Joints can wear out. Millions have successfully undergone joint replacement surgery for hips, knees and shoulders.
Dr. Richard Cimpl, Board-certified orthopedic surgeon at Columbus Orthopedic & Sports Medicine Clinic, discusses the ins and outs of total joint replacement.
The Ins and Outs of Total Joint Replacement
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Learn more about Richard R. Cimpl, MD
Richard R. Cimpl, MD
Richard R. Cimpl, MD is responsible for bringing orthopedic care to Columbus, opening his orthopedic and sports medicine clinic in 1983. Dr. Cimpl lived in Columbus before beginning his medical school training at Creighton University School of Medicine in Omaha. Following completion of his orthopedic residency at St. Louis University Hospitals, Dr. Cimpl returned to Columbus and established the first and, to date, only orthopedic practice in the community.Learn more about Richard R. Cimpl, MD
Transcription:
Bill Klaproth (Host): Over the years millions of Americans have undergone joint replacement surgeries, which can help relieve issues with shoulders, knees, and hips. Here to talk with us about the ins and outs of total joint replacement is Dr. Richard Cimpl, board-certified orthopedic surgeon at Columbus Orthopedic and Sports Medicine Clinic at Columbus Community Hospital. Dr. Cimpl, thank you for your time. So what is total joint replacement?
Dr. Richard Cimpl, MD (Guest): Well as orthopedic surgeons, our goal is to help improve patient's pain, improve their joint function, and when one gets osteoarthritis, for me at least throughout the hip and knee, we are trying to help them so they can get returned to their normal activities as much as possible. Obviously total joint replacement is a procedure done for individuals who predominately have osteoarthritis, but this also could be post-traumatic arthritis from previous injuries or rheumatoid arthritis or inflammatory arthritis which can be disabling to them.
Bill: So is osteoarthritis the most common issue that leads to joint replacement?
Dr. Cimpl: Yes. You know, osteoarthritis is predominately a disease of aging, and it starts when individuals get about age fifty and then continues to increase thereafter. It can certainly be progressive, and if it gets to the point where individuals are frustrated and they don't respond to conservative treatment modalities, then we would consider a surgical procedure for them.
Bill: So what is the most common joint in need of replacement?
Dr. Cimpl: I don't know the exact numbers, but total knees are much more common, and I would say total hips are second. Certainly that seems to be the pattern in the patients that I see.
Bill: So the knees and hips constantly working, right? The years of just walking, and standing, and up and down, sitting, up and down stairs, things like that. That would seem to make sense. So how have the joint replacement procedures changed over the years? I know there's been tremendous advancements.
Dr. Cimpl: Well I think that the way we're implanting total joints and doing the procedures technically is significantly more advanced, I personally use a computer assisted model during surgery where we put trackers on the bone, and then we have infrared beams going to a monitor. It tells us exactly where the cut should be, how to place the component with the trial component, make sure they're placed properly, and balance the knee.
We know that if you can get the center of the hip, the center of the knee, and the center of the ankle in alignment, you're going to have less chance of a knee, for example, wearing out on one side or the other, if it's truly balanced and straight, and if the ligaments are balanced.
So the cutting blocks we use in the computer assisted surgical navigation, the implants themselves, everything is much improved. I think back thirty-five years when I started here at Columbus, we would have a cutting block, we'd kind of hold it up against the bone, you'd take a saw, and kind of make the cut, and you were hopeful that you had it pretty accurate and close. We did the best we could with what we had, but it's so much more accurate.
We're also making smaller incisions, I think technique-wise our anesthesia care providers are giving us better blocks to help control pain issues. And their therapy afterwards- even before is helping patients be more prepared and better optimized to undergo a procedure.
Bill: So these advancements then, I would imagine they help the recovery process. So what is the recovery process like for someone who gets a new hip or knee?
Dr. Cimpl: Well patients are usually in the hospital about forty-eight hours. Procedures take about an hour to an hour and a half each whether it's a total hip or a total knee. Some are quicker, some are longer, but that's kind of an average. But normally a patient comes in the hospital day one, you do the surgery, that afternoon we have them up walking and taking a few steps. And then usually they have a group therapy the next day, and then they leave- get them out the second day, so two nights in the hospital. They may use a walker or crutches when they go home. Thirty years ago, we would put patients on bed rest, we wouldn't move them for a week, and now we mobilize them right away and get them active and get them returning.
Studies have shown if we get patients back home sooner in their own environment, their own bed, where they feel most comfortable, even though they have pain issues with which we can control, there are less chances of complications when someone's staying in the hospital for longer periods of time.
Bill: That is amazing. An hour and a half to replace a knee, and you have them up on that knee later that afternoon. That's amazing.
