If your knee is severely damaged by arthritis or injury, it may be hard for you to perform simple activities, such as walking or climbing stairs.
You may even begin to feel pain while you are sitting or lying down.
If nonsurgical treatments like medications and using walking supports are no longer helpful, you may want to consider total knee replacement surgery.
Joint replacement surgery is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume normal activities.
Tune into SMG radio to learn about joint replacement surgery in an exclusive interview with renowned knee surgeon Dr. Richard Rosa of Summit Medical Group.
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Knee Replacement Surgery: A Safe and Effective Procedure
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Learn more about Dr. Richard Rosa
Richard Rosa, MD
Dr. Richard Rosa specializes in total knee replacement, partial (unicompartmental) knee replacement, total hip replacement, and total shoulder replacement. He was fellowship trained at the Hospital for Special Surgery in Manhattan, one of the world’s top orthopedic hospitals. Dr. Rosa has been featured many times in Castle Connolly "Top Doctors," listing and has also been featured in New Jersey Monthly’s "Top Doctor" listings.Learn more about Dr. Richard Rosa
Transcription:
Knee Replacement Surgery: A Safe and Effective Procedure
Melanie Cole (Host): If you have knee pain and it bothers you for quite some time, you might wonder if you need a knee replacement. How do you know? My guest today is Dr. Richard Rosa. He is a renowned knee surgeon who specializes in total knee replacement at Summit Medical Group. Welcome to the show, Dr. Rosa. People suffer from knee pain all the time, millions of people. How do they know when it is just generalized knee pain, osteoarthritis, or something that might possibly need a replacement?
Dr. Richard Rosa (Guest): The way they know is when they come in and we take a history, we do an examination. We take x-rays and we determine what the source of the pain is. If we see that there is arthritis there, we will come up with a treatment plan. Arthritis is the wearing down of the joint. The most common type of arthritis is osteoarthritis or degenerative arthritis. When you have arthritis, you can’t cure the arthritis. You can only control the symptoms. Generally, we will start with anti-inflammatory medication, sometimes a physical therapy program. Frequently, a weight loss program is beneficial. If that is not working or we want to do more, that’s when we have injections that we can do that are lubricating gel injections called “hyaluronic acid.” What hyaluronic acid is, it’s the major molecule in healthy joint fluid. There are commercial preparations available where we can inject this hyaluronic acid into the knee. What that does is actually helps to lubricate the knee and to relieve a lot of the pain. The earlier you do this in osteoarthritis, the more effective it is, in general. As the arthritis gets worse, sometimes patients get to the point where conservative treatment is no longer beneficial. When they get to that point and they are having severe pain, you have to make a decision as to whether or not the pain is severe enough that they would consider surgery to relieve that pain. That surgery would be either a knee replacement or a partial knee replacement. I tell patients, when you have severe arthritis, when conservative management has no longer been helpful and you get to the point where you say, “I can’t live like this anymore”. That’s different for different people. Some people will wait until they can barely walk. Some people will do it when they feel that it is impacting on their lifestyle. What we will do is, we will correlate their symptoms with the x-ray findings and decide whether or not they may be a candidate for this type of procedure. If we get to that point, then we have to decide if they are a candidate for a full knee replacement or a partial knee replacement. The advancements in knee replacements have been fantastic over the past 10 years or so and we are still improving by leaps and bounds. Right now, actually, the knee replacement prosthesis that I use is a patient specific, custom-designed knee replacement. It’s made specifically for the patient’s knee and what it does is, it’s an exact replica of that patient’s knee prior to having developed the arthritis. We get a CT scan. Off of the CT scan, we get a computerized design and we fabricate the knee prosthesis that matches the patient’s knee in every way. We also make a set of instruments that match that patient’s knee so that when we put that knee replacement in the ligaments in the knee are perfectly balanced and the knee matches their knee in every way. It’s as close to a normal knee as you can get under the circumstances. We have been having fantastic results with this knee with much quicker recovery and much greater patient satisfaction.
Melanie: That is absolutely fascinating. Dr. Rosa, speak about the recovery a little bit. People hear total replacement and they think, “Oh, I’m going to be out for six months.” How long does it take someone to get back to daily activities much less exercising?
Dr. Rosa: That’s a good question. Years ago it was six months. Now, we are recovering much more quickly. That is a result of a combination of advancements, one of which is the surgical technique and the prosthesis that we are using. The other is the advances in anesthesia and the advances in pain management. For patients who have knee replacements now, we have long acting local anesthetics that we use. We have nerve blocks that we have our pain management people do. Not uncommonly, a lot of our patients immediately after the surgery have little or no pain. That allows us to get them up, get them out of bed, get them walking and getting that knee bending as soon as possible. The more quickly we can do that, the more quickly they will rehabilitate and the more likely they are to have a much more favorable result.
