How Long Will My New Knee or Hip Last?

When patients are dealing with the chronic pain and decreasing mobility created by chronic knee or hip pain, the first treatments are always non-surgical. Physical therapy, changes in some activities, and corticosteroid injections all fit into the normal course of treatment. 

But when these don’t help and your osteoarthritis in your knee or hip is beginning to really impact your life, patients start to consider knee or hip replacement surgery with Dr. Moore at Pinehurst Surgical. 

One of the first questions we get during the initial consultation is, “So, how long will my artificial knee/hip last?” 

In this pre-Thanksgiving blog, let’s get into some rough estimates of what you can expect. 

Failure 

The failure of an artificial replacement can happen early on or over time. While most people wonder about the overall longevity of their prosthesis, they need to manage risk factors to ensure they get the longest duration out of their new knee or hip. Infection is usually the cause of any early failure. Risk factors that can contribute to this are uncontrolled diabetes, obesity, and poor nutrition. 

Long-term failure is most likely to occur because the bond between the bone and the implant loosens over time, or a component of the implant wears down. This will require revision surgery to replace the original implant. Revision surgeries are more involved than the original replacement in many cases, so patients wonder how long they can expect their artificial implant to last. 

The numbers 

Technology and materials continue to improve with modern replacements. But these are still manufactured components and, as with any manufactured item, they have a lifespan. 

It’s generally thought that around 90 percent of modern total knee replacements still function well 10 to 15 years after the placement. For total hip replacement, that number is closer to 20 years. 

But those numbers may be shortchanging the duration of modern implants, as they are evolving quite quickly. The problem is that the data currently available is from implants that, in many cases, aren’t even on the market any longer. For instance, one of the newer technologies is a plastic called “highly cross-linked polyethylene.” It has been showing very low-wear properties, and it is expected that implants made with this plastic will last longer than those made with previous plastics. 

As we’ve discussed in other blogs, how you respect and manage your new knee or hip moving forward also impacts its lifespan. This is especially true of impact activities, such as playing basketball or running. 

When you meet with Dr. Moore, the two of you will discuss trends in the implants he is placing. But it’s expected that 20 years from now the longevity numbers should be even better. 

Are you tired of dealing with chronic knee or hip pain? Give Dr. Moore a call at Pinehurst Surgical, (910) 295-0224, and set up a consultation for possible knee or hip replacement.

Knee Anatomy 101

Knee replacement has become a relatively commonplace procedure — last year in the U.S. over 700,000 people had knee replacement. Those numbers are expected to continue to grow as more and more baby boomers move into their mid to upper 60s and above. Estimates place knee replacements in the U.S. at 3.5 million by 2030. 

That’s a whole lotta titanium and Teflon replacing bone and cartilage. 

Dr. Moore is a board-certified orthopaedic surgeon who has been serving our patients at Pinehurst Surgical for over two decades, and he has helped many people overcome their chronic knee pain caused by osteoarthritis through outpatient and inpatient knee replacement. 

But what do we all really know about our knees anyway? We know they allow us to make all sorts of complex movements, from running in a softball game to springing up to grab a rebound on a basketball court. But what makes up our knees? Let’s get into that in this autumnal blog for Pinehurst Surgical Orthopaedic & Joint Replacement. 

Let’s call it Knee 101. 

The largest joint in the body 

Working like a hinge, our knee is the largest joint in the human body. It’s the junction of the bones of the upper and lower legs. The knee consists of three bones: the femur (thigh bone), the tibia (shin bone), and the patella (the kneecap). 

The ends of the bones are covered with a layer of cartilage, a slick, elastic material that absorbs shock and allows the bones to glide easily against one another as they move. Between the tibia and femur bones are two crescent-shaped pads of cartilage that reduce friction and disperse the weight of the body across the joint. They are the lateral meniscus (situated at the outside of the knee) and the medial meniscus (situated on the inside of the knee). 

The bones of the knee are held together in a joint capsule, which consists of two distinct layers — an outer layer of dense connective tissue and an inner membrane, called the synovium, which secretes a fluid to lubricate the joint. 

The outer layer of the capsule is attached to the ends of the bones and is supported by these ligaments and tendons: 

  •     Quadriceps tendon, which attaches the quadriceps to the patella
  •     Medial collateral ligament (MCL), which gives stability to the inner part of the knee
  •     Lateral collateral ligament (LCL), which stabilizes the outer part of the knee
  •     Anterior cruciate ligament (ACL), which is located in the center of the knee and prevents excessive forward movement of the tibia
  •     Posterior cruciate ligament (PCL), which is located in the center of the knee and prevents excessive backward shifting of the knee

Two groups of muscles support the knee: the hamstrings on the back of the thigh, which run from the hip to just below the knee and work to bend the knee; and the quadriceps, four muscles on the front of the thigh that run from the hip to the knee and straighten the knee from a bent position. 

Now you’re a knee expert. There’ll be a pop quiz later! So how does your knee feel? If it’s causing you chronic pain, it’s time to give us a call at Pinehurst Surgical, (910) 295-0224, and let’s see how Dr. Moore and our entire team can help.

Healthcare worker at home visit.

Diagnostic Imaging

At Pinehurst Surgical, patients can tell us what’s going on with their joints. They can detail their pain, where it seems to come from, and when it occurs. And Dr. Moore can move the joint and examine the surrounding areas to get a good idea of what’s going on. 

But sometimes you just can’t beat the amazing images generated by modern diagnostic imaging. At Pinehurst Surgical, we’re especially proud to work with Alliance Imaging to offer an array of tests, from CT scans to MRIs to Nuclear Bone Scans, all in house. Beyond the obvious convenience, there’s also no need for you to have an individual disk with the imaging or additional paperwork — we load all of the images and readings directly into your patient file. 

