Healthy Focus

Your hips don’t lie: Faster, easier options for joint replacement

Dr. Mark Cutright, Orthopedic Surgeon with Innovative Orthopedics and Sports Medicine

Hip, knee and shoulder replacements just aren’t what they used to be—thankfully.

Today’s improved joint replacements require shorter hospital stays and recovery times. As a result, these surgeries are more often a first choice for those with active lives rather than a last-resort option for the severely disabled. And joint replacement patients are getting younger: A decade ago patients were more likely to be in their 60s or older, but surgeons now mostly treat patients who are age 50 and older. “Patients today are not willing to live with disability. That’s why replacements are occurring more commonly than they used to,” says Dr. Mark Cutright, Orthopedic Surgeon with Innovative Orthopedics and Sports Medicine. “People are extending their lifestyles and participating in activities our parents or grandparents would not,” adds Dr. Cutright.

Not only are the typical joint replacement patients different than they were a decade or two ago, so is the surgery itself. Most of the physicians who specialize in joint replacements today have completed hundreds–and in many cases, thousands–of these surgeries and know how to anticipate complications.

How it works

Your hip, knee and shoulder joints are lined with cartilage that helps them move easily. When that cartilage is worn away by arthritis or other diseases, it hurts to move the joint. During joint replacement surgery, the damaged joint lining is replaced by a metal, plastic and/or ceramic prosthesis, generally a ball and a socket.

Joint replacement parts come in many more sizes than they used to, adjusted for women and men as well as for the size of the patient. The more customized parts mean the replacement joints fit better, cause less pain and require less recovery time, says Dr. Cutright.

Although any artificial part eventually will wear out, new ceramic bearing technology, rather than stainless steel parts, can help replacements last longer, says Dr. Cutright. A typical replacement joint will last 20 years, but the longevity varies depending on the patient and joint condition.  MRI imaging has helped surgeons better align replacement joints, adds Dr. Cutright, which also leads to a better fit, a shorter hospital stay and overall a more positive experience.

Non-surgical options

Before exploring joint replacement, your doctor typically will have you try a range of over-the-counter and prescription remedies for pain management. An arthritis brace–a custom device that is more substantial than an Ace bandage–can help shift your gait and alignment, thus reducing pain when the joint is used. Other braces may keep a joint warm, also reducing pain.

Cortisone injections, which typically combine a corticosteroid medication and a local anesthetic, may help reduce pain for up to three months.
Dr. Cutright says some of his patients repeat these injections for years and successfully ward off the need for surgery. In addition, weight loss can help decrease the strain on arthritic joints.

Up and at ‘em

If surgery does become necessary, rehab typically begins right away after the operation, which generally takes up to two and a half hours for a hip or knee replacement, and two to four hours for a shoulder replacement. Most surgeons like to have their patients up and walking (with assistance, of course) the same day as their surgery, Dr. Cutright says.
The hospital stay for joint replacement usually is three days. You’ll receive physical therapy starting in the hospital, and then either at home or as an outpatient, likely three times a week. You’ll probably be able to participate in your favorite activities again post-surgery, possibly within six to eight weeks. But Dr. Cutright urges sticking to low-impact sports like walking, golf and swimming.

“I do not get upset about a basketball game at a family picnic,” he says. “But the heavy pounding of joining a basketball team can be hard.” Adds Dr. Cutright, “After surgery, patients feel more natural. They feel like they can do stuff, the things they did when they were young.”

Making the decision

Although some joint replacement surgery is necessitated by a fall, a car accident or other trauma, the more common reason is the cumulative effects of arthritis and chronic diseases, says Dr. Cutright. The decision to have surgery is a gray area that tends to be driven by the patient’s needs and desires, he says: “It boils down to a quality of life issue. When can they no longer tolerate hip or joint pain?”
“We used to look at the X-rays, but they don’t necessarily mean a patient needs to have a joint replacement,” explains Dr. Cutright. “You have to talk to the patient. If the pain doesn’t interfere with their lifestyle, then it doesn’t matter what the X-rays say.”

5 reasons to consider joint replacement surgery

  1. Severe joint pain or stiffness that inhibits everyday activities
  2. Moderate or severe joint pain while resting
  3. Chronic joint inflammation and swelling that isn’t helped by rest or medication
  4. Joint deformity
  5. No major improvement in joint pain after other less-invasive treatments

Source: American Academy of Orthopaedic Surgeons

Bottoms up: Protecting your pelvic floor

Like other muscles and connective tissue, your pelvic floor can weaken as you age, leading to such unpleasant events as urinary or bowel leakages.

The remedy? Use it or lose it, just as with other muscles.

Your pelvic floor supports your reproductive organs, bladder and bowels and helps control urination, sexual activity and bowel movements. By not smoking, maintaining a healthy weight, and performing simple pelvic floor strengthening exercises, however, you can help keep your pelvic floor in tiptop shape.

Joe Mobley, III, MD
Urologist at Kentucky Lake Urologic Associates

More pelvic floor problems

The incidence of pelvic floor problems such as incontinence or pelvic organ prolapse is on the rise, in large part because the population is aging and women are living longer after menopause, says Dr. Joe Mobley, III, Urologist, KY Lake Urology.

Pelvic organ tissues, such as those of the vagina and bladder, need estrogen to stay healthy and supple. But estrogen levels decline after menopause, causing these delicate tissues to thin and become easily irritated. Your bladder can’t hold as much urine, and your vagina produces less lubrication, making sexual intercourse difficult or even painful.

