Joint Replacement: One Patient's Story
Pain from an arthritic hip was making it extremely difficult for Sarah G. Adams to run her bed and breakfast on Martha's Vineyard.
"I had to take a couple of Aleves every day, but even so, whenever I would attempt a project, I would have to sit down for a while," said the innkeeper, who divides her time between Oak Bluffs and Rehoboth. "It was so painful, I couldn't even plant my daffodils. It just got worse and worse. One hip was lower than the other. I was bent forward. When I went to Spain last summer, I had to use a cane."
Adams underwent minimally invasive hip replacement surgery last fall. Mark Haffenreffer, MD, an orthopedic surgeon with Needham Orthopedics and Sports Medicine, performed the operation at Beth Israel Deaconess Hospital-Needham.
"I'm thrilled," said Adams, who is in her early 60s. "I was back to driving and running the bed and breakfast a month after the surgery. I was using a walker at first, and then a cane. Now, I'm walking around without the cane. I am standing tall again. My physical therapist just tested my strength and she was amazed. I'm getting very strong."
Dr. Haffenreffer said the minimally invasive operation, which involves a tiny incision and does not require muscle to be cut, allowed Adams to get up and around right away.
"She was moving the joint the day of the surgery and was up and walking the next morning," he said.
That was especially critical to her because she has arthritis in her other hip and both knees, Dr. Haffenreffer said. If those other joints had been immobile for any length of time, he said, they would have stiffened up and weakened, making her rehabilitation that much more difficult.
The key to any successful joint replacement is getting patients quickly into an aggressive rehabilitation program, in most cases at home, he said. Many patients are standing and walking as early as the day of the surgery, whether they get minimally invasive or traditional surgery.
"We are aggressively doing physical therapy," Dr. Haffenreffer said. "We are much better now in shortening how long it takes to get better. We stretch them out immediately. No longer are we letting scar tissue form."
In addition, he said, it is critical to personalize the care to the individual patient.
"There is an active involvement by the surgeon in the physical therapy," he said. "It's not assembly line. I spend a half-hour each day with my patients. The amount of time spent after the surgery is crucial. I know each physical therapist and see each patient every day. I frequently call the patients and make sure rehabilitation is progressing. It separates us from a lot of programs."
Each year, 340,000 Americans undergo hip replacements, with another 400,000 getting knee replacements.
Most joint replacements are the result of arthritis, and patients range in age from mid-40s to mid-70s, Dr. Haffenreffer said. New joints are usually made of metal, plastic or both. They are either cemented in place or not cemented, so that the bone will grow into the new joint.
Dr. Haffenreffer, who performs both hip and knee replacements, said both operations have evolved and have excellent track records. The implants last between 10 and 20 years.
In total hip replacement, the surgeon cuts away the ball part of the joint, replacing it with a ball attached to a stem that is wedged into a hollowed-out space in the thighbone. Damaged cartilage and bone are removed from the socket and a cup-like component is inserted into the socket. The operation may be done in the traditional way or in a minimally invasive fashion, as was the case for Adams. According to Dr. Haffenreffer, the minimally invasive hip replacement is particularly effective for patients, like Adams, who have other joints that are giving them problems.
In a standard total knee replacement, the damaged areas of the thighbone, shinbone and kneecap are removed and replaced with prostheses. The ends of the remaining bones are smoothed and reshaped to accommodate the prostheses. Pieces of the artificial knee are typically held in place with cement. According to Dr. Haffenreffer, the jury is still out as to whether the minimally invasive type of knee replacement offers results that are as good as the traditional method.
Shoulder replacement surgery is another type of joint replacement available to patients, although it is less common than hip or knee replacement, with only about 23,000 performed annually in the U.S.