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Joint Replacement & Reconstruction

Repairing a severely injured or diseased joint is more than treating just that body part. It's caring for the whole person to improve their quality of life. We offer skilled hands-on evaluation, appropriate diagnostic testing, and state-of-the-art surgical equipment and techniques to give you the best care.

Americans today enjoy longer, more active lives than ever. But as we age, a lifetime of movement and even overuse can take its toll and result in problems with joints and muscles. Stiff and painful joints can sometimes be life-altering and prevent you from participating in activities you once enjoyed.

The orthopedics staff at MWHC has the clinical expertise to quickly and accurately diagnose the problem and develop an individually customized plan of care to relieve your joint pain or discomfort.

Rest assured that we exhaust every appropriate treatment option before surgery is considered. However, if a surgical procedure becomes the right choice, our skilled orthopedic surgeons are standing by to play their role in a complete continuum of care that produces outstanding clinical results.

Our team will prepare you mentally and physically every step of the way. We will continually monitor and manage your entire pre- and post-surgical performance and progress. It's a full-service approach, coordinated with your primary care physician, orthopedic surgeon, and clinical support staff, to restore your joint's maximum function as quickly and safely as possible.

Our orthopedic surgeons replace all major joints, including hip replacements and knee replacements.

If you're scheduled for joint replacement surgery at Mary Washington Healthcare, read on for more detailed information on our Joint Care Plus Program, which will assist your return to optimum health.

Joint Care Plus Program

We look forward to helping restore your quality of living. Our program is a comprehensive and individually customized course of treatment for your joint replacement. You play a key role in your successful recovery, and our goal is to keep you involved through each step of the program.

Your care team includes physicians, physician assistants, care management, nurses, and physical and occupational therapists who specialize in total joint care. We will review with you every detail of your care, from pre-operative education to post-operative care and exercising.

For the best outcomes after surgery, you should prepare yourself for what to expect before, during, and after the procedure. Please review the patient education video(s) on this website for your type of surgery before you come in for your Pre-Admission Testing (PAT) Nurse Practitioner appointment.

REGARDLESS OF THE TYPE OF SURGERY YOU WILL HAVE, YOU AND YOUR CAREGIVER SHOULD WATCH THE COACH'S CLASS VIDEO TO BE WELL PREPARED WHEN YOU RETURN HOME. WATCH THE COACH'S CLASS HERE.

How to Prepare for Total Joint Replacement Surgery

Begin following these steps as soon as you are scheduled for Total Joint Replacement Surgery.

  1. Call Enterprise Scheduling at 540.741.2000 (Monday-Friday) to pre-register and schedule a telephone nurse interview and PAT Nurse Practitioner appointment.
  2. Have your telephone nursing interview at the specified date and time. The nurse will ask questions about your health history, medications (prescription, over the counter, supplements, herbals, etc.). Please have the bottles with you while you talk to the nurse. The nurse will also tell you what to expect before and after your surgery.
  3. Come in for your PAT Nurse Practitioner appointment at the scheduled date and time. There is no additional cost for seeing the PAT Nurse Practitioner. Please bring with you any paperwork from your surgeon's office, a complete list of your medications, and a pen and paper to write down information or instructions we give you. If you have any questions, feel free to discuss your concerns with the Nurse Practitioner. Mary Washington Hospital's PAT office is beside the hospital in the Tompkins-Martin Medical Plaza, Suite 203.
  4. Please notify your Primary Care Physician that you are scheduled for surgery.
  5. Contact your insurance company about your benefits for inpatient rehabilitation, physical's and occupational therapy, and home health services.
  6. On the day of your surgery, check in at Patient Access near the front entrance of Mary Washington Hospital.

Call Pre-Admission Testing (PAT) at 540.741.4669 if you have any questions.

We encourage you to watch an informative video about your procedure. It's a roadmap providing details on:

  • Pre-admission testing (PAT)
  • What to bring for your hospital stay
  • What you're expected to do
  • What happens during your hospital stay
  • Rehabilitation during recovery and some exercises you'll do
  • Going home
  • How we may manage any pain you have

Please view this informative video prior to your surgery.

After viewing the video, click here to let us know you have completed Joint Care Plus Patient Education.

Please read the Joint Care Plus packet you received from your surgeon's office for details on what to expect before, during, and after your hospital stay.

Total Knee Replacement

When knee pain, swelling and stiffness interfere with your ability to perform daily activities, your doctor may prescribe physical therapy, anti-inflammatory medications or steroid injections. When these treatments no longer provide relief, you may be a candidate for a total knee replacement (TKR). This is a surgical procedure to remove and replace your damaged knee joint with an artificial joint (called a prosthesis).

Now a common procedure, approximately 600,000 total knee replacements are performed in the United States each year.

