Joint replacement can reopen the door to physical activity. Once cleared by your doctor, you can gradually rebuild strength to resume the full activity level you once had.
Orthopedic surgeon Dr. Seth Greenky discusses why it’s important to stay active after joint replacement and the appropriate levels of activity as you heal.
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Staying Active After Joint Replacement Surgery
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Learn more about Seth S. Greenky, MD
Seth S. Greenky, MD
Dr. Greenky is a board-certified, fellowship-trained orthopedic surgeon specializing in adult reconstruction, including total joint replacement, sports injuries and fracture care. He received his medical degree from SUNY Health Science Center at Syracuse a bachelor’s degree from Northwestern University. Dr. Greenky serves as the medical director for the orthopedic service line at St. Joseph’s Hospital Health Center as well as the section chair for orthopedics. Along with his brother, Dr. Brett Greenky, he serves as the co-director of the joint replacement program at the hospital.Learn more about Seth S. Greenky, MD
Transcription:
Prakash Chandran (Host): Joint replacement can reopen the door to physical activity and with the many advancements in orthopedic surgery, coupled with the right movement recovery, you can actually rebuild strength to resume the full activity level you once had. Here to discuss today is Dr. Seth Greenky, an orthopedic surgeon at St. Joseph’s Health. Dr. Greenky, thanks so much for being here today.
Dr. Seth Greenky (Guest): My pleasure.
Prakash: So to start, what are the most common issues that lead to someone needing orthopedic surgery?
Dr. Greenky: Orthopedic surgery itself is a huge pot of different surgical procedures ranging from foot and ankle, sports medicine, spine surgery and the things that lead to joint replacement whether it be a hip or knee or other joints is usually the joint wears out or becomes nonfunctional from a number of different sources. It can be a wear and tear arthritis. It can be a disease like rheumatoid arthritis. It can be from trauma so there’s a lot of different etiologies, but they all end up in one place, which is a worn out joint.
Prakash: So I think there’s a lot of people out there that are actually living with pain in their joints, and a lot of them will just hope that it goes away over time. How can they know when it’s the right time for surgery or that joint replacement that you’re talking about.
Dr. Greenky: Well you know if the joint wears out, most people believe that the onset of arthritis is sort of a gradual process. Like you have a stiffness in the morning and the stiffness gets worse and gradually becomes pain. Usually what actually happens is you’re sort of motoring along at your base level and then for reasons, even a minor injury, all the sudden what was a relatively minor problem, becomes a major problem. So it’s more sudden and more acute onset than most people think. As far as when to seek help, it depends on how much it interferes with your daily activity, but there’s a lot of different modalities to treat arthritis before it ends up at a joint replacement. There’s medications, there’s different types of injections, there’s physical therapy, so usually we try some sort of conservative modality and the end game is a joint replacement when nothing else is really working adequately.
Prakash: Now is there a waiting too long time or a time when someone should really consider the joint replacement. Is it just when it’s impeding on their lifestyle?
Dr. Greenky: I would say normally there’s not a too long time. A joint reconstruction or joint replacement can be done in any – along the timeline. It doesn’t really effect the outcome as to when you do it. As far as the determination of when it’s time, it’s an impact on quality of life. For some people, it’s not being able to walk 18 holes of golf. For some people it’s not being able to downhill ski, and for other people it’s not being able to get up from a chair at a restaurant and walk to your car or walk to a movie theater that’s in a mall, so it’s very variable depending on the person’s perspective.
Prakash: That makes a lot of sense. So let’s talk a little bit about recovery time. You know we’ve been hearing a lot about a recent shift to outpatient replacement options as opposed to the traditional nights at the hospital for recovery. Can you give us your thoughts on this?
