Joint pain and disability lead to almost one million total joint replacements in the United States each year. However, there are countless people who avoid surgery due to certain myths about the procedure, resulting in unnecessary, chronic suffering.
Listen in as Savyasachi Thakkar, MD, breaks down the myths and truths about joint replacement surgery, and offers answers for those considering the option.
Myths of Joint Replacement Surgery
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Learn more about Savyasachi Thakkar, MD
Savyasachi C. Thakkar, MD
Savyasachi Thakkar, MD, is a board-eligible orthopaedic surgeon at MedStar Orthopaedic Institute. He is a member of the Maryland Orthopaedic Association, the American Academy of Orthopaedic Surgeons, the International Congress for Joint Reconstruction, the AO Foundation, and the American Association of Hip & Knee Surgeons.Learn more about Savyasachi Thakkar, MD
Transcription:
Myths of Joint Replacement Surgery
Melanie Cole (Host): If your knees or hips are causing you constant pain, you may have thought about undergoing surgery to have them replaced but are myths about joint replacement holding you back? My guest today is Dr. Salvia Thakkar. He's an orthopedic surgeon and a member of MedStar Orthopedic Institute. Welcome to the show, Dr. Thakkar. Let's debunk some of these myths for the listeners starting with age. Some people think if they're in pain and they've been told they should consider a replacement, that they're too young for that and that that's only for people who are elderly.
Dr. Salvia Thakkar (Guest): Thank you, Melanie. Thanks for having me on the show. So, yes, that's a very frequent myth and frequently patients tell me that "Well, you know, Grandma got this surgery when she was 80 years old and why should I have it done when I'm 60 years old?" Well, we have new literature which shows us that even patients under the age of 55, let's say they undergo a total knee arthroplasty, which is a total knee replacement surgery, 30 years down the line, 60-70% of these patients are still going to have their implants in good shape. Now, I always tell the patients that if they get to be 85, that I will go ahead and do a revision surgery for them and if they get to be 115, then one of my partners will go ahead and revise this for them. So, the procedure can last for a good 25-30 years in most patients with the current activity levels and I think that to improve their quality of life, why wait until that late?
Melanie: So, then if people are waiting, another myth that I've heard quite often, is that you have to be in excruciating pain and you can no longer walk or function before you even consider replacement surgery. Do you agree with that?
Dr. Thakkar: I don't agree with that at all. So, pain is definitely one of the indicators to say that you want to have surgery but how does that pain impact your quality of life? Which matters more? So, let's take an instance. Let's take someone who's in excruciating pain, they haven't been walking around, they're bedridden. What happens to that person? That person becomes overweight, their muscles are not as strong because of disuse and their recovery is just even harder after surgery. What if we have someone who's an avid athlete, who's a golfer, who likes to bike and they're so having some pain and they have terrible arthritis? Well, for that patient, if they're not in excruciating pain, they've been using their joints a little bit, they've been using their muscles, they're stronger, and they can recover faster. So, I think that pain is one of the markers but it's not the end-all, be-all for these procedures.
Melanie: And, what about people who think that they will be bedridden afterward and that the recovery process is so long and severe that it will just take too much out of their quality of life?
Dr. Thakkar: Oh, that's, again, another myth. So, you know, my patients, I try to do the surgeries as early as possible in the morning, so let's say we do it at 7: 30 in the morning, most surgeries last about two hours, so by 9: 30 they're out of surgery. I have a deal with our physical therapists that they are up and walking by noon. So, patients are up out of bed the same day. They may be get to a chair and then the next day after surgery, they're walking in the wards, they're walking up and down steps, and most of the patients who have a hip replacement surgery go home the next day after surgery and most of the knee patients are in the hospital for two days and then go home thereafter. So, that's a total myth. The goal of this procedure is to get them up and walking and not to keep them in bed.
Melanie: People also feel that sometimes they'll have so much restriction after a joint replacement that they won't be able to move as well and they'll lack range of motion and hips especially scare them because we use do much with our hips. So, speak about that and permanent restrictions of range of motion after surgery.
Dr. Thakkar: Absolutely. So, any period immediately after surgery is sensitive in terms of recovery. So, we try to protect the muscles. We're trying to protect the soft tissues that we've used to approach the joint for surgery. Now, let's take the example of hips. There are several ways to approach a hip replacement. You can go in from the front in an anterior approach, or you can go in from the back, a posterior approach. These are the main approaches that we use today. Each of these approaches dissects through specific muscle planes and these muscles are designed to protect the hip against dislocating or popping out. Now, what we want to try and do is that the first six to eight weeks after any hip surgery, we want to try and give patients certain restrictions. So, if I go through the front, I want to make sure that they do not hyperextend their hip and they're careful about rotating their foot externally. If I go through the back, I'm careful about telling them that they should not flex at the waist beyond 90 degrees and they should not be tying their own shoes. Someone should be helping them do that. These are restrictions only for the immediate post-operative period. That's about six to eight weeks. After that, patients can get back to doing whatever they like doing. They can get back to any activity they like doing without any significant restrictions. So, I think that we've come a long way in making sure that they have a balanced, pain-free, and functional joint and I don't restrict them tremendously.
Melanie: And, what about if somebody is alone and they feel that they're going to be going through this alone? What do you tell patients about joint replacement and support needed?
Dr. Thakkar: Right. So, that has been the Holy Grail of joint replacement surgeries--how to find help for these patients, how to make sure that they get to us safely, we treat them safely, and then they go back home. So, for that, we have this unique program at the Washington Hospital Center and also at Georgetown--both MedStar hospitals. These are Patient Acute Care Coordinators, or PAC Coordinators. We have three of these individuals who are specially trained social workers who coordinate everything for the patient from the day they agree to have surgery, on the day of surgery, and then during the rehabilitation process thereafter. So, you have a point person to go to who makes sure that you'll have your doctor's visits, you'll have your surgeon who'll evaluate and treat you during your hospitalization, and who'll also make sure that your physical therapy and nursing needs are taken care of after surgery. So, you don't have to be afraid at all. We have people to take care of you.
Melanie: And Dr. Thakkar, the implant itself, people hear about the different types and whether they're going to set off the alarms at the airport. Speak about what's going on and the latest advances in the implants for replacement surgery.
Dr. Thakkar: Yes, absolutely. So, this is the part that excites me the most, is what bearing surfaces we're using in lieu of the natural cartilage that we have in our joints. So, traditionally, we used a lot of different types of metals, largely either titanium or cobalt-chromium metals. Some patients can be allergic to one metal and we make sure that these are patients are selected pretty carefully, and we don't use that metallic implant in those patients. In such patients, we use ceramic implants, we use polyethylene bearing surfaces, which kind of help reduce that load transfer, help make the motion more smooth, and these patients don't have reactions. I like to try and use implants that have been in the industry for at least 10-15 years. I like to see the outcomes. I don't want to be a trailblazer in putting something very new in a patient that we don't have outcomes associated with. In addition to the implants, what we also use is that we have robotic assistance and computer-guided assistance to make sure that we place these implants in a very narrow range of allowable tolerances because we want to make sure that they last for 20-30 years. The current implants that we use definitely assure that for the patients.
Melanie: So, wrap it up. It's such great information. You've really cleared up so many of the myths that would keep someone from considering replacement surgery for joints. Wrap it up for us. Give your best advice for what you say to patients every single day, Dr. Thakkar, about when they need to consider a replacement.
Dr. Thakkar: Absolutely. So, I tell patients that the minute their joint pain has started affecting their quality of life, which means that they cannot work, they cannot enjoy their life, they cannot live independently, that's the best time to come in. We'll start talking. We'll explore all the options that we have. We have a therapeutic ladder that we climb with the patients from non-operative management all the way to surgery, and then even the recovery process, and we make sure that we care for the patients from day one and we try and make them their best. We try and give them a pain-free, stable, and functional joint.
Melanie: Thank you so much, Dr. Thakkar, for being with us today. You're listening to Medical Intel with MedStar Washington Hospital Center. For more information, you can go to www.medstarwashington.org. That's www.medstarwashington.org. This is Melanie Cole, thanks so much for listening.
Myths of Joint Replacement Surgery
Melanie Cole (Host): If your knees or hips are causing you constant pain, you may have thought about undergoing surgery to have them replaced but are myths about joint replacement holding you back? My guest today is Dr. Salvia Thakkar. He's an orthopedic surgeon and a member of MedStar Orthopedic Institute. Welcome to the show, Dr. Thakkar. Let's debunk some of these myths for the listeners starting with age. Some people think if they're in pain and they've been told they should consider a replacement, that they're too young for that and that that's only for people who are elderly.
Dr. Salvia Thakkar (Guest): Thank you, Melanie. Thanks for having me on the show. So, yes, that's a very frequent myth and frequently patients tell me that "Well, you know, Grandma got this surgery when she was 80 years old and why should I have it done when I'm 60 years old?" Well, we have new literature which shows us that even patients under the age of 55, let's say they undergo a total knee arthroplasty, which is a total knee replacement surgery, 30 years down the line, 60-70% of these patients are still going to have their implants in good shape. Now, I always tell the patients that if they get to be 85, that I will go ahead and do a revision surgery for them and if they get to be 115, then one of my partners will go ahead and revise this for them. So, the procedure can last for a good 25-30 years in most patients with the current activity levels and I think that to improve their quality of life, why wait until that late?
Melanie: So, then if people are waiting, another myth that I've heard quite often, is that you have to be in excruciating pain and you can no longer walk or function before you even consider replacement surgery. Do you agree with that?
Dr. Thakkar: I don't agree with that at all. So, pain is definitely one of the indicators to say that you want to have surgery but how does that pain impact your quality of life? Which matters more? So, let's take an instance. Let's take someone who's in excruciating pain, they haven't been walking around, they're bedridden. What happens to that person? That person becomes overweight, their muscles are not as strong because of disuse and their recovery is just even harder after surgery. What if we have someone who's an avid athlete, who's a golfer, who likes to bike and they're so having some pain and they have terrible arthritis? Well, for that patient, if they're not in excruciating pain, they've been using their joints a little bit, they've been using their muscles, they're stronger, and they can recover faster. So, I think that pain is one of the markers but it's not the end-all, be-all for these procedures.
Melanie: And, what about people who think that they will be bedridden afterward and that the recovery process is so long and severe that it will just take too much out of their quality of life?
Dr. Thakkar: Oh, that's, again, another myth. So, you know, my patients, I try to do the surgeries as early as possible in the morning, so let's say we do it at 7: 30 in the morning, most surgeries last about two hours, so by 9: 30 they're out of surgery. I have a deal with our physical therapists that they are up and walking by noon. So, patients are up out of bed the same day. They may be get to a chair and then the next day after surgery, they're walking in the wards, they're walking up and down steps, and most of the patients who have a hip replacement surgery go home the next day after surgery and most of the knee patients are in the hospital for two days and then go home thereafter. So, that's a total myth. The goal of this procedure is to get them up and walking and not to keep them in bed.
Melanie: People also feel that sometimes they'll have so much restriction after a joint replacement that they won't be able to move as well and they'll lack range of motion and hips especially scare them because we use do much with our hips. So, speak about that and permanent restrictions of range of motion after surgery.
Dr. Thakkar: Absolutely. So, any period immediately after surgery is sensitive in terms of recovery. So, we try to protect the muscles. We're trying to protect the soft tissues that we've used to approach the joint for surgery. Now, let's take the example of hips. There are several ways to approach a hip replacement. You can go in from the front in an anterior approach, or you can go in from the back, a posterior approach. These are the main approaches that we use today. Each of these approaches dissects through specific muscle planes and these muscles are designed to protect the hip against dislocating or popping out. Now, what we want to try and do is that the first six to eight weeks after any hip surgery, we want to try and give patients certain restrictions. So, if I go through the front, I want to make sure that they do not hyperextend their hip and they're careful about rotating their foot externally. If I go through the back, I'm careful about telling them that they should not flex at the waist beyond 90 degrees and they should not be tying their own shoes. Someone should be helping them do that. These are restrictions only for the immediate post-operative period. That's about six to eight weeks. After that, patients can get back to doing whatever they like doing. They can get back to any activity they like doing without any significant restrictions. So, I think that we've come a long way in making sure that they have a balanced, pain-free, and functional joint and I don't restrict them tremendously.
Melanie: And, what about if somebody is alone and they feel that they're going to be going through this alone? What do you tell patients about joint replacement and support needed?
Dr. Thakkar: Right. So, that has been the Holy Grail of joint replacement surgeries--how to find help for these patients, how to make sure that they get to us safely, we treat them safely, and then they go back home. So, for that, we have this unique program at the Washington Hospital Center and also at Georgetown--both MedStar hospitals. These are Patient Acute Care Coordinators, or PAC Coordinators. We have three of these individuals who are specially trained social workers who coordinate everything for the patient from the day they agree to have surgery, on the day of surgery, and then during the rehabilitation process thereafter. So, you have a point person to go to who makes sure that you'll have your doctor's visits, you'll have your surgeon who'll evaluate and treat you during your hospitalization, and who'll also make sure that your physical therapy and nursing needs are taken care of after surgery. So, you don't have to be afraid at all. We have people to take care of you.
Melanie: And Dr. Thakkar, the implant itself, people hear about the different types and whether they're going to set off the alarms at the airport. Speak about what's going on and the latest advances in the implants for replacement surgery.
Dr. Thakkar: Yes, absolutely. So, this is the part that excites me the most, is what bearing surfaces we're using in lieu of the natural cartilage that we have in our joints. So, traditionally, we used a lot of different types of metals, largely either titanium or cobalt-chromium metals. Some patients can be allergic to one metal and we make sure that these are patients are selected pretty carefully, and we don't use that metallic implant in those patients. In such patients, we use ceramic implants, we use polyethylene bearing surfaces, which kind of help reduce that load transfer, help make the motion more smooth, and these patients don't have reactions. I like to try and use implants that have been in the industry for at least 10-15 years. I like to see the outcomes. I don't want to be a trailblazer in putting something very new in a patient that we don't have outcomes associated with. In addition to the implants, what we also use is that we have robotic assistance and computer-guided assistance to make sure that we place these implants in a very narrow range of allowable tolerances because we want to make sure that they last for 20-30 years. The current implants that we use definitely assure that for the patients.
Melanie: So, wrap it up. It's such great information. You've really cleared up so many of the myths that would keep someone from considering replacement surgery for joints. Wrap it up for us. Give your best advice for what you say to patients every single day, Dr. Thakkar, about when they need to consider a replacement.
Dr. Thakkar: Absolutely. So, I tell patients that the minute their joint pain has started affecting their quality of life, which means that they cannot work, they cannot enjoy their life, they cannot live independently, that's the best time to come in. We'll start talking. We'll explore all the options that we have. We have a therapeutic ladder that we climb with the patients from non-operative management all the way to surgery, and then even the recovery process, and we make sure that we care for the patients from day one and we try and make them their best. We try and give them a pain-free, stable, and functional joint.
Melanie: Thank you so much, Dr. Thakkar, for being with us today. You're listening to Medical Intel with MedStar Washington Hospital Center. For more information, you can go to www.medstarwashington.org. That's www.medstarwashington.org. This is Melanie Cole, thanks so much for listening.