Melanie: The knee, as we’ve spoken a little bit before, is like a hinge joint. So when you are replacing it, is there any limited movement once you’ve put in a new knee?
Dr. Rosa: The limited movement generally comes from a discomfort that patient will have after the surgery. That is one of the reasons that we push the rehabilitation very early and very quickly. Patients may be in the hospital for a day or two, then they will generally go home. For younger or very active patients, sometimes we can do it as a same day surgery but there is an advantage at this point to have a hospital setting, at least in the beginning. As we get them started on a very aggressive physical therapy program in the hospital, then we continue as soon as they go home. Historically, we have had patients after that attending outpatient therapy three times per week for about three months. Some patients don’t need that much. Some patients will need about six weeks and then they can continue on their own. The goal is number one, to get up and walk, which happens very quickly. The second goal is to get as much motion as possible in the knee. If we see that a patient is a candidate for a partial knee replacement or what we call a “unicompartmental knee replacement”, or a “uni-knee”, when we do that, some patients when they develop arthritis, they develop arthritis in just one part of the knee instead of the entire knee. In that case, they may be a candidate for a partial knee replacement, the advantage being that it is a much smaller incision, does not violate the muscle at all, it is a much quicker rehabilitation, a much quicker recovery. That, we can frequently do as a same day surgery. Patients are up and walking on it immediately. Most patients with a partial knee replacement will need a maximum of six weeks of physical therapy. Many patients only need four weeks of physical therapy. The advantage, again, of the partial knee replacement is that it is a much more normal feel to the knee because the rest of the knee is your own. Basically, when we are doing a knee replacement or a partial knee replacement, we are resurfacing the arthritic surface, like a tire retread. When we do the partial, we are only resurfacing a part of it. The rest of the knee is your own so that lot of times the patient feels completely normal when they have a partial knee replacement. To determine whether or not you are a candidate for a partial knee replacement or a full knee replacement, part of the evaluation, part of the x-ray series that we do and then we have a discussion with the patient to talk about it; we talk about the pros and cons. Then, we decide together what would be best for them and how they think this would best fit into their lifestyle.
Melanie: How is their new knee different? Will they hear a clicking of metal or plastic? Will they set off the security at airports? Speak about the implant a little bit.
Dr. Rosa: Those are all very good questions. Sometimes, they will feel clicking. Generally, it happens in younger, more active patients. There was a time where we wouldn’t consider a knee replacement in anyone under 65, but now patients in their early ‘50s who have arthritis aren’t content to sit around and baby that knee. They want to get out and they want to be active. So, we are actually doing knee replacement in younger age groups now. Sometimes, there will be a clicking. That’s not abnormal because the knee replacement is a metal and plastic device. It is a metal surface, generally a combination of titanium and cobalt chrome and a high molecular weight polyethylene, which is basically a heavy-duty high tech plastic, which is the bearing. So, they may hear that. In terms of the airport, yes, when they go through security they will set off the devices especially now, because we are doing so many more knee replacements then we ever did before and the numbers are just increasing by leaps and bounds. We just counsel our patient and tell them, “Listen, when you go through, you are going to set off the reactor. You have to tell TSA, ‘I have a knee replacement.’ They will take you to the side and they will scan that knee and they will confirm that.”
Melanie: How long does the new knee last? Is this a forever thing or might it have to be looked at 15 years down the line?
Dr. Rosa: We always tell patients that there is a good chance that they will have to have it redone at some time in the future. When we first started doing knee replacements in the last ‘70s and in the early ‘80s, we predicted that a knee would last for about 10 years. With improved techniques, improved implant designs and improved patient selection, we have patients that are going now 20 years or longer. This can conceivable go on for many, many years. There are some that feel that if a knee is doing very well clinically and radiographically at about six or seven years, that potentially it could go on for much longer than that. So, we don’t know what the end result will be, what the end game will be. What we always tell patients is listen, you might have to have this redone. We’re hoping that if we have to redo it, it may just be a matter of replacing the bearings that may be wearing down and not having to take the knee out but it is always a consideration. The other thing is it, is related a lot to the patient, to their activity level, to their weight. Certainly, if you are carrying a lot of extra weight, that puts a lot more stress on the implant. If you are a young very, very active individual, you are going to put more stress on that implant. You have to be reasonable about it. For example, if you are in your early ‘50s and you weigh 225 pounds and you are a collegiate football player and you want to go out and do something heavy duty, that’s not the best thing for the knee. You can be active. Yu can walk; you can play tennis. We have patients that ski on them but you have to be reasonable about it and you have to be careful.