Your Knee

The knee is the largest joint in the body and is involved in just about everything you do! The ends of the femur (thighbone), tibia (shinbone) and kneecap (patella) form the knee and are coated with a thin layer of cartilage where they touch. That cartilage helps the bones move easily and provides protection.

C-shaped wedges, called menisci act as shock absorbers between the femur and tibia. Thigh muscles provide strength while long ligaments hold the femur and tibia together and keep them stable. The rest of the knee is covered by the synovial membrane which releases lubricating fluid to reduce friction. When any of these parts fail to work in harmony, the result can be pain, weakness or impaired function.

Signs that you may be a candidate for knee surgery

There are no age or weight restrictions for TKR surgery. Our approach is to exhaust all possible treatments before recommending surgical treatment. Your surgeon will help you determine if and when TKR is a good choice for you. In addition to a complete medical evaluation of your knee, diagnostic tests such as X-ray or MRI may be performed. In general, good TKR candidates experience:

  • Severe pain and stiffness that interferes with every day activities
  • Moderate to severe pain even when at rest
  • Chronic inflammation or swelling
  • Deformity of the knee
  • Less invasive treatments do not provide satisfactory relief

How TKR works

During the one to two hour TKR procedure, your surgeon resurfaces the bones involved in the knee - the tibia, femur and patella. Typical steps include:

  • Remove damaged cartilage from the bone surface
  • Shape the bone surfaces to receive the prosthetic components
  • Place the prosthetic components
  • Insert a spacer between the femur and tibia to help the parts glide smoothly

Preparing for TKR

For the best outcome with your joint replacement, you must know what to expect before, during and after your surgery. Through our Joint Care Plus program, you will be involved in every step of your treatment and recovery from pre-operative teaching to post-operative care and exercise. Your team includes physicians, physician assistants, care management, nurses, and physical and occupational therapists specializing in total joint care.

Your care team’s goal is to keep you motivated for an optimal recovery. They will encourage you to prepare, eat well and do your exercises so you can quickly gain strength and mobility to become more independent. Give yourself a leg-up in the process by learning and practicing the post-surgical exercises in advance of your procedure.

Pre-admission

In addition to a scheduled 30-minute telephone nurse interview to review your medical history and medications, you will schedule an appointment with the Pre-Admission Testing (PAT) nurse practitioner. During this comprehensive pre-surgical evaluation, typically 3-4 weeks before your surgery, the nurse practitioner identifies your risks so a plan can be put in place to prevent complications. The appointment takes approximately one hour during which blood and urine samples may be taken, and you will have an EKG. The nurse practitioner can also answer your specific questions about the procedure or the preparations you need to make.

Preparing your home

Part of your pre-operative teaching includes how to prepare yourself and your home for your post-operative care. We want you to be as independent in your home as possible and reduce the risk of injuries due to falls. If you live alone, you will want to make arrangements for a friend or family member to stay with you for at least one week following your discharge from the hospital. These steps will help you prepare your home:

  • Make sure light switches are accessible
  • Put away throw rugs or tack them down
  • Make sure stairways are well lit
  • Make sure handrails on the stairway are sturdy
  • Clear floors of clutter
  • Clearly mark raised thresholds
  • Clear loose cords from your floor
  • Program your phone with emergency numbers
  • Make sure furniture has good back and arm support
  • Create a lighted path from bedroom to bathroom
  • Keep a charged flashlight near your bed
  • Install safety and guard bars by your bath tub (if possible)
  • Place rubber mats in and in front of your bath tub
  • Use a wide sturdy step for high cabinets

What to Pack

You won’t need much during your approximately three-day hospital recovery. Bring a positive attitude and the motivation to work hard along with these items:

  • Loose fitting clothes (scrubs, sweats, tee shirts) that won’t rub your incision
  • Closed shoes like sneakers (we provide floor gripping socks)
  • A list of your medications and dosages (do not bring any medications from home)
  • Talk to your doctor about which medications to take on the morning of your procedure.

Following Surgery

Several hours after your surgery, you will be asked to sit up and dangle your legs from the bed. You may also stand up and take a few assisted steps. The first full day after your surgery will include individual therapy as well as group physical therapy sessions where you will begin learning to walk with your new joint. Our team will assure that you are using the correct techniques so you are safe and will not hinder your recovery. In fact, getting mobile is an important part of the process! We also carefully monitor your pain and assure that it is under control so you can progress through your rehabilitation.

During physical therapy you will learn exercises that you must perform on your own even following your discharge from the hospital. We will also teach you movements to avoid until you are fully recovered.

After Hospital Discharge

Your discharge plan is completely customized. Based on your needs and your surgeon’s preferences, we will arrange for a visit from a homecare nurse. Arrangements will also be made for you to continue your physical therapy three times a week for at least four weeks.