Dr. Greenky: Well you know the first thing you look at is how do you achieve the best outcome in an operation of any type, but we’re talking about joint replacement and so the first thing you do is you look at some of the things that can happen negatively, and one of the things that can happen negatively is infection. Infection is the number one thing we want to prevent, and even though it’s a very, very low number, it’s still high enough that you want to control it. When I say a low number, in the United States, it’s less than 2% and in certain hospitals, like our hospital, it’s well under 1%, but if you do it in an outpatient facility, the percentage of infection goes down even more because it’s not housed by a hospital where a lot of sick people hang out. I’m not suggesting that every joint replacement should be done as an outpatient because different people have different underlying medical conditions and the vast majority of joint replacements still belong in a hospital. The people that are selected as an outpatient candidate are people that have medical problems that are under really good control or have very few medical problems.
Prakash: So I’ve also heard you say that movement is like medicine for the joints, and it feels like especially after surgery that’s really important. Can you talk a little bit about the appropriate levels of movement and activity as you heal and afterwards?
Dr. Greenky: Sure, you know the joint replacement recovery period has changed dramatically over the years. Twenty years ago – or thirty years ago when I started, the recovery was up to a five day stay in the hospital, and then you were on a walker for a long period of time, gradually on a cane and you know weeks or months later you’d be resuming relatively normal activity. That has accelerated considerably and even in the hospital now the vast majority of people are in the hospital for one night. They’re walking the first day of surgery. They’re doing stairs before they leave the hospital. They’re able to get in and out of the bed and in and out of a chair on their own, and they require very little care at home. So it’s a dramatic shift in terms of the time of recovery. As far as activities after surgery it’s really pretty loose. I would say that in the traditional joint replacement world the activities that you avoid are impact loading activities and the activities that are encouraged are non-impact loading activities. For example, you would avoid a regular running program or a basketball program. Where as swimming, biking, walking, an elliptical machine, a rowing machine, yoga, tai chi, those types of things are all allowed an encouraged.
Prakash: Okay, and I’m very curious, you mentioned that today the recovery time is so much faster, what do you think is the reason for that?
Dr. Greenky: I think there’s a lot of reasons. One reason is the pain control modalities we have now are much better than in the past. I think we now understand that the activity actually makes the joint get better quicker. In other words, the more active you can be in a reasonable way as soon as possible, makes the pain less, and I think the surgery, the techniques of surgery have improved in a way that allows much quicker mobilization.
Prakash: Dr. Greenky thanks so much for bringing your 30 years of experience and for your time today. For more information please visit sjhsyr.org, that’s sjhsyr.org. This is St. Joseph’s Health Medcast from St. Joseph’s Health. I’m Prakash Chandran, thanks so much for listening.
Prakash Chandran (Host): Joint replacement can reopen the door to physical activity and with the many advancements in orthopedic surgery, coupled with the right movement recovery, you can actually rebuild strength to resume the full activity level you once had. Here to discuss today is Dr. Seth Greenky, an orthopedic surgeon at St. Joseph’s Health. Dr. Greenky, thanks so much for being here today.
Dr. Seth Greenky (Guest): My pleasure.
Prakash: So to start, what are the most common issues that lead to someone needing orthopedic surgery?
Dr. Greenky: Orthopedic surgery itself is a huge pot of different surgical procedures ranging from foot and ankle, sports medicine, spine surgery and the things that lead to joint replacement whether it be a hip or knee or other joints is usually the joint wears out or becomes nonfunctional from a number of different sources. It can be a wear and tear arthritis. It can be a disease like rheumatoid arthritis. It can be from trauma so there’s a lot of different etiologies, but they all end up in one place, which is a worn out joint.
Prakash: So I think there’s a lot of people out there that are actually living with pain in their joints, and a lot of them will just hope that it goes away over time. How can they know when it’s the right time for surgery or that joint replacement that you’re talking about.