Even for pre-menopausal women, pregnancy, childbirth and repeated heavy lifting or exertion can put stress and pressure on the pelvic floor muscles, as can being obese or overweight.

“Obesity is a huge risk factor for pelvic floor problems,” says Dr. Mobley. “Having a BMI [body mass index, a measure of body fat] of 30 or higher significantly increases your risk.”

Illnesses such as diabetes, multiple sclerosis, Alzheimer’s disease and vascular disease can also put you at greater risk for pelvic floor problems.

Urinary incontinence

A weakened pelvic floor can easily lead to urinary incontinence, or loss of bladder control, which women are twice as likely as men to suffer from.

Stress incontinence results from weakness in the bladder muscles. You may leak a small amount of urine when you sneeze or lift something heavy. In severe cases, you may have uncontrolled wetting. On the other hand, if you frequently have a strong urge to urinate, you likely have an overactive bladder, or urgency incontinence.

Many women have a combination of stress and urgency incontinence. Underactive bladder muscles, low estrogen or an obstruction in the urethra can cause your bladder to become too full (overflow incontinence), which can also lead to leaking. The good news is that Kegel exercises, bladder training, and medications can successfully fix most urinary incontinence problems.

Fecal incontinence

When trauma, nerve injury or diseases such as irritable bowel syndrome (IBS) damage the muscle mechanics around the anus (the opening of the rectum), it can lead to unintentional bowel loss, or fecal incontinence.

“Sometimes, simply identifying and avoiding certain foods can alleviate fecal incontinence,” says Dr. Mobley. Treating any underlying diseases, modifying your diet and adding bulk to your bowels will help resolve most fecal incontinence problems. When these measures do not prove effective, we have minimally invasive procedures to help rectify the problem.”

Pelvic organ prolapse

Pelvic organ prolapse occurs when tissue from other organs, such as the bladder or uterus, abnormally protrudes into the vagina.

“Pelvic organ prolapse is actually a hernia,” says Dr. Mobley.

Symptoms can include the sensation of vaginal fullness, lower back pain and difficulty going to the bathroom or having sexual intercourse. But often pelvic organ prolapse isn’t bothersome and may not require any treatment. Some women use a device called a pessary, which they or their doctor insert into the vagina to support the prolapsed organ.

Pelvic protection strategies

One of the most important ways to prevent pelvic health problems is completely within your control: Don’t smoke.

“Smoking reduces tissue integrity, especially as we age and are exposed to other risk factors,” says Dr. Mobley.

Taking charge of your health—and your diet—will also help you avoid pelvic floor problems. “Control your weight before you become obese,” says Dr. Mobley, “and do Kegel exercises. Don’t underestimate the importance of doing these exercises, especially if you are having children. Kegel exercises are always a part of any pelvic floor treatment regimen.

“A lot of women live with pelvic floor problems, thinking they are a normal consequence of aging,” he adds. “They’re not. At least 80 percent of these problems can be treated satisfactorily.”

Kegel quickies

Strengthen your pelvic floor muscles by regularly performing Kegels:

  • Squeeze the muscles that you use to stop the flow of urine. This contraction pulls the vagina and rectum up and back.
  • Hold for up to 10 seconds, then release.
  • Do 50 contractions a day for at least four to six weeks.

Source: American College of Obstetrics and Gynecology

Sweet Potato and Squash Hash with Hot-Sweet Tomato Topping

The following recipe starts with roasting to intensify the sweetness in butternut squash and finishes with skillet browning for a delicious, satisfying and healthful side dish.

2 cups sweet potato, diced into ½-inch pieces (1 medium-large sweet potato)
2 cups butternut squash, diced into ½-inch pieces
Olive oil cooking spray
1-1/4 cups chopped red onion (1 medium onion)
1 cup no-salt-added, fire-roasted diced canned tomatoes
1 teaspoon honey
3/8 teaspoon salt, divided
1/4 teaspoon pepper, divided
1/8 teaspoon chipotle chile powder
1/8 teaspoon dried, crushed thyme

Place sweet potato and butternut squash on large baking sheet with a rim. Spray with cooking spray. Spread out vegetables on baking sheet. Roast in preheated 400-degree oven for 10 minutes or until almost tender. Remove and set aside.

Spray a small saucepan with cooking spray. Add 1/4 cup onion and cook over medium heat 5 minutes, stirring occasionally, or until onion is transparent. Add tomatoes, honey, 1/8 teaspoon salt, 1/8 teaspoon pepper and chile powder. Cook over medium heat 10 minutes or until mixture is thick; keep warm.

Spray large, heavy-bottomed skillet with cooking spray. Add remaining 1 cup onion. Cook over medium heat 7 minutes or until onion is transparent. Add roasted vegetables, remaining 1/4 teaspoon salt, remaining 1/8 teaspoon pepper and thyme. Stir gently but well. Press vegetables down into skillet. Cook over medium heat 10 to 15 minutes, or until vegetables are tender, stirring occasionally.

To serve, spoon hash onto four plates; top each with 1/4 of the tomato topping.

Makes 4 (3/4-cup) servings.

Per serving: 130 calories / 0.5 grams total fat / 3 grams protein / 30 grams carbohydrates / 270 milligrams sodium / 4.75 grams dietary fiber