Here’s more about our diagnostic imaging at Pinehurst Surgical. 

What is diagnostic imaging? 

Diagnostic imaging uses different technologies to allow us to see inside your body (usually into your joints in our situation) for diagnosis and treatment of disease and other health issues. Although everyone knows the original form of diagnostic imaging — the x-ray — today x-rays have been joined by CT scans, MRIs, PET scans, ultrasound, and other technologies to make a huge impact on diagnostic ability. At Pinehurst, our association with Alliance Imaging, allows us to provide CT scans, MRIs, and Nuclear Bone Scans right here in our facility on First Village Drive. 

What should I expect during my imaging session? 

Everyone has had an x-ray, either at the dentist or doctor’s office. The difference in our x-rays at Pinehurst Surgical is that we often have the patient either stand or squat. This can provide better information on joint inflammation. 

MRIs are the one test that some people have trouble with. This is because the patient must be inside the MRI system for a period of 2-5 minutes for each section being imaged. When inside, you must remain very still to not distort the images being taken. The overall MRI procedure can take from 20 minutes to an hour depending on the area being imaged. 

CT scans are like MRIs in that the patient is on a table and is moved into the imaging machine. The difference is that in a CT scan the table continues to move through the machine, rather than being enclosed inside it. 

What are the risks of diagnostic imaging tests? 

There is a slight risk of radiation exposure with x-rays, but our digital x-ray system uses far less radiation than the previous film x-ray systems. Occasional x-rays for orthopedic injuries really involve no risk with radiation exposure. The average person receives more radiation from normal activities and sun exposure in a year than if they had a number of x-rays. 

MRIs don’t use radiation. Instead, they generate three-dimensional images using a magnetic field. These have no risks. 

CT scans, short for computer tomography, use low dose x-rays combined with computer technology to produce their three-dimensional images. Again, these doses are very low, and most patients may only receive a CT scan once every few years. 

Trust Dr. Moore and our team at Pinehurst Surgical Orthopaedic & Joint Replacement Center to provide the finest in orthopedic care and orthopedic diagnostic imaging. To make an appointment, call (910) 295-0224.

When You May Be Considering Hip Replacement

Our hips bear much of the load of the human body. And when you have a damaged or deteriorating hip, some of the most seemingly simple movements can become an exercise in torture. Walking around the block or getting up from a chair can involve shooting pain. Sleeping on your bad hip becomes almost impossible. 

When the pain and lack of mobility really starts to impact your life, it’s time to consider hip replacement with Dr. Moore and our team at Pinehurst Surgical Orthopaedic & Joint Replacement Center. Our patients have great success with these surgeries, enabling them to get back on their feet and back to normal. 

What is a hip replacement? 

The hips are involved in all our movements when we’re upright, and a damaged hip can make many of life’s simple pleasures, things like walking on the beach, excruciatingly painful, if not at the time, then hours afterward. Things you may have taken for granted your entire life, such as getting out of a chair, now are painful. Sleep can be difficult, as your bad hip is loaded when on your side. The damage is usually simply a result of long-term use. This can be especially true if you’ve participated in activities or sports with lots of impact, such as running or gymnastics. You’ve likely damaged the cartilage in the hip socket or maybe the cartilage has worn away. 

The goal becomes simply stopping the pain. People opt for cortisone injections or hip resurfacing procedures that “clean out” the torn or frayed cartilage. They stop participating in certain sports or activities they love. 

But when the pain continues, as it will when the damage is within the hip socket, it could be time to consider a total hip replacement with Dr. Moore. Hip replacement is one of the most successful operations performed in the medical world. As we age as a population, the need is growing all the time. Hip replacement can make a real difference in the life of the patient, in effect allowing the person to return to a pain-free life once again. 

Hip replacement involves addressing both the bone and the socket. The damaged ball of the thighbone is replaced with a metal ball; the socket is ground clean of damage and a metal socket is inserted into it for the new metal ball to pivot within. 

How will I know if I need a hip replacement? 

There is no “this is the day” threshold with hip replacement. The question usually comes down to how much your damaged hip is impacting your daily life. There isn’t a typical age threshold, but most of our Pinehurst Surgical hip replacement patients are between the ages of 50 and 80. 

People considering hip replacement surgery usually have been dealing with the pain for a long time, possibly decades. The question is — how badly is the pain affecting your life? Our team helps walk you through the decision to move forward with replacement. These are some of the common issues people have when considering hip replacement: 

  •     Hip pain is limiting activities such as walking or bending.
  •     Hip pain is impacting sleep.
  •     Hip pain continues even when resting.
  •     There is stiffness in the hip that limits movement.
  •     Other avenues to address the pain have not been effective — physical therapy, band-aid procedures such as hip resurfacing, cortisone injections, and other options are not stopping the pain.

Are your painful hips beginning to really affect your quality of life? Call Dr. Moore at (910) 295-0224, and let’s see how we can help you get past the pain.

Chronic Hip Pain

Our knees get all the glory when it comes to replacement surgery. Almost three quarters of a million Americans are getting new knees every year and those numbers are continuing to swell along with the average age of the nation’s population. 

But if you have chronic hip pain, in some ways it can be worse than knee pain. For instance, a good pull-over knee brace may allow you to avoid some of the pain associated with certain movements if your knee is degrading but you’re not quite ready for replacement surgery. But if your hip or hips are causing chronic pain, they will tell you about it when you’re walking and upright (just as your knee will). When you lay down, however, your knee probably quiets down. Not so with your hip. Sleeping can become a challenge, especially if you have damage in both hips. 

Let’s get into some of