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In this segment, Dr. Jason Gessel, discusses the red flags to indicate that you may need to have a joint replaced, and what questions you should ask your doctor about the procedure.
When Should You Have Joint Replacement Surgery?
Featured Speaker:
Jason Gessel, DO
Dr. Jason Gessel is an orthopedic surgeon in Marietta, Ohio and is affiliated with multiple hospitals in the area, including Marietta Memorial Hospital and St. Joseph Health Center. Transcription:
When Should You Have Joint Replacement Surgery?
Melanie Cole (Host): According to the American Academy of Orthopedic Surgeons, almost a million total joint replacements are performed in the United States every year. Hip and knee replacements are the most commonly performed joint replacements, but they can be also performed on other joints as well, including the ankle, wrist, shoulder and elbow. My guest today is Dr. Jason Gessel. He’s an orthopedic surgeon with Memorial Health System. Welcome to the show, Dr. Gessel. What happens to our joints as we age, and are different joints subject to different limitations as we age?
Dr. Jason Gessel (Guest): Hello, thanks for having me. Yes, as we age, unfortunately, our joints tend to deteriorate. Now, this can happen at different rates for different people, and also certain joints, for instance, your hip and knee joints – the ones that tend to bear most of the load when we walk – have a tendency to wear out a little bit sooner than say a shoulder joint. However, this is highly variable in different people.
Melanie: People experience pain, Dr. Gessel – we have pain in our knees, pain in our hips, or in our shoulders – and we sort of slough some of it off. When does it start to be something that you say, “You know what, I need to get in and have this looked at?”
Dr. Gessel: What I tell patients is when the pain becomes more persistent and consistent, you probably should have it evaluated. Who you go with to have it evaluated for that initial visit can either be your primary care physician that you’re seeing at a time for a routine checkup, or you can directly call a specialist such as an orthopedic surgeon or a sports medicine doctor and have the problem looked at.
Typically, if you’re having physiological signs in addition to your symptoms, things like swelling of your knee that you notice, warmth to touch, difficulty doing things that used to be easier for your to do, then that’s a pretty good indication that you need to have it looked at, versus, I did some extra work this weekend -- maybe had a project around the house that I worked on -- and then the knee was sore. Sometimes that will go away with time, in a few days, but when you start to notice things more consistently, that is usually when you should have it looked at.
Melanie: What would be the first line of defense, as surgery would not necessarily be the first thing you would recommend? What do you do, and how do you diagnose what the problem is, how severe it is, and when surgery might be recommended?
Dr. Gessel: When we first see someone, the first thing we do is obtain an accurate history, which is basically just me asking you questions, trying to figure out when it’s bothering you, how often it bothers you, and those sorts of things. Then we perform a physical examination. Often times we’re going to incorporate X-rays with that. When you’re taking X-rays to look for arthritis, it’s best if you’re standing for those X-rays if you’re X-raying a hip or a knee. Obviously, you can’t stand on your hands, so we don’t do that when we X-ray the shoulder, but when you’re looking specifically for arthritis, those X-rays should be standing. Often times when a specialist is not ordering the X-rays, sometimes they do not order them standing, and it can affect the results of what the X-rays show.
Often times if the joint has not been bothering you that much and the arthritis does not look that severe, often times we will start with something as simple as some topical medications. There’s also oral medications that you can take that help with inflammation -- the class of medications known as NSAIDs – and often times we start with injections. These can either be what’s referred to as cortisone injections, which is a corticosteroid or a powerful anti-inflammatory drug, or sometimes viscosupplementation injections, which is a lubricating fluid that we will inject into the knee.
When these things no longer work, then often times the only option that’s left is to have a joint replacement, whether that’s a partial joint replacement or a complete joint replacement.
Melanie: What is a new joint like, and what does it feel like for the patient? Is it something that they would notice as a foreign body in their body, or does it just meld in and become something they really don’t notice?