Melanie: It is great information and such a fascinating topic. Thank you so much, Dr. Rosa. You’re listening to SMG Radio. For more information, you can go to SummitMedicalGroup.com. That’s SummitMedicalGroup.com. This is Melanie Cole. Thanks so much for listening.
Knee Replacement Surgery: A Safe and Effective Procedure
Melanie Cole (Host): If you have knee pain and it bothers you for quite some time, you might wonder if you need a knee replacement. How do you know? My guest today is Dr. Richard Rosa. He is a renowned knee surgeon who specializes in total knee replacement at Summit Medical Group. Welcome to the show, Dr. Rosa. People suffer from knee pain all the time, millions of people. How do they know when it is just generalized knee pain, osteoarthritis, or something that might possibly need a replacement?
Dr. Richard Rosa (Guest): The way they know is when they come in and we take a history, we do an examination. We take x-rays and we determine what the source of the pain is. If we see that there is arthritis there, we will come up with a treatment plan. Arthritis is the wearing down of the joint. The most common type of arthritis is osteoarthritis or degenerative arthritis. When you have arthritis, you can’t cure the arthritis. You can only control the symptoms. Generally, we will start with anti-inflammatory medication, sometimes a physical therapy program. Frequently, a weight loss program is beneficial. If that is not working or we want to do more, that’s when we have injections that we can do that are lubricating gel injections called “hyaluronic acid.” What hyaluronic acid is, it’s the major molecule in healthy joint fluid. There are commercial preparations available where we can inject this hyaluronic acid into the knee. What that does is actually helps to lubricate the knee and to relieve a lot of the pain. The earlier you do this in osteoarthritis, the more effective it is, in general. As the arthritis gets worse, sometimes patients get to the point where conservative treatment is no longer beneficial. When they get to that point and they are having severe pain, you have to make a decision as to whether or not the pain is severe enough that they would consider surgery to relieve that pain. That surgery would be either a knee replacement or a partial knee replacement. I tell patients, when you have severe arthritis, when conservative management has no longer been helpful and you get to the point where you say, “I can’t live like this anymore”. That’s different for different people. Some people will wait until they can barely walk. Some people will do it when they feel that it is impacting on their lifestyle. What we will do is, we will correlate their symptoms with the x-ray findings and decide whether or not they may be a candidate for this type of procedure. If we get to that point, then we have to decide if they are a candidate for a full knee replacement or a partial knee replacement. The advancements in knee replacements have been fantastic over the past 10 years or so and we are still improving by leaps and bounds. Right now, actually, the knee replacement prosthesis that I use is a patient specific, custom-designed knee replacement. It’s made specifically for the patient’s knee and what it does is, it’s an exact replica of that patient’s knee prior to having developed the arthritis. We get a CT scan. Off of the CT scan, we get a computerized design and we fabricate the knee prosthesis that matches the patient’s knee in every way. We also make a set of instruments that match that patient’s knee so that when we put that knee replacement in the ligaments in the knee are perfectly balanced and the knee matches their knee in every way. It’s as close to a normal knee as you can get under the circumstances. We have been having fantastic results with this knee with much quicker recovery and much greater patient satisfaction.
Melanie: That is absolutely fascinating. Dr. Rosa, speak about the recovery a little bit. People hear total replacement and they think, “Oh, I’m going to be out for six months.” How long does it take someone to get back to daily activities much less exercising?
Dr. Rosa: That’s a good question. Years ago it was six months. Now, we are recovering much more quickly. That is a result of a combination of advancements, one of which is the surgical technique and the prosthesis that we are using. The other is the advances in anesthesia and the advances in pain management. For patients who have knee replacements now, we have long acting local anesthetics that we use. We have nerve blocks that we have our pain management people do. Not uncommonly, a lot of our patients immediately after the surgery have little or no pain. That allows us to get them up, get them out of bed, get them walking and getting that knee bending as soon as possible. The more quickly we can do that, the more quickly they will rehabilitate and the more likely they are to have a much more favorable result.
Melanie: The knee, as we’ve spoken a little bit before, is like a hinge joint. So when you are replacing it, is there any limited movement once you’ve put in a new knee?
