 year data on the longevity of total hips and total knees is very

encouraging. More than 90 percent of the implants still function well in many

studies. This is not a guarantee or assurance. Many things can go wrong, such

as

fractures, implant failure, late infections and deterioration in your overall

health.

Joint replacement longevity depends on:

* How well you take care of yourself and your health.

* Understanding and respecting the limitations of a prosthetic

lifestyle.

* Activity level.

* Understanding that things like running, racquetball, tennis,

jogging, jumping and high-impact aerobics or sports compromise the longevity of

your

prosthetic joint.

_Back to the top_

(http://ortho.muhealth.org/hipandknee/generalquestions.html#top)

My knee is degenerative and I am not ready for a replacement. Will

arthroscopic surgery help?

It depends on the extent of arthritis. If the pain suddenly turns worse, or

the knee catches or locks, then arthroscopy often helps relieve acute

symptoms. In almost all cases of knee arthritis, the arthroscopic procedure

allows

us to make a couple of small holes, look inside the knee, get an idea of the

extent of the degenerative change, shave off and remove any loose pieces, and

trim away any sharp, torn cartilage edges. Almost everyone feels better after

such a procedure.

Whether such a procedure will help in your specific case is an individual

decision. Arthroscopy can be very useful at temporizing the situation and might

be preferable to a complete knee replacement. Arthroscopy does not prevent

the eventual need for further surgery. In most cases, arthritis progressively

destroys joints and makes further surgery inevitable.

For information on arthroscopic hip surgery, follow_ this link._

(http://ortho.muhealth.org/hipandknee/procedures.html#arthro)

_Back to the top_

(http://ortho.muhealth.org/hipandknee/generalquestions.html#top)

Will I gain or lose any leg length as a result of my surgery?

It is not possible to gain or lose leg lengths to any significant degree

with a knee replacement, because your ligaments guide how thick the

polyethylene

insert can be. Whatever is taken out of the knee joint must be replaced with

artificial parts in order to balance the knee for optimal performance.

During hip replacement, because the ball at the top of the femur is removed

entirely, the surgeon has more control of your leg lengths. In most, if not all

cases it is possible to nearly equalize leg lengths after hip replacement,

keeping in mind that normally, our two legs are not quite equal to begin with.

We

aim to reproduce the pre-existing leg lengths, but slight lengthening is

sometimes necessary to achieve optimal stability in a hip replacement and avoid

the complication of dislocation of the artificial parts.

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How may joints can one have replaced?

It is possible to have multiple joints replaced safely. It is wisest and

safest to get these done one at a time, starting with the worst one first. Some

of our patients have had more than a single hip or knee replacement. In

certain instances, it is possible to have both hips and both knees replaced

with

artificial implants.

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(http://ortho.muhealth.org/hipandknee/generalquestions.html#top)

How big will my scar be?

The routine hip replacement can be done through two incisions. One is about

an inch long. The other is anywhere from two to four inches, depending on the

size of the patient, the degree to which the tissues are contracted from

long-standing degenerative disease, and the degree to which the hip is

deformed.

Most knee replacements require a four-inch incision, with variability

necessary to accommodate each patient's individual anatomy and needs.

The size of the incision does not affect healing, although who would not

prefer a smaller incision? The key is what the surgeon does once the incision

is

made. With the MIS-2-incision total hip procedure, the muscles are simply

pushed apart, and the recovery is dramatically better than with any standard

hip approach, regardless of the size of the incision. Patients who have had

this procedure on one side, and the standard, traditional approach on the other

side for a prior hip replacement cannot stop telling us how much easier and

faster the recovery with the MIS-2-incision hip replacement is. Likewise, in

knee replacement, independent of the size of the skin cut, the key is not to

invade the quadriceps muscle. Traditional knee replacement surgery required

that the quadriceps muscle be cut for exposure, and then re-stitched. By using

custom instruments that we have designed in our operating rooms over the

past several years, and by sharing our experiences with colleagues elsewhere

around the country, we can spare the quadriceps muscle, resulting in a much

easier and quicker recovery.

_Back to the top_

(http://ortho.muhealth.org/hipandknee/generalquestions.html#top)

I have arthritis of the hip or knee joint. The joint surfaces are rough

instead of being smooth; so won’t therapy and exercise before surgery hurt

the

joint?

No, the human joints are living tissues and they respond very well to a

regular program of light, aerobic exercise when osteoarthritis develops.

Proper

nutrition, regular exercise, weight loss, and over-the-counter

anti-inflammatory medications help relieve the pain of osteoarthritis. These

non-surgical

methods should always be considered before embarking upon any surgery.

_Back to the top_

(http://ortho.muhealth.org/hipandknee/generalquestions.html#top)

With the new, minimally invasive surgery methods, should I not go ahead and

have my joint replaced, or should I wait longer?

New technology, easier surgical methods, and better implants should never

enter your decision making process to embark upon any surgical intervention.

It is imperative that you try non-surgical methods described elsewhere on this

web site first. Surgery is always the last option; and it is best avoided

if possible. Joint replacement surgery is always a salvage procedure for your

own joint that is worn out. So, it is best to wait until you have

uncontrolled pain, or if the symptoms otherwise interfere with living your

life. No

matter how advanced our surgical methods get, the fact remains that the joints

you were born with are the best that nature offers. Keep them as long as

you possibly can.

_Back to the top_

(http://ortho.muhealth.org/hipandknee/generalquestions.html#top)

Another orthopaedic surgeon looked at my knee or hip x-rays and said that

the arthritis is really bad. I was advised to have surgery done quickly,

because waiting will only make things worse. Can I safely wait in such a

situation?

Yes. Waiting till symptoms dictate the need for surgery is always wise. Do

not let any doctor, no matter how well-intentioned, talk you into surgery.

You can safely wait; the deformity of arthritis can always be easily

corrected by surgery. About the only downside to waiting is that as muscles

get

weaker, the recovery from surgery may take a little longer. You can of course

avoid this by maintaining reasonable body weight, and a program of light

exercise to keep your muscles in shape. We have performed surgery on even

severely

deformed knees and hips that have been misshapen since birth or since an

accident during childhood. Experience shows that even those patients who have

waited for many years with an arthritic joint do very well after joint

replacement surgery. There is never any hurry to rush into elective,

first-time

joint replacement surgery.

One exception applies to revision, or re-do surgery. If your joint was

replaced many years ago, and the wear particles are starting to dissolve bone,

we

may advise you to have surgery sooner rather than later. This is to avoid

further compromise of bone. Another exception applies to joints that have a

suspected infection of the prosthetic device. In those cases, corrective

surgery is recommended early, so that the infection does not penetrate the

bone.

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How much do the implants weigh? What are they made of?

The usual hip and knee parts are made of metal alloys, commonly

cobalt-chrome and titanium. Both are extremely durable, and inert, i.e., they

do not

react with the body. For the bearing parts, i.e., that parts that do the

actual

moving, ultra-high molecular weight polyethylene is the most common bearing,

followed by polished metal, and ceramic. In a primary, i.e., first-time hip

or knee replacement, the parts weight around 5 pounds or so, which is more

than the weight of the bone we remove. But, given the strength of human

muscles, you will not feel any change in weight. The knee or hip may feel

tired

easily early on in your recovery, but as you gain strength, this will

disappear. So, in summary, the artificial parts weigh more than what we take

out,

but this fact is of little, if any, clinical consequence

In a message dated 10/30/2006 3:54:24 P.M. Central Standard Time,

mjs93311@... writes:

Marla, I don't know how much they weigh, but titanium is light, right?

So they shouldn't change your weight a significant amount. That is my

best guess.

Marta

> Marta, how much do two sets of titanium knee replacements weigh? I

thought

> I would gain and initially I did.