Dr. Gessel: Typically, after you recover from the postoperative pain that you have, over the course of time – typically, with a hip or a knee, usually around three months – the joint tends to just become part of you. Now, one of the things that patients have told me after undergoing joint replacement surgery is they will occasionally hear a clicking type sound. This is artificial parts that we put in. They are made out of metal and plastic and sometimes that plastic will bang against the metal and you will hear the sound similar to what hitting your writing pen on a desk may sound like, and that’s normally. It usually doesn’t cause the patient any sensation that they feel, it’s just something audible that they hear, but for the most part, the joint feels pretty normal to them.
Melanie: And is this something that typically would last awhile or sometimes, do joints have to be replaced again?
Dr. Gessel: Joints typically, the average lifespan that we like to quote our patients – and I think given the new technologies that we have, it’s probably a conservative estimate on the part of orthopedic surgeons, but we say 15 to 20 years. Certainly, I have seen patients that have had joints in much longer than this and are doing perfectly fine, and sometimes depending on what the patient does, the joint may wear out quicker. Sometimes, yes, there needs to be a second joint replacement done later in the patient’s life. We see this most often in people who have conditions that require them to undergo a replacement at a younger age than what we would consider to be the typical age for a joint replacement.
Melanie: Dr. Gessel, what is post-surgery like for these patients? And how long, generally – and I know we’re talking various types of joints. Hips are different than knees, different than shoulders – but what do you see as generally the physical therapy requirements afterward and how soon they can return to some of their daily activities?
Dr. Gessel: The typical post-operative course is that you have the surgery done. We typically, then keep you in the hospital one to two nights afterward. We’re getting you up the same day as surgery having you walk with physical therapy. When you’re in the hospital, you’re receiving physical therapy two times a day. Once we feel that you’re safe to go home -- and we realize that every individual patient and the condition of their environment that they come from is different, so we want to make sure that we’re not sending you home to an unsafe environment where you’re at risk to harm yourself or not be taken care of appropriately. Once we feel you’re safe to go, you’re typically discharged to home. Now, some of our elderly, more debilitated patients may need some extra care, and they may end up at an acute rehab facility, or even a skilled nursing facility for a few extra days after the replacement.
Typically, you go home, and then you begin outpatient physical therapy. We’re in a more rural area, so some of our patients live quite a ways away from an outpatient physical therapy location. We have some great home-health agencies in the area that often times will assist those patients and actually do in-home visits with them rather than the patient trying to drive an hour to physical therapy. Typically, you’re going to go to outpatient physical therapy three times a week. The sessions are about 45 mins for each physical therapy session. When you leave the hospital, most often if you’ve had a hip or knee replacement, you’re walking with a walker. Usually, you do that for one to two weeks and then transition to a cane for another one to two weeks. Usually around one month in the postoperative period for a hip or knee replacement we will have you off of assisted devices, walking on your own, but still doing therapy. Usually, around three months is when you’re feeling pretty normal again. Complete healing can even take up to a year for small amounts of mild soreness to go away completely.
Usually for driving, if it is your right leg that’s had either a hip or a knee replacement, usually around six weeks until your reaction time is sufficient again to allow you to drive. If you’ve had a left-sided replacement, as long as your car is an automatic transmission care, I will allow patients to drive usually at two to three weeks as long as they are off narcotic pain medications.
Melanie: Wrap it up for us, Dr. Gessel, with your best advice for people that are suffering from pain in their knees, or hips, or shoulders, and they’re considering a replacement surgery, what questions would you like them to ask their doctor? What would you like to tell them about what’s going on in the world of joint replacement today?
Dr. Gessel: I feel that the technology from our joint implant corporations getting improved each and every year. They are trying to see what problems implants that have been made in the past have had, and they’re working to try to improve those. In terms of patients, I tell the patients that I really think that they should try conservative measures first if they have not had those done and try to hold off having the replacement until essentially all of the conservative treatment measures aren’t helping them any longer and their pain is affecting their activities of daily living. That’s when I feel it’s time for a patient to have a replacement.
Specific questions that a patient should ask, essentially you should ask your surgeon a lot of the things that we’ve covered today. What happens during my course at the hospital? When will I be able to do certain activities and return to certain activities? What will be required of me, the patient? The patient should know that the post-operative period, and what they do in terms of physical therapy and following physician instructions, actually can make them recover from their joint replacement surgery much quicker if they’re willing to be compliant with what’s asked of them.