Dr. Rosa: The limited movement generally comes from a discomfort that patient will have after the surgery. That is one of the reasons that we push the rehabilitation very early and very quickly. Patients may be in the hospital for a day or two, then they will generally go home. For younger or very active patients, sometimes we can do it as a same day surgery but there is an advantage at this point to have a hospital setting, at least in the beginning. As we get them started on a very aggressive physical therapy program in the hospital, then we continue as soon as they go home. Historically, we have had patients after that attending outpatient therapy three times per week for about three months. Some patients don’t need that much. Some patients will need about six weeks and then they can continue on their own. The goal is number one, to get up and walk, which happens very quickly. The second goal is to get as much motion as possible in the knee. If we see that a patient is a candidate for a partial knee replacement or what we call a “unicompartmental knee replacement”, or a “uni-knee”, when we do that, some patients when they develop arthritis, they develop arthritis in just one part of the knee instead of the entire knee. In that case, they may be a candidate for a partial knee replacement, the advantage being that it is a much smaller incision, does not violate the muscle at all, it is a much quicker rehabilitation, a much quicker recovery. That, we can frequently do as a same day surgery. Patients are up and walking on it immediately. Most patients with a partial knee replacement will need a maximum of six weeks of physical therapy. Many patients only need four weeks of physical therapy. The advantage, again, of the partial knee replacement is that it is a much more normal feel to the knee because the rest of the knee is your own. Basically, when we are doing a knee replacement or a partial knee replacement, we are resurfacing the arthritic surface, like a tire retread. When we do the partial, we are only resurfacing a part of it. The rest of the knee is your own so that lot of times the patient feels completely normal when they have a partial knee replacement. To determine whether or not you are a candidate for a partial knee replacement or a full knee replacement, part of the evaluation, part of the x-ray series that we do and then we have a discussion with the patient to talk about it; we talk about the pros and cons. Then, we decide together what would be best for them and how they think this would best fit into their lifestyle.
Melanie: How is their new knee different? Will they hear a clicking of metal or plastic? Will they set off the security at airports? Speak about the implant a little bit.
Dr. Rosa: Those are all very good questions. Sometimes, they will feel clicking. Generally, it happens in younger, more active patients. There was a time where we wouldn’t consider a knee replacement in anyone under 65, but now patients in their early ‘50s who have arthritis aren’t content to sit around and baby that knee. They want to get out and they want to be active. So, we are actually doing knee replacement in younger age groups now. Sometimes, there will be a clicking. That’s not abnormal because the knee replacement is a metal and plastic device. It is a metal surface, generally a combination of titanium and cobalt chrome and a high molecular weight polyethylene, which is basically a heavy-duty high tech plastic, which is the bearing. So, they may hear that. In terms of the airport, yes, when they go through security they will set off the devices especially now, because we are doing so many more knee replacements then we ever did before and the numbers are just increasing by leaps and bounds. We just counsel our patient and tell them, “Listen, when you go through, you are going to set off the reactor. You have to tell TSA, ‘I have a knee replacement.’ They will take you to the side and they will scan that knee and they will confirm that.”
Melanie: How long does the new knee last? Is this a forever thing or might it have to be looked at 15 years down the line?
Dr. Rosa: We always tell patients that there is a good chance that they will have to have it redone at some time in the future. When we first started doing knee replacements in the last ‘70s and in the early ‘80s, we predicted that a knee would last for about 10 years. With improved techniques, improved implant designs and improved patient selection, we have patients that are going now 20 years or longer. This can conceivable go on for many, many years. There are some that feel that if a knee is doing very well clinically and radiographically at about six or seven years, that potentially it could go on for much longer than that. So, we don’t know what the end result will be, what the end game will be. What we always tell patients is listen, you might have to have this redone. We’re hoping that if we have to redo it, it may just be a matter of replacing the bearings that may be wearing down and not having to take the knee out but it is always a consideration. The other thing is it, is related a lot to the patient, to their activity level, to their weight. Certainly, if you are carrying a lot of extra weight, that puts a lot more stress on the implant. If you are a young very, very active individual, you are going to put more stress on that implant. You have to be reasonable about it. For example, if you are in your early ‘50s and you weigh 225 pounds and you are a collegiate football player and you want to go out and do something heavy duty, that’s not the best thing for the knee. You can be active. Yu can walk; you can play tennis. We have patients that ski on them but you have to be reasonable about it and you have to be careful.
Melanie: It is great information and such a fascinating topic. Thank you so much, Dr. Rosa. You’re listening to SMG Radio. For more information, you can go to SummitMedicalGroup.com. That’s SummitMedicalGroup.com. This is Melanie Cole. Thanks so much for listening.