Individuals with many stairs in their home or who cannot arrange for a caregiver to be with them for the first week, may need to recover at a skilled nursing facility until they are able to be independent at home.

The key to optimizing your total knee replacement results is your commitment to performing the exercises that build your strength and range of motion. Our staff is dedicated to providing the motivation and support you need to be successful.

Please watch this informative video prior to your surgery.

After viewing the video, click here to let us know you have completed Joint Care Plus Patient Education.

Please read the Joint Care Plus packet you received from your surgeon's office for details on what to expect before, during, and after your hospital stay.

Total Hip Replacement

Total hip replacement (THR) is a surgical procedure to remove and replace your damaged hip joint with an artificial joint (called a prosthesis). The procedure may be performed if you fracture your hip or if you have hip pain, swelling and stiffness that interferes with your ability to perform daily activities and is not relieved by physical therapy, anti-inflammatory medications or steroid injections.

According to the American Academy of Orthopaedic Surgeons, more than 285, 000 total hip replacement surgeries are performed each year.

Your Hip

The hip is one of your body’s largest joints. It is a ball and socket joint meaning the ball-shaped femoral head, located at the top of the thigh bone, fits inside a socket formed by the acetabulum, which is part of the pelvis bone. The ends of the bones are coated with a thin layer of cartilage where they touch to provide protection and help them move easily.

A thin tissue called the sinuvial membrane surrounds the hip joint to cushion the bones and keep the cartilage lubricated to eliminate friction. A band of ligaments holds the ball to the socket to keep the joint stable.

Causes of Hip Pain

When any of these parts fail to work in harmony, the result can be pain, weakness or impaired function. The most common cause of hip pain is arthritis including osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis. With arthritis, the protective layer of cartilage may peel away until the bones grind against each other, causing acute pain. Other causes of hip pain include avascular necrosis and childhood hip disease.

Signs That You May Be a Candidate for Hip Surgery

With severe arthritis, you may be unable to move or bend at the hip which can severely limit your mobility and quality of life. After all other treatments are exhausted, including medications, physical therapy and assistive devices such as a walking cane, total hip replacement may be considered. Hip replacement is also a treatment for some hip fractures, hip deformities and infection.

There are no age or weight restrictions for THR surgery, but most candidates are between the ages of 50-80. In addition to a complete medical evaluation of your hip, diagnostic tests such as X-ray or MRI may be performed.

Most candidates have:

  • Hip pain that limits everyday activities such as walking or bending
  • Hip pain that continues with resting
  • Stiffness in the hip that limits the ability to move or lift the leg
  • No relief from other treatments such as medications, physical therapy and assistive devices

How THR Works

During a THR procedure, your surgeon removes damaged bone and cartilage and replaces it with prosthetic components. Typical steps include:

  • Remove damaged cartilage from the bone surface
  • Shape the bone surfaces to receive the prosthetic components
  • Place the prosthetic components
  • Insert a spacer between the new ball and socket to allow for a smooth gliding surface

Preparing for THR

For the best outcome with your joint replacement, you must know what to expect before, during and after your surgery. Through our Joint Care Plus program, you will be involved in every step of your treatment and recovery from pre-operative teaching to post-operative care and exercise. Your team includes physicians, physician assistants, care management, nurses, and physical and occupational therapists specializing in total joint care.

Your care team’s goal is to keep you motivated for an optimal recovery. They will encourage you to prepare, eat well and do your exercises so you can quickly gain strength and mobility to become more independent. Give yourself a leg-up in the process by learning and practicing the post-surgical exercises in advance of your procedure.

Pre-admission

In addition to a scheduled 30-minute telephone nurse interview to review your medical history and medications, you will schedule an appointment with the Pre-Admission Testing (PAT) nurse practitioner. During this comprehensive pre-surgical evaluation, typically 3-4 weeks before your surgery, the nurse practitioner identifies your risks so a plan can be put in place to prevent complications. The appointment takes approximately one hour during which blood and urine samples may be taken, and you will have an EKG. The nurse practitioner can also answer your specific questions about the procedure or the preparations you need to make.