Dr. Greenky: Well you know if the joint wears out, most people believe that the onset of arthritis is sort of a gradual process. Like you have a stiffness in the morning and the stiffness gets worse and gradually becomes pain. Usually what actually happens is you’re sort of motoring along at your base level and then for reasons, even a minor injury, all the sudden what was a relatively minor problem, becomes a major problem. So it’s more sudden and more acute onset than most people think. As far as when to seek help, it depends on how much it interferes with your daily activity, but there’s a lot of different modalities to treat arthritis before it ends up at a joint replacement. There’s medications, there’s different types of injections, there’s physical therapy, so usually we try some sort of conservative modality and the end game is a joint replacement when nothing else is really working adequately.
Prakash: Now is there a waiting too long time or a time when someone should really consider the joint replacement. Is it just when it’s impeding on their lifestyle?
Dr. Greenky: I would say normally there’s not a too long time. A joint reconstruction or joint replacement can be done in any – along the timeline. It doesn’t really effect the outcome as to when you do it. As far as the determination of when it’s time, it’s an impact on quality of life. For some people, it’s not being able to walk 18 holes of golf. For some people it’s not being able to downhill ski, and for other people it’s not being able to get up from a chair at a restaurant and walk to your car or walk to a movie theater that’s in a mall, so it’s very variable depending on the person’s perspective.
Prakash: That makes a lot of sense. So let’s talk a little bit about recovery time. You know we’ve been hearing a lot about a recent shift to outpatient replacement options as opposed to the traditional nights at the hospital for recovery. Can you give us your thoughts on this?
Dr. Greenky: Well you know the first thing you look at is how do you achieve the best outcome in an operation of any type, but we’re talking about joint replacement and so the first thing you do is you look at some of the things that can happen negatively, and one of the things that can happen negatively is infection. Infection is the number one thing we want to prevent, and even though it’s a very, very low number, it’s still high enough that you want to control it. When I say a low number, in the United States, it’s less than 2% and in certain hospitals, like our hospital, it’s well under 1%, but if you do it in an outpatient facility, the percentage of infection goes down even more because it’s not housed by a hospital where a lot of sick people hang out. I’m not suggesting that every joint replacement should be done as an outpatient because different people have different underlying medical conditions and the vast majority of joint replacements still belong in a hospital. The people that are selected as an outpatient candidate are people that have medical problems that are under really good control or have very few medical problems.
Prakash: So I’ve also heard you say that movement is like medicine for the joints, and it feels like especially after surgery that’s really important. Can you talk a little bit about the appropriate levels of movement and activity as you heal and afterwards?
Dr. Greenky: Sure, you know the joint replacement recovery period has changed dramatically over the years. Twenty years ago – or thirty years ago when I started, the recovery was up to a five day stay in the hospital, and then you were on a walker for a long period of time, gradually on a cane and you know weeks or months later you’d be resuming relatively normal activity. That has accelerated considerably and even in the hospital now the vast majority of people are in the hospital for one night. They’re walking the first day of surgery. They’re doing stairs before they leave the hospital. They’re able to get in and out of the bed and in and out of a chair on their own, and they require very little care at home. So it’s a dramatic shift in terms of the time of recovery. As far as activities after surgery it’s really pretty loose. I would say that in the traditional joint replacement world the activities that you avoid are impact loading activities and the activities that are encouraged are non-impact loading activities. For example, you would avoid a regular running program or a basketball program. Where as swimming, biking, walking, an elliptical machine, a rowing machine, yoga, tai chi, those types of things are all allowed an encouraged.
Prakash: Okay, and I’m very curious, you mentioned that today the recovery time is so much faster, what do you think is the reason for that?
Dr. Greenky: I think there’s a lot of reasons. One reason is the pain control modalities we have now are much better than in the past. I think we now understand that the activity actually makes the joint get better quicker. In other words, the more active you can be in a reasonable way as soon as possible, makes the pain less, and I think the surgery, the techniques of surgery have improved in a way that allows much quicker mobilization.
Prakash: Dr. Greenky thanks so much for bringing your 30 years of experience and for your time today. For more information please visit sjhsyr.org, that’s sjhsyr.org. This is St. Joseph’s Health Medcast from St. Joseph’s Health. I’m Prakash Chandran, thanks so much for listening.