Brian Gladnick MD

Frequently Asked Questions (FAQs)

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The first step in diagnosing arthritis is to listen to the patient’s story and do a thorough physical exam. The description of a patient’s symptoms, the specific location of the pain, the circumstances in which it arises, and what factors alleviate or exacerbate the condition, will help guide the physician toward the diagnosis. Reproducing the patient’s symptoms by taking the joint through a range of motion or employing certain physical exam maneuvers will help to confirm the patient history.

Once a preliminary diagnosis is suspected, it is then confirmed with x-rays, which will clearly demonstrate loss of cartilage or bone spurs consistent with arthritic damage to the joint. In rare cases, advanced imaging such as an MRI may be required when other diagnoses are suspected, such as labral tears or avascular necrosis.

It is always preferred to attempt treatment with conservative, or non-operative, modalities prior to considering surgery. As a first line, simple anti-inflammatory medications, weight loss, a home exercise program, physical therapy, and occasional use of a cane may help to control the majority of symptoms. Subsequently, patients may benefit from a cortisone injection, which is a powerful steroid anti-inflammatory medication that is injected into the joint. Gel injections, also known as visco-supplementation, may be appropriate in certain patients.

Ultimately, the decision to proceed with joint replacement surgery is made after an earnest attempt to exhaust all the conservative options, in a patient who continues to have a significantly impaired quality of life due to arthritis of the hip or knee.

The wound is closed using a Dermabond mesh, which is a sterile, superglue-like barrier that seals off the wound from the outside world. There is no need to cover the wound with any dressings or other materials. However, if you are putting ice on the area or using an ice machine, a towel or some other barrier should cover the skin so that there is no moisture condensation on the wound.

Showering is allowed right away after surgery. You may allow soap and water to gently pass over the Dermabond, but do not try to scrub, clean, or spray the area directly with water. Soaking of any kind (bath, hot tub, or pool) is strictly forbidden until six weeks after surgery.

Over time, the Dermabond will gradually flake away with the natural exfoliation of your skin. If it starts to peel prematurely, the peeling edges may be trimmed with a scissor, but do not pull any additional Dermabond away from the wound. In most patients, it should stay in place for 4-6 weeks.

Arthritis of the hip or knee can occur for a variety of reasons. In most patients, arthritis develops due to simple wear-and-tear (also known as osteoarthritis), but genetics play a factor, and this condition does frequently run in families.

 Inflammatory types of arthritis, such as rheumatoid arthritis or psoriatic arthritis, are generally immunologic conditions that cause progressive loss of cartilage and may present sooner in life. Finally, a previous injury or surgery in the hip or knee, or a longstanding deformity, may change the biomechanical environment of the joint and result in a progressive loss of cartilage. 

Whether the cause is simple wear-and-tear, an immunologic condition, or post-traumatic in nature, arthritis of the hip or knee can be a crippling condition that in most patients is very treatable.

Arthritis is a degenerative condition of the joints, in which the cartilage that lines the ends of our bones becomes progressively worn out over time.

Ultimately, once all the cartilage has been lost, there is bone grinding against bone, which results in significant pain and stiffness.

Most simply put, a joint replacement is a surgical procedure in which the arthritic, worn out joint surfaces are removed, and then resurfaced with a low-friction bearing surface to eliminate pain and restore function. However, there are many types of joint replacements, several different ways to dissect down to the involved joint (called surgical approaches), and various types of bearing surfaces used by different surgeons. 

One of the most important components of the pre-operative discussion is to get a full understanding of the surgeon’s training and experience, what type of operation they plan to perform, and why.

After a direct anterior total hip replacement, total knee replacement, or partial knee replacement, patients may immediately weight bear as tolerated, with no restrictions. 

Most patients will spend one night in the hospital and go home the next day, but some patients may prefer to go home on the same day of surgery. Specific physical therapy protocols are available on the website and will be initiated by your physical therapist.

Overall recovery time depends on the age, activity level, and health of the patient. Generally speaking, for the first 2-3 weeks, patients are encouraged to walk, practice going up and down stairs, and resume the activities of daily living.

By 4-6 weeks, most patients have discontinued the need for a cane and are walking unsupported.

From 6-12 weeks, the patient will notice larger gains in physical therapy in terms of endurance, range of motion, and strength.

Usually, by 3-4 months, the patient is starting to feel close to normal and is resuming most activities, but many patients continue to see ongoing improvement even up through one year after surgery. 

Total Hip Replacement

The most important part of the implant is the bearing surface. This is the smooth, polished part of the implant that articulates at the level of the joint, allowing the low-friction motion which is required to walk normally. Over time, surgeons have tried many different combinations of bearing surfaces, each of which has certain advantages and drawbacks. The most predictable results are found using bearing surfaces that have stood the test of time, and have demonstrated decades-long survivorship in longitudinal registry studies.

The hip replacement prosthetic is a ball-and-socket articulation. The ball is made of a highly polished medical-grade ceramic, which is a very smooth and very durable material. The ceramic ball is impacted onto the trunnion of a titanium-alloy stem which has been inserted into the canal of the femur. This titanium stem is coated with a rough layer of a material called hydroxyapatite, which encourages the patient’s own bone to robustly grow onto the new stem.  