Preparing Your Home

Part of your pre-operative teaching includes how to prepare yourself and your home for your post-operative care. We want you to be as independent in your home as possible and reduce the risk of injuries due to falls. If you live alone, you will want to make arrangements for a friend or family member to stay with you for at least one week following your discharge from the hospital. These steps will help you prepare your home:

  • Make sure light switches are accessible
  • Put away throw rugs or tack them down
  • Make sure stairways are well lit
  • Make sure handrails on the stairway are sturdy
  • Clear floors of clutter
  • Clearly mark raised thresholds
  • Clear loose cords from your floor
  • Program your phone with emergency numbers
  • Make sure furniture has good back and arm support
  • Create a lighted path from bedroom to bathroom
  • Keep a charged flashlight near your bed
  • Install safety and guard bars by your bath tub (if possible)
  • Place rubber mats in and in front of your bath tub
  • Use a wide sturdy step for high cabinets

What to Pack

You won’t need much during your approximately three-day hospital recovery. Bring a positive attitude and the motivation to work hard along with these items:

  • Loose fitting clothes (scrubs, sweats, tee shirts) that won’t rub your incision
  • Closed shoes like sneakers (we provide floor gripping socks)
  • A list of your medications and dosages (do not bring any medications from home)
  • Talk to your doctor about which medications to take on the morning of your procedure.

Following Surgery

Several hours after your surgery, you will be asked to sit up and dangle your legs from the bed. You may also stand up and take a few assisted steps. The first full day after your surgery will include individual therapy as well as group physical therapy sessions where you will begin learning to walk with your new joint. Our team will assure that you are using the correct techniques so you are safe and will not hinder your recovery. In fact, getting mobile is an important part of the process! We also carefully monitor your pain and assure that it is under control so you can progress through your rehabilitation.

During physical therapy you will learn exercises that you must perform on your own even following your discharge from the hospital. We will also teach you movements to avoid until you are fully recovered.

After Hospital Discharge

Your discharge plan is completely customized. Based on your needs and your surgeon’s preferences, we will arrange for a visit from a homecare nurse. Arrangements will also be made for you to continue your physical therapy three times a week for at least four weeks.

Individuals with many stairs in their home or who cannot arrange for a caregiver to be with them for the first week, may need to recover at a skilled nursing facility until they are able to be independent at home.

The key to optimizing your total hip replacement results is your commitment to performing the exercises that build your strength and range of motion. Our staff is dedicated to providing the motivation and support you need to be successful.

Please watch this informative video prior to your surgery.

Anterior Approach To Hip Replacement

Some surgeons use an anterior approach when performing hip replacement surgery. This less invasive alternative to traditional hip replacement provides the same outcomes, but because the surgeon can access the hip joint without cutting through major muscle groups, which can take up to 6 months to heal, you are likely to experience less pain and be less restricted with your movement during recovery. You can typically get back to your normal routine more quickly following this type of procedure.

About the Procedure

All of the preparatory steps for surgery are the same with the anterior approach. The major difference is during the procedure itself. You lay on your back on a specially designed operating table that enables the surgeon to access your hip joint through a 4 to 6 inch incision in the front of your hip rather than the side or the back. Your surgeon can follow a natural pathway between muscles and tendons to remove and replace your damaged joint.

Recovery

Recovery is similar to that with a traditional hip replacement. Physical and occupational therapy will still be an important part of your recovery as you work to gain strength and range of motion. Because the muscles around your hip joint remain intact, you will have reduced risk of dislocation of the new ball from its socket during the first months of recovery.

Risks

Because of the pressure placed on your femur during the procedure, the anterior approach is not recommended if you have osteoporosis. Your surgeon will recommend the best approach based on your risks and needs.

Source: American Association of Orthopedic Surgeons

Joint Revision Surgery

Prosthetic joints are more durable and function better because of advancing surgical techniques and improvements to their design and composition. With typical wear and tear your artificial joint may need to be replaced in ten to twenty years through a highly specialized procedure called revision surgery. In just ten percent of total hip and total knee surgeries, replacement components fail prematurely due to infection, loosening or dislocation and must also be replaced through revision surgery.

Indications that you may need joint revision include:

  • Pain
  • Swelling
  • A limp
  • Stiffness and
  • Instability

You may also experience a decline in the function of your joint. A physical exam or X-ray can evaluate the position and condition of your prosthesis. Your surgeon will determine if revision surgery is the best option for you. Non-surgical treatments include pain medication, use of assistive devices such as a cane or walker, and limiting activities.

Revision Surgery

Success rates for revision surgery are greater than 90 percent according to the American Association of Orthopaedic Surgeons. Key to success is proper planning and understanding of the patient’s condition including existing bone quality, ability to reconstruct existing bone and soft tissue structures and the ability to affix the new components to the bone.

It is likely that your surgeon will make a more extensive incision for revision surgery. The surgeon carefully removes the replacement components and prepares your bones and ligaments to receive the new prosthetic joint by removing any abnormal bone or scar tissue. The hip or knee bones are carefully reconstructed before the new implant is inserted and adhered.

Following Surgery

Rehabilitation is similar to what you experienced during your initial joint replacement. Special care is taken to protect against infection or damage to the replacement joint. Physical therapy can begin within 24 hours of your procedure, but your activities may be restricted for 6 to 12 weeks depending on your recovery.

Source: American Association of Orthopedic Surgeons

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