Dr. Cimpl: It is. In similar patients, we talk about doing joint replacements as an outpatient procedure. It's still a big operation, and I think staying overnight at least one night is important. And some of our patients do go home the following morning, but usually it's two days, and we do get them up as soon as their blocks are wearing off, and we feel they're awake from the anesthetic, we want to get them up and moving.
Bill: Wow, so because of these advancements and people are leading more active lifestyles later in life, has the number of people in need of joint replacement increased?
Dr. Cimpl: Well yes, I mean I think if you look at what the baby boomer population is here, and there's certainly an increased number of patients, and in that age group they're over fifty, and they're coming to a point where they're going to require knee replacement surgery or hip replacement if they require it.
Bill: And Dr. Cimpl, what would you tell someone who may be considering total joint replacement surgery?
Dr. Cimpl: I think we need to always be sure that they've been treated conservatively and they've tried all the options for treatments of osteoarthritis first. But like the anti-inflammatories, cortisone injections, modifications to activities, maybe some therapy, bracing. But if they get to that point where they're really frustrated, and if they find their activities of daily living are really affected, they can't keep up with the grandkids or their family, they want to travel more but their knee or hip hurts them, they shouldn't have to suffer. The joint replacement surgery is successful, I think it's one of the more gratifying procedures as far as the surgeries that we do. I think I said from the start, our goal is really to help patients reduce their pain, to improve their joint function, and allow them to engage in as normal of activity as they possibly can.
Usually surgery is considered when their osteoarthritis is severe enough to interfere with their activities of daily living. Prior to surgery, we obviously always do a thorough medical history, an x-ray assessment, and focus on the patients. Make sure that patients are optimized to undergo a procedure, but I think if they're frustrated, then a replacement procedure certainly can bring an improved quality of life to them.
Bill: And last question, Dr. Cimpl, for someone who may be thinking, "Gosh, this is really for me," who is a good candidate then for total joint replacement surgery?
Dr. Cimpl: Again, I mentioned optimization of care. Obviously if patients have significant cardiac history, diabetic history, if they're smokers, lung problems, you have to balance the risks and the benefits. If there is significant comorbidities or medical issues that would make them at a higher risk, we want to have them involved with their primary care physicians, and if it's necessary, cardiologists or pulmonologists to look at the whole picture to make sure they're a suitable candidate to undergo a procedure.
It still is a big procedure, we try to make smaller incisions, we try to do things in a more standardized fashion, but minor surgery is something they do on somebody else, if it's on me or you or our patients, we consider it a major operation. So we want to make sure that patients are optimally suitable to undergo a procedure.
Bill: Absolutely. Well Dr. Cimpl, thank you so much for your time today. For more information about total joint replacement, head over to www.ColumbusHosp.org. That's www.ColumbusHosp.org. This is Columbus Community Hospital HealthCast from Columbus Community Hospital. I'm Bill Klaproth, thanks for listening.
Bill Klaproth (Host): Over the years millions of Americans have undergone joint replacement surgeries, which can help relieve issues with shoulders, knees, and hips. Here to talk with us about the ins and outs of total joint replacement is Dr. Richard Cimpl, board-certified orthopedic surgeon at Columbus Orthopedic and Sports Medicine Clinic at Columbus Community Hospital. Dr. Cimpl, thank you for your time. So what is total joint replacement?
Dr. Richard Cimpl, MD (Guest): Well as orthopedic surgeons, our goal is to help improve patient's pain, improve their joint function, and when one gets osteoarthritis, for me at least throughout the hip and knee, we are trying to help them so they can get returned to their normal activities as much as possible. Obviously total joint replacement is a procedure done for individuals who predominately have osteoarthritis, but this also could be post-traumatic arthritis from previous injuries or rheumatoid arthritis or inflammatory arthritis which can be disabling to them.
Bill: So is osteoarthritis the most common issue that leads to joint replacement?
Dr. Cimpl: Yes. You know, osteoarthritis is predominately a disease of aging, and it starts when individuals get about age fifty and then continues to increase thereafter. It can certainly be progressive, and if it gets to the point where individuals are frustrated and they don't respond to conservative treatment modalities, then we would consider a surgical procedure for them.
Bill: So what is the most common joint in need of replacement?
Dr. Cimpl: I don't know the exact numbers, but total knees are much more common, and I would say total hips are second. Certainly that seems to be the pattern in the patients that I see.
Bill: So the knees and hips constantly working, right? The years of just walking, and standing, and up and down, sitting, up and down stairs, things like that. That would seem to make sense. So how have the joint replacement procedures changed over the years? I know there's been tremendous advancements.
Dr. Cimpl: Well I think that the way we're implanting total joints and doing the procedures technically is significantly more advanced, I personally use a computer assisted model during surgery where we put trackers on the bone, and then we have infrared beams going to a monitor. It tells us exactly where the cut should be, how to place the component with the trial component, make sure they're placed properly, and balance the knee.
We know that if you can get the center of the hip, the center of the knee, and the center of the ankle in alignment, you're going to have less chance of a knee, for example, wearing out on one side or the other, if it's truly balanced and straight, and if the ligaments are balanced.
So the cutting blocks we use in the computer assisted surgical navigation, the implants themselves, everything is much improved. I think back thirty-five years when I started here at Columbus, we would have a cutting block, we'd kind of hold it up against the bone, you'd take a saw, and kind of make the cut, and you were hopeful that you had it pretty accurate and close. We did the best we could with what we had, but it's so much more accurate.
We're also making smaller incisions, I think technique-wise our anesthesia care providers are giving us better blocks to help control pain issues. And their therapy afterwards- even before is helping patients be more prepared and better optimized to undergo a procedure.
Bill: So these advancements then, I would imagine they help the recovery process. So what is the recovery process like for someone who gets a new hip or knee?
Dr. Cimpl: Well patients are usually in the hospital about forty-eight hours. Procedures take about an hour to an hour and a half each whether it's a total hip or a total knee. Some are quicker, some are longer, but that's kind of an average. But normally a patient comes in the hospital day one, you do the surgery, that afternoon we have them up walking and taking a few steps. And then usually they have a group therapy the next day, and then they leave- get them out the second day, so two nights in the hospital. They may use a walker or crutches when they go home. Thirty years ago, we would put patients on bed rest, we wouldn't move them for a week, and now we mobilize them right away and get them active and get them returning.
Studies have shown if we get patients back home sooner in their own environment, their own bed, where they feel most comfortable, even though they have pain issues with which we can control, there are less chances of complications when someone's staying in the hospital for longer periods of time.
Bill: That is amazing. An hour and a half to replace a knee, and you have them up on that knee later that afternoon. That's amazing.
Dr. Cimpl: It is. In similar patients, we talk about doing joint replacements as an outpatient procedure. It's still a big operation, and I think staying overnight at least one night is important. And some of our patients do go home the following morning, but usually it's two days, and we do get them up as soon as their blocks are wearing off, and we feel they're awake from the anesthetic, we want to get them up and moving.
Bill: Wow, so because of these advancements and people are leading more active lifestyles later in life, has the number of people in need of joint replacement increased?
Dr. Cimpl: Well yes, I mean I think if you look at what the baby boomer population is here, and there's certainly an increased number of patients, and in that age group they're over fifty, and they're coming to a point where they're going to require knee replacement surgery or hip replacement if they require it.
Bill: And Dr. Cimpl, what would you tell someone who may be considering total joint replacement surgery?
Dr. Cimpl: I think we need to always be sure that they've been treated conservatively and they've tried all the options for treatments of osteoarthritis first. But like the anti-inflammatories, cortisone injections, modifications to activities, maybe some therapy, bracing. But if they get to that point where they're really frustrated, and if they find their activities of daily living are really affected, they can't keep up with the grandkids or their family, they want to travel more but their knee or hip hurts them, they shouldn't have to suffer. The joint replacement surgery is successful, I think it's one of the more gratifying procedures as far as the surgeries that we do. I think I said from the start, our goal is really to help patients reduce their pain, to improve their joint function, and allow them to engage in as normal of activity as they possibly can.
Usually surgery is considered when their osteoarthritis is severe enough to interfere with their activities of daily living. Prior to surgery, we obviously always do a thorough medical history, an x-ray assessment, and focus on the patients. Make sure that patients are optimized to undergo a procedure, but I think if they're frustrated, then a replacement procedure certainly can bring an improved quality of life to them.
Bill: And last question, Dr. Cimpl, for someone who may be thinking, "Gosh, this is really for me," who is a good candidate then for total joint replacement surgery?
Dr. Cimpl: Again, I mentioned optimization of care. Obviously if patients have significant cardiac history, diabetic history, if they're smokers, lung problems, you have to balance the risks and the benefits. If there is significant comorbidities or medical issues that would make them at a higher risk, we want to have them involved with their primary care physicians, and if it's necessary, cardiologists or pulmonologists to look at the whole picture to make sure they're a suitable candidate to undergo a procedure.
It still is a big procedure, we try to make smaller incisions, we try to do things in a more standardized fashion, but minor surgery is something they do on somebody else, if it's on me or you or our patients, we consider it a major operation. So we want to make sure that patients are optimally suitable to undergo a procedure.
Bill: Absolutely. Well Dr. Cimpl, thank you so much for your time today. For more information about total joint replacement, head over to www.ColumbusHosp.org. That's www.ColumbusHosp.org. This is Columbus Community Hospital HealthCast from Columbus Community Hospital. I'm Bill Klaproth, thanks for listening.