On the socket side, the bearing surface is a highly cross-linked polyethylene liner, a very durable medical-grade plastic with superior wear properties. This liner is impacted into a titanium hemispherical shell, which has been inserted into the patient’s own hip socket. Like the stem, this new socket has a roughened outer surface that allows new bone to grow in, unitizing the implant to the patient’s body and providing long-lasting, durable fixation. Thus, while the implants themselves are made of titanium alloy, the final bearing surface is ceramic-on-polyethylene.

Total Knee Replacement

The most important part of the implant is the bearing surface. This is the smooth, polished part of the implant that articulates at the level of the joint, allowing the low-friction motion which is required to walk normally. Over time, surgeons have tried many different combinations of bearing surfaces, each of which has certain advantages and drawbacks. The most predictable results are found using bearing surfaces that have stood the test of time, and have demonstrated decades-long survivorship in longitudinal registry studies.

The knee replacement prosthetic is a hinge-type articulation, consisting of the rounded condyles of the lower part of the thigh bone (the femur), flexing and extending along the flat surface of the upper part of the shin bone (the tibia). The femoral component, which re-surfaces the arthritic femoral condyles (similar to capping a tooth) is made of a very durable, polished metal, a cobalt-chrome alloy. This implant is cemented into the femur using high-viscosity bone cement.

On the tibial side, the bearing surface is made of a highly cross-linked polyethylene liner and is locked into the tibial baseplate, which is made of titanium alloy. The tibial baseplate is cemented into the tibia using the same high-viscosity bone cement. Thus, the final bearing surface is metal-on-polyethylene.

Navigation involves the use of computer software to enhance implant positioning. Historically, surgeons have used a variety of handheld jigs to estimate the bone cuts made during surgery. The introduction of computer navigation has significantly improved the accuracy and precision of these bone cuts. Essentially, the computer software is used to calculate the center of the hip, knee, and ankle during surgery.

Once these points are registered, the mechanical axes of the femur and tibia are determined by the software, and the bone cuts are planned using these data. Multiple studies have now demonstrated that computer navigation improves both implant position and patient-reported outcomes in total knee replacement.

Robotic-assisted knee replacement expands upon the previous forms of computer navigation by using a haptic robotic arm, which is brought onto the surgical field to assist with the bone resections. The surgeon registers multiple anatomic checkpoints into the computer, creating a 3-dimensional map of the patient's knee which is matched to a preoperative CT scan. A virtual surgery is trialed on the computer, creating a plan which accurately reconstructs the mechanical axis of the limb while ensuring proper gap balancing. The robotic arm is then brought onto the sterile field and executes the surgical plan. 

Partial (Unicompartmental) Knee Replacement

The most important part of the implant is the bearing surface. This is the smooth, polished part of the implant that articulates at the level of the joint, allowing the low-friction motion which is required to walk normally. Over time, surgeons have tried many different combinations of bearing surfaces, each of which has certain advantages and drawbacks. The most predictable results are found using bearing surfaces that have stood the test of time, and have demonstrated decades-long survivorship in longitudinal registry studies.

The knee replacement prosthetic is a hinge-type articulation, consisting of the rounded condyles of the lower part of the thigh bone (the femur), flexing and extending along the flat surface of the upper part of the shin bone (the tibia). The femoral component, which re-surfaces the arthritic femoral condyles (similar to capping a tooth) is made of a very durable, polished metal, a cobalt-chrome alloy. This implant is cemented into the femur using high-viscosity bone cement.

On the tibial side, the bearing surface is made of a highly cross-linked polyethylene liner and is locked into the tibial baseplate, which is made of titanium alloy. The tibial baseplate is cemented into the tibia using the same high-viscosity bone cement. Thus, the final bearing surface is metal-on-polyethylene.

Revision Hip and Knee Replacement

The most important part of the implant is the bearing surface. This is the smooth, polished part of the implant that articulates at the level of the joint, allowing the low-friction motion which is required to walk normally. Over time, surgeons have tried many different combinations of bearing surfaces, each of which has certain advantages and drawbacks. The most predictable results are found using bearing surfaces that have stood the test of time, and have demonstrated decades-long survivorship in longitudinal registry studies.

The hip replacement prosthetic is a ball-and-socket articulation. The ball is made of a highly polished medical-grade ceramic, which is a very smooth and very durable material. The ceramic ball is impacted onto the trunnion of a titanium-alloy stem which has been inserted into the canal of the femur. This titanium stem is coated with a rough layer of a material called hydroxyapatite, which encourages the patient’s own bone to robustly grow onto the new stem.  

On the socket side, the bearing surface is a highly cross-linked polyethylene liner, a very durable medical-grade plastic with superior wear properties. This liner is impacted into a titanium hemispherical shell, which has been inserted into the patient’s own hip socket. Like the stem, this new socket has a roughened outer surface that allows new bone to grow in, unitizing the implant to the patient’s body and providing long-lasting, durable fixation. Thus, while the implants themselves are made of titanium alloy, the final bearing surface is ceramic-on-polyethylene.

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