Hip and Knee Joint Arthroplasty
The Hip and Knee Joint Arthroplasty Service at Penn State Hershey offers central Pennsylvania an unparalleled level of expertise in the treatment of arthritis of the hip and knee. All of our board certified surgeons have completed orthopaedic subspecialty fellowships in the area of joint arthroplasty. Our surgeons offer expertise in a range of pain relieving procedures including joint preservation surgery, hip resurfacing, partial knee replacement, total joint arthroplasty, and complex revision surgery. More than 1000 joint replacement procedures will be performed in state of the art operating rooms this year.
- Avascular Necrosis
- Complex Revision
- Hip Arthritis
- Hip Resurfacing
- Infected Arthroplasty
- Knee Arthritis
- Partial Knee Replacement
- Total Hip Arthroplasty
Penn State Hershey has recently opened the Bone and Joint Institute which combines convenient services such as therapy, radiology, and prosthetics with our surgeon consultation areas. An integrated, multidisciplinary approach combines a team of dedicated physician assistants, orthopaedic nurses, anesthesia teams, and physical therapists to ensure a safe and appropriately brief hospital stay. Weekly joint replacement education classes prepare patients for their pre-operative, hospital, and rehabilitation experiences.
Total Joint Replacement: A Patient’s Perspective
The American Association of Hip and knee Surgeons (AAHKS) has prepared a nice video about hip and knee replacement titled “Total Joint Replacement: A Patient’s Perspective”. It will show you what it is like to have a hip or knee replacement. The documentary itself is about 1 hour long and can be viewed here.
Appointments or referrals can be made directly by calling Penn State Hershey Bone and Joint Institute at 717-531-5638 or Careline at 717-531-6955 or 800-243-1455.
If you are a physician making a referral, you may call Penn State MD Network at 717-531-5880 or -800-233-4082.
Q: What is arthritis?
A: Arthritis is a wearing away of the lining (cartilage) between the ends of the bones in a joint. The cartilage is a smooth teflon-like surface that covers the ends of the bones. It acts as a shock absorber and allows the bones to move on each other in a smooth, painless manner. As the cartilage wears away the rough bone ends begin to rub on each other (“bone-on-bone”) resulting in stiffness and pain.
Q: What causes arthritis?
A: There are a number of causes for arthritis. The most common type of arthritis is osteoarthritis which is often referred to as “wear and tear” arthritis. In most cases, it results from a lifetime of use of the joint for walking or other daily activities. It is not always clear why one person develops osteoarthritis and another does not or why only one hip or knee develops osteoarthritis. There can be a family or genetic link, especially in families where osteoarthritis at a young age is common.
A second relatively common from of arthritis is rheumatoid arthritis. This type results from an inflammation and swelling of the joint lining (synovium) which damages the joint surface. Patients with this type of arthritis are often cared for by a rheumatologist and an orthopedic surgeon in a team effort to control the inflammation and maintain joint function.
Prior injury to a joint may also predispose to early arthritis, especially if the joint is damaged in a fracture or break of the bone. This form of arthritis is termed post-traumatic arthritis and is often seen in younger patients.
Q: How is arthritis treated and what are the non-operative methods of treatment?
A: There are a number of treatment options for arthritis. The typical initial measures include activity modification, nonsteroidal anti-inflammatory medications (NSAIDs), acetaminophen (Tylenol), gait aids (cane, crutch, walker) and weight loss.
Activity modification means avoiding activities which cause the joint to hurt. This may include limiting walking, lifting activities, overhead activities, stairs and squatting.
NSAIDs are medications intended to decrease inflammation and pain and soreness in a joint or muscle. They are best taken on a regular basis in those patients with chronic pain however may be taken intermittently if the pain is not always present. Stomach upset may be a significant problem with these medications.
Acetaminophen (Tylenol) can be very helpful in some patients with pain from arthritis used according to the label directions. Patients with liver problems should discuss this with a physician prior to use.
Gait aids can significantly relieve stress across the hip and knee and thus decrease pain. A cane or single crutch should generally be used in the hand opposite to the painful hip or knee.
Weight loss is extremely helpful in decreasing the pain of arthritis. Body weight is magnified up to seven times in passing through the hip or knee joint. Thus, even a small decrease in weight may result in a dramatic decrease in the forces across the hip or knee joint and less pain.
Q: Do I need an arthroscopy?
A: Arthroscopic surgery for osteoarthritis is most frequently performed at the knee, however, may occasionally be performed at the shoulder or elbow as well. It involves placing a small camera into the joint and using small instruments to remove loose pieces of cartilage. The results of this procedure are somewhat unpredictable, however it may be indicated in some patients with mild to moderate disease. This does not cure the arthritis, however it may significantly decrease the level of pain associated with the arthritis.
Q: Do I need an injection?
A: Several different types of injections are available for patients with osteoarthritis. The most common is an injection of corticosteroids possibly combined with an anaesthetic medication. This may provide significant pain relief for a substantial period of time in patients with mild to moderate arthritis, however it is somewhat unpredictable. Some patients do not have any improvement after the injection. The injection is generally performed as an office procedure and does not interfere with the ability to drive home. Injections can be repeated every several months for a total of up to three or four injections. This does not cure the arthritis, however it may decrease the level of pain.
More recently injections of synvisc or hyalgan have become more common. This is a viscous substance which is intended to decrease inflammation into the knee joint. The benefit of this substance has yet to be proven, however there is no evidence for significant complications related to its use.
Q: What is an osteotomy?
A: Some young , highly active patients with particular patterns of arthritis may be candidates for an osteotomy. This involves realigning the leg so that more of the weight is transmitted through the more normal parts of the joint. In many instances this may significantly decrease a patient's level of pain for a number of years. It is designed primarily for younger, highly active patients with relatively localized forms of arthritis.
Q: Who needs a joint replacement?
A: Joint replacements (joint arthroplasties) have been performed in the United States for approximately thirty years. Joint replacement involves removing the arthritic portions of the joint and replacing them with a plastic and metal artificial joint. It is generally available for hip, knee, shoulder, and elbow joints and is very effective for relieving pain at these joints. Range of motion is generally maintained with these joint replacements and most patients have an excellent functional result. Joint replacements are indicated in patients who have joint pain from arthritis which significantly interferes with their lifestyle and daily activities. It is generally recommended for older patients as there is a finite lifespan. At the hip and knee, an uncomplicated joint replacement has an approximately 85% chance of being intact and functioning after fifteen years. The overall results of joint replacement in properly selected patients are excellent and most patients have little or no pain after recovery from the surgery. The hospital stay is between four and six days with the full recovery between six weeks and three months. Following a hip or knee replacement, patients can drive, walk as far as they would like, ride an exercise bicycle, swim, play golf, dance, bike, and enjoy most other activities which do not involve repetitive jumping or twisting. Following your joint replacement, you should have x-rays at least every three to five years to be sure that the joint replacement is functioning properly.