Melanie: Thank you, so much, Dr. Gessel, for being with us today. That’s great information. You’re listening to Memorial Health Radio with Memorial Health System, and for more information, you can go to MHSystem.org, that’s MHSystem.org. This is Melanie Cole. Thanks, so much, for listening.
When Should You Have Joint Replacement Surgery?
Melanie Cole (Host): According to the American Academy of Orthopedic Surgeons, almost a million total joint replacements are performed in the United States every year. Hip and knee replacements are the most commonly performed joint replacements, but they can be also performed on other joints as well, including the ankle, wrist, shoulder and elbow. My guest today is Dr. Jason Gessel. He’s an orthopedic surgeon with Memorial Health System. Welcome to the show, Dr. Gessel. What happens to our joints as we age, and are different joints subject to different limitations as we age?
Dr. Jason Gessel (Guest): Hello, thanks for having me. Yes, as we age, unfortunately, our joints tend to deteriorate. Now, this can happen at different rates for different people, and also certain joints, for instance, your hip and knee joints – the ones that tend to bear most of the load when we walk – have a tendency to wear out a little bit sooner than say a shoulder joint. However, this is highly variable in different people.
Melanie: People experience pain, Dr. Gessel – we have pain in our knees, pain in our hips, or in our shoulders – and we sort of slough some of it off. When does it start to be something that you say, “You know what, I need to get in and have this looked at?”
Dr. Gessel: What I tell patients is when the pain becomes more persistent and consistent, you probably should have it evaluated. Who you go with to have it evaluated for that initial visit can either be your primary care physician that you’re seeing at a time for a routine checkup, or you can directly call a specialist such as an orthopedic surgeon or a sports medicine doctor and have the problem looked at.
Typically, if you’re having physiological signs in addition to your symptoms, things like swelling of your knee that you notice, warmth to touch, difficulty doing things that used to be easier for your to do, then that’s a pretty good indication that you need to have it looked at, versus, I did some extra work this weekend -- maybe had a project around the house that I worked on -- and then the knee was sore. Sometimes that will go away with time, in a few days, but when you start to notice things more consistently, that is usually when you should have it looked at.
Melanie: What would be the first line of defense, as surgery would not necessarily be the first thing you would recommend? What do you do, and how do you diagnose what the problem is, how severe it is, and when surgery might be recommended?
Dr. Gessel: When we first see someone, the first thing we do is obtain an accurate history, which is basically just me asking you questions, trying to figure out when it’s bothering you, how often it bothers you, and those sorts of things. Then we perform a physical examination. Often times we’re going to incorporate X-rays with that. When you’re taking X-rays to look for arthritis, it’s best if you’re standing for those X-rays if you’re X-raying a hip or a knee. Obviously, you can’t stand on your hands, so we don’t do that when we X-ray the shoulder, but when you’re looking specifically for arthritis, those X-rays should be standing. Often times when a specialist is not ordering the X-rays, sometimes they do not order them standing, and it can affect the results of what the X-rays show.
Often times if the joint has not been bothering you that much and the arthritis does not look that severe, often times we will start with something as simple as some topical medications. There’s also oral medications that you can take that help with inflammation -- the class of medications known as NSAIDs – and often times we start with injections. These can either be what’s referred to as cortisone injections, which is a corticosteroid or a powerful anti-inflammatory drug, or sometimes viscosupplementation injections, which is a lubricating fluid that we will inject into the knee.
When these things no longer work, then often times the only option that’s left is to have a joint replacement, whether that’s a partial joint replacement or a complete joint replacement.
Melanie: What is a new joint like, and what does it feel like for the patient? Is it something that they would notice as a foreign body in their body, or does it just meld in and become something they really don’t notice?
Dr. Gessel: Typically, after you recover from the postoperative pain that you have, over the course of time – typically, with a hip or a knee, usually around three months – the joint tends to just become part of you. Now, one of the things that patients have told me after undergoing joint replacement surgery is they will occasionally hear a clicking type sound. This is artificial parts that we put in. They are made out of metal and plastic and sometimes that plastic will bang against the metal and you will hear the sound similar to what hitting your writing pen on a desk may sound like, and that’s normally. It usually doesn’t cause the patient any sensation that they feel, it’s just something audible that they hear, but for the most part, the joint feels pretty normal to them.
