At the Valley Hip and Knee Institute, we specialize in the latest joint replacement techniques and minimally invasive procedures, helping you to regain your mobility and resume the activities you love.
Being prepared for what to expect before, during, and after joint replacement surgery will help make it a less intimidating experience.
Erik Zeegen, MD is here to discuss hip and knee replacement and how Valley Hip and Knee Institute is leading the way.
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Hip and Knee Replacement from Valley Hip & Knee Institute
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In caring for his patients, Dr. Zeegen uses the latest medical technologies, including minimally invasive techniques, as well as sophisticated knee pain and hip pain management protocols. His care philosophies and practices allow his patients the greatest opportunity of returning to an active lifestyle with the least amount of postoperative pain and discomfort. Dr. Zeegen also offers transfusion-free surgery to those patients who request it.
Dr. Zeegen is an Assistant Clinical Professor of Orthopaedic Surgery in the Department of Orthopaedic Surgery at the UCLA School of Medicine. He has authored numerous academic papers and textbook chapters about hip and knee replacement surgery, and has presented talks on the topic at national and international meetings.
A native of Southern California, Dr. Zeegen is a graduate of the University of California, Los Angeles Medical School. He completed his internship and orthopaedic surgery residency at UCLA, took a fellowship in orthopaedic surgical oncology at Massachusetts General Hospital and Boston Children’s Hospital, and completed his fellowship in adult reconstructive surgery at Boston’s New England Baptist Hospital.
Dr. Zeegen is a member of the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons, the Musculoskeletal Tumor Society, the California Orthopaedic Association, and the American Medical Association.
Erik Zeegen, MD
Erik N. Zeegen, MD, is board-certified in orthopaedic surgery and one of Southern California’s leading joint replacement surgeons specializing in surgery of the hip and knee.In caring for his patients, Dr. Zeegen uses the latest medical technologies, including minimally invasive techniques, as well as sophisticated knee pain and hip pain management protocols. His care philosophies and practices allow his patients the greatest opportunity of returning to an active lifestyle with the least amount of postoperative pain and discomfort. Dr. Zeegen also offers transfusion-free surgery to those patients who request it.
Dr. Zeegen is an Assistant Clinical Professor of Orthopaedic Surgery in the Department of Orthopaedic Surgery at the UCLA School of Medicine. He has authored numerous academic papers and textbook chapters about hip and knee replacement surgery, and has presented talks on the topic at national and international meetings.
A native of Southern California, Dr. Zeegen is a graduate of the University of California, Los Angeles Medical School. He completed his internship and orthopaedic surgery residency at UCLA, took a fellowship in orthopaedic surgical oncology at Massachusetts General Hospital and Boston Children’s Hospital, and completed his fellowship in adult reconstructive surgery at Boston’s New England Baptist Hospital.
Dr. Zeegen is a member of the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons, the Musculoskeletal Tumor Society, the California Orthopaedic Association, and the American Medical Association.
Transcription:
Hip and Knee Replacement from Valley Hip & Knee Institute
Melanie Cole (Host): Being prepared for what to expect before, during, and after joint replacement surgery can help make it a less intimidating experience. And at the Valley Hip and Knee Institute, they specialize in the latest joint replacement techniques and minimally invasive procedures that help you regain your mobility and resume the activities that you love. My guest today is Dr. Erik N. Zeegen. He’s associate medical director of the Valley Hip and Knee Institute, and he’s a board certified orthopedic surgeon and one of Southern California’s leading joint replacement surgeons specializing in surgery of the hip and knee. Welcome to the show, Dr. Zeegen. Tell us a little bit about what would require somebody to need hip and/or knee surgery. What kind of conditions are you thinking about?
Dr. Erik N. Zeegen (Guest): Well, the most common condition that we see in people that are going to need their hip or knee replaced are people who have severe osteoarthritis. There are other various arthritis conditions, but the most common is osteoarthritis, which is the wear and tear of the joint where the cartilage starts to wear out and people start to develop bone-on-bone situations. In the hip, that usually presents as groin pain; in the knee, knee pain that is associated with deformities, contractures. Basically, we’re trying to avoid surgery as much as possiblefor various amounts of time with cortisone injections, physical therapy. But a lot of times, despite those measures, people get to a point where their symptoms become so severe that it intrudes on their quality of life and keeps them from even simple things like going up and down stairs, tying their shoes, getting dressed, just walking a block down the street. When they get to that situation, surgery is probably the best option for patients to regain mobility, get rid of the pain in their hip or their knee and really get back to an active, functional lifestyle.
Melanie: Dr. Zeegen, when does it differ? When do you decide that replacement surgery is what’s needed over, say, a laparoscopic type surgery, a minimally invasive surgery where you go in and maybe clean up the area or shave something down? When does that kind of surgery then move on to the bigger replacement surgery?
Dr. Zeegen: Well, we know from a multitude of studies that arthroscopic surgery, which is minimally invasive where we’re just making a small incision and putting a camera in the joint, that’s really best served for people who have specific pathology in the joint. Say, for instance, in the knee where they have a meniscus tear. The meniscus is a different type of cartilage. It’s not the cartilage on the ends of the bones but more of a shock absorber cartilage that sits between the femur and the tibia. When that gets torn, a flap of the meniscus can get caught between the bones and cause symptoms such as catching, popping, locking. And those types of issues are very well addressed through an arthroscopic approach. But we know now from multiple studies that when people have degenerative arthritis in their knee, going in to so-called cleaning out really doesn’t work. In fact, it may even make the situation worse. So we try to avoid arthroscopic procedures for people who have even moderate or severe arthritis of their knee or their hip.
Melanie: What can people expect? When they hear about replacement, they think of all kinds of technological-looking, space age sort of joints. Tell us a little bit about what’s going on in the world of hip and knee replacement. And what are they looking at for the actual replacement part?
Dr. Zeegen: Well, let’s start with the hip. The hip is a ball and socket joint, and when it wears out, it doesn’t move very well. The patient has stiffness and pain. And what we’re doing is we’re recreating a new ball and socket joint that moves freely, provides patients with better range of motion, painless hips that they can walk on. The essence of the hip replacement is restoring the anatomy and the mechanics of that joint. Some of the more exciting advances that we’ve seen in the last 10 years is going through what’s called the anterior approach or coming through the front of the hip as opposed to the traditional posterior approach. The anterior approach, by going through the front of the hip, there’s a natural plane or interval between a group of muscles where we’re able to get into the hip joint and do the bony work and recreate that ball and socket joint without having to detach tendons or muscles or cut muscles. And what that means for the patient is that they can experience a quicker recovery, particularly in the first few weeks. Now, the posterior approach is an excellent way to do it, and I still do that kind of approach for a certain subset of my patients. I think by six to eight weeks after the surgery, there’s really no major difference between going through the posterior approach or the anterior approach. I think the results are pretty equivalent, but I do think there are studies to support this that in the early few weeks, going through an anterior approach does offer patients a little bit of a quicker rehab process.
Melanie: Speaking of the rehab process, hips, being such a complicated, amazing joint, seem to have one of the shorter rehab times when we hear about replacing. Tell us about rehab for both knees and hips, but start with hips and what it’s like—when people can expect to drive again, to walk again, to go back to work. What are they looking at?
Dr. Zeegen: Well, you’re right in that. Notoriously, patients will often tell us that recovering from a hip replacement is a little bit easier than a knee replacement. I think in part that’s because the hip is a deeper joint. It’s surrounded by a lot more muscle, more padding, so to speak. We’re not really trying to get people to move their hip in extreme positions. It’s pretty much just get up and go and walk. Whereas in the knee replacement, there’s not a lot of padding around the knee. And we’re pretty early on asking the patients to start working on range of motion exercises and strengthening, and so that can be a little more painful. But to answer your question, in terms of rehab, for the hips, I usually tell patients—and this is an average; every patient has a little bit different experience—but on average, I think it takes people about four to six weeks to recover from a hip replacement. When I say recover, I mean that’s when people are walking independent of a cane or walker. They pretty much stopped having to take any pain medications, swelling has gone down, pain levels have subsided. People who are golfers, they’re getting back out on the golf course and starting to hit the ball. If they play tennis, they’re starting to get out and swing the tennis racket a little bit. They’re back driving, definitely going back to work unless their job entails climbing ladders and stooping down and crawling under tight spaces. For the most part, people are back to work at that point. For knee replacement patients, it takes a little bit longer. I tell people it usually takes about anywhere from two to three months to really get to a point where they’re doing those same types of things that we talked about the hip, where they’re getting back to walking without pain, going up and down stairs, playing golf, tennis. I think it depends on the patient’s motivation level, the type of job they have, their pain thresholds. But a lot of times, people who have more sedentary jobs are able to get back to work probably within six to eight weeks after a knee replacement, maybe a little sooner if they’re more motivated. But I think that’s about the average that we see. You also asked about driving. When the right lower extremity that we’ve operated on, whether it be a hip or a knee, as a rule of thumb, I usually tell patients that it’s probably in their best interest to wait about four weeks before getting behind the wheel to drive. I don’t think it’s so much whether they can or can’t do it, but I think that it’s probably just a safety issue in terms of really having the strength and the mobility and the reflexes to be able to adequately go from the gas to the break and really be safe behind the wheel. That’s kind of what I tell patients in terms of driving.
Melanie: In just the last minute, Dr. Zeegen, if you would, give the listeners your very best advice for those considering hip or knee replacement surgery and why they should come to the Valley Hip and Knee Institute for their surgery.
Dr. Zeegen: Well, I think anybody who has been dealing with arthritis in their hip or knee that has not really improved with nonsurgical means of treatment, there is such a thing as waiting too long. We see people come in and they’ve waited years and years and years and now, their reconstruction becomes more challenging. The most common thing I hear from people after it’s all said and done is, “Boy, I wish I did this sooner.” I think it’s a great operation, both hip and the knee replacement. Myself and my associate here at the Valley Hip and Knee Institute have quite extensive amount of experience in joint replacement surgery. This is all we do. We are both fellowship trained in joint replacement surgery. We each perform approximately 300 or 400 joint replacement surgeries a year, and I think we have more experience in that regard than anybody else here in the Valley.
Melanie: Thank you so much for wonderful information. For more information on the Valley Hill and Knee Institute, you can go to valleypres.org. That’s valleypress.org. You’re listening to VPH Med with Valley Presbyterian Hospital. This is Melanie Cole. Thanks so much for listening.
Hip and Knee Replacement from Valley Hip & Knee Institute
Melanie Cole (Host): Being prepared for what to expect before, during, and after joint replacement surgery can help make it a less intimidating experience. And at the Valley Hip and Knee Institute, they specialize in the latest joint replacement techniques and minimally invasive procedures that help you regain your mobility and resume the activities that you love. My guest today is Dr. Erik N. Zeegen. He’s associate medical director of the Valley Hip and Knee Institute, and he’s a board certified orthopedic surgeon and one of Southern California’s leading joint replacement surgeons specializing in surgery of the hip and knee. Welcome to the show, Dr. Zeegen. Tell us a little bit about what would require somebody to need hip and/or knee surgery. What kind of conditions are you thinking about?
Dr. Erik N. Zeegen (Guest): Well, the most common condition that we see in people that are going to need their hip or knee replaced are people who have severe osteoarthritis. There are other various arthritis conditions, but the most common is osteoarthritis, which is the wear and tear of the joint where the cartilage starts to wear out and people start to develop bone-on-bone situations. In the hip, that usually presents as groin pain; in the knee, knee pain that is associated with deformities, contractures. Basically, we’re trying to avoid surgery as much as possiblefor various amounts of time with cortisone injections, physical therapy. But a lot of times, despite those measures, people get to a point where their symptoms become so severe that it intrudes on their quality of life and keeps them from even simple things like going up and down stairs, tying their shoes, getting dressed, just walking a block down the street. When they get to that situation, surgery is probably the best option for patients to regain mobility, get rid of the pain in their hip or their knee and really get back to an active, functional lifestyle.
Melanie: Dr. Zeegen, when does it differ? When do you decide that replacement surgery is what’s needed over, say, a laparoscopic type surgery, a minimally invasive surgery where you go in and maybe clean up the area or shave something down? When does that kind of surgery then move on to the bigger replacement surgery?
Dr. Zeegen: Well, we know from a multitude of studies that arthroscopic surgery, which is minimally invasive where we’re just making a small incision and putting a camera in the joint, that’s really best served for people who have specific pathology in the joint. Say, for instance, in the knee where they have a meniscus tear. The meniscus is a different type of cartilage. It’s not the cartilage on the ends of the bones but more of a shock absorber cartilage that sits between the femur and the tibia. When that gets torn, a flap of the meniscus can get caught between the bones and cause symptoms such as catching, popping, locking. And those types of issues are very well addressed through an arthroscopic approach. But we know now from multiple studies that when people have degenerative arthritis in their knee, going in to so-called cleaning out really doesn’t work. In fact, it may even make the situation worse. So we try to avoid arthroscopic procedures for people who have even moderate or severe arthritis of their knee or their hip.
Melanie: What can people expect? When they hear about replacement, they think of all kinds of technological-looking, space age sort of joints. Tell us a little bit about what’s going on in the world of hip and knee replacement. And what are they looking at for the actual replacement part?
Dr. Zeegen: Well, let’s start with the hip. The hip is a ball and socket joint, and when it wears out, it doesn’t move very well. The patient has stiffness and pain. And what we’re doing is we’re recreating a new ball and socket joint that moves freely, provides patients with better range of motion, painless hips that they can walk on. The essence of the hip replacement is restoring the anatomy and the mechanics of that joint. Some of the more exciting advances that we’ve seen in the last 10 years is going through what’s called the anterior approach or coming through the front of the hip as opposed to the traditional posterior approach. The anterior approach, by going through the front of the hip, there’s a natural plane or interval between a group of muscles where we’re able to get into the hip joint and do the bony work and recreate that ball and socket joint without having to detach tendons or muscles or cut muscles. And what that means for the patient is that they can experience a quicker recovery, particularly in the first few weeks. Now, the posterior approach is an excellent way to do it, and I still do that kind of approach for a certain subset of my patients. I think by six to eight weeks after the surgery, there’s really no major difference between going through the posterior approach or the anterior approach. I think the results are pretty equivalent, but I do think there are studies to support this that in the early few weeks, going through an anterior approach does offer patients a little bit of a quicker rehab process.
Melanie: Speaking of the rehab process, hips, being such a complicated, amazing joint, seem to have one of the shorter rehab times when we hear about replacing. Tell us about rehab for both knees and hips, but start with hips and what it’s like—when people can expect to drive again, to walk again, to go back to work. What are they looking at?
Dr. Zeegen: Well, you’re right in that. Notoriously, patients will often tell us that recovering from a hip replacement is a little bit easier than a knee replacement. I think in part that’s because the hip is a deeper joint. It’s surrounded by a lot more muscle, more padding, so to speak. We’re not really trying to get people to move their hip in extreme positions. It’s pretty much just get up and go and walk. Whereas in the knee replacement, there’s not a lot of padding around the knee. And we’re pretty early on asking the patients to start working on range of motion exercises and strengthening, and so that can be a little more painful. But to answer your question, in terms of rehab, for the hips, I usually tell patients—and this is an average; every patient has a little bit different experience—but on average, I think it takes people about four to six weeks to recover from a hip replacement. When I say recover, I mean that’s when people are walking independent of a cane or walker. They pretty much stopped having to take any pain medications, swelling has gone down, pain levels have subsided. People who are golfers, they’re getting back out on the golf course and starting to hit the ball. If they play tennis, they’re starting to get out and swing the tennis racket a little bit. They’re back driving, definitely going back to work unless their job entails climbing ladders and stooping down and crawling under tight spaces. For the most part, people are back to work at that point. For knee replacement patients, it takes a little bit longer. I tell people it usually takes about anywhere from two to three months to really get to a point where they’re doing those same types of things that we talked about the hip, where they’re getting back to walking without pain, going up and down stairs, playing golf, tennis. I think it depends on the patient’s motivation level, the type of job they have, their pain thresholds. But a lot of times, people who have more sedentary jobs are able to get back to work probably within six to eight weeks after a knee replacement, maybe a little sooner if they’re more motivated. But I think that’s about the average that we see. You also asked about driving. When the right lower extremity that we’ve operated on, whether it be a hip or a knee, as a rule of thumb, I usually tell patients that it’s probably in their best interest to wait about four weeks before getting behind the wheel to drive. I don’t think it’s so much whether they can or can’t do it, but I think that it’s probably just a safety issue in terms of really having the strength and the mobility and the reflexes to be able to adequately go from the gas to the break and really be safe behind the wheel. That’s kind of what I tell patients in terms of driving.
Melanie: In just the last minute, Dr. Zeegen, if you would, give the listeners your very best advice for those considering hip or knee replacement surgery and why they should come to the Valley Hip and Knee Institute for their surgery.
Dr. Zeegen: Well, I think anybody who has been dealing with arthritis in their hip or knee that has not really improved with nonsurgical means of treatment, there is such a thing as waiting too long. We see people come in and they’ve waited years and years and years and now, their reconstruction becomes more challenging. The most common thing I hear from people after it’s all said and done is, “Boy, I wish I did this sooner.” I think it’s a great operation, both hip and the knee replacement. Myself and my associate here at the Valley Hip and Knee Institute have quite extensive amount of experience in joint replacement surgery. This is all we do. We are both fellowship trained in joint replacement surgery. We each perform approximately 300 or 400 joint replacement surgeries a year, and I think we have more experience in that regard than anybody else here in the Valley.
Melanie: Thank you so much for wonderful information. For more information on the Valley Hill and Knee Institute, you can go to valleypres.org. That’s valleypress.org. You’re listening to VPH Med with Valley Presbyterian Hospital. This is Melanie Cole. Thanks so much for listening.