Melanie: And is this something that typically would last awhile or sometimes, do joints have to be replaced again?
Dr. Gessel: Joints typically, the average lifespan that we like to quote our patients – and I think given the new technologies that we have, it’s probably a conservative estimate on the part of orthopedic surgeons, but we say 15 to 20 years. Certainly, I have seen patients that have had joints in much longer than this and are doing perfectly fine, and sometimes depending on what the patient does, the joint may wear out quicker. Sometimes, yes, there needs to be a second joint replacement done later in the patient’s life. We see this most often in people who have conditions that require them to undergo a replacement at a younger age than what we would consider to be the typical age for a joint replacement.
Melanie: Dr. Gessel, what is post-surgery like for these patients? And how long, generally – and I know we’re talking various types of joints. Hips are different than knees, different than shoulders – but what do you see as generally the physical therapy requirements afterward and how soon they can return to some of their daily activities?
Dr. Gessel: The typical post-operative course is that you have the surgery done. We typically, then keep you in the hospital one to two nights afterward. We’re getting you up the same day as surgery having you walk with physical therapy. When you’re in the hospital, you’re receiving physical therapy two times a day. Once we feel that you’re safe to go home -- and we realize that every individual patient and the condition of their environment that they come from is different, so we want to make sure that we’re not sending you home to an unsafe environment where you’re at risk to harm yourself or not be taken care of appropriately. Once we feel you’re safe to go, you’re typically discharged to home. Now, some of our elderly, more debilitated patients may need some extra care, and they may end up at an acute rehab facility, or even a skilled nursing facility for a few extra days after the replacement.
Typically, you go home, and then you begin outpatient physical therapy. We’re in a more rural area, so some of our patients live quite a ways away from an outpatient physical therapy location. We have some great home-health agencies in the area that often times will assist those patients and actually do in-home visits with them rather than the patient trying to drive an hour to physical therapy. Typically, you’re going to go to outpatient physical therapy three times a week. The sessions are about 45 mins for each physical therapy session. When you leave the hospital, most often if you’ve had a hip or knee replacement, you’re walking with a walker. Usually, you do that for one to two weeks and then transition to a cane for another one to two weeks. Usually around one month in the postoperative period for a hip or knee replacement we will have you off of assisted devices, walking on your own, but still doing therapy. Usually, around three months is when you’re feeling pretty normal again. Complete healing can even take up to a year for small amounts of mild soreness to go away completely.
Usually for driving, if it is your right leg that’s had either a hip or a knee replacement, usually around six weeks until your reaction time is sufficient again to allow you to drive. If you’ve had a left-sided replacement, as long as your car is an automatic transmission care, I will allow patients to drive usually at two to three weeks as long as they are off narcotic pain medications.
Melanie: Wrap it up for us, Dr. Gessel, with your best advice for people that are suffering from pain in their knees, or hips, or shoulders, and they’re considering a replacement surgery, what questions would you like them to ask their doctor? What would you like to tell them about what’s going on in the world of joint replacement today?
Dr. Gessel: I feel that the technology from our joint implant corporations getting improved each and every year. They are trying to see what problems implants that have been made in the past have had, and they’re working to try to improve those. In terms of patients, I tell the patients that I really think that they should try conservative measures first if they have not had those done and try to hold off having the replacement until essentially all of the conservative treatment measures aren’t helping them any longer and their pain is affecting their activities of daily living. That’s when I feel it’s time for a patient to have a replacement.
Specific questions that a patient should ask, essentially you should ask your surgeon a lot of the things that we’ve covered today. What happens during my course at the hospital? When will I be able to do certain activities and return to certain activities? What will be required of me, the patient? The patient should know that the post-operative period, and what they do in terms of physical therapy and following physician instructions, actually can make them recover from their joint replacement surgery much quicker if they’re willing to be compliant with what’s asked of them.
Melanie: Thank you, so much, Dr. Gessel, for being with us today. That’s great information. You’re listening to Memorial Health Radio with Memorial Health System, and for more information, you can go to MHSystem.org, that’s MHSystem.org. This is Melanie Cole. Thanks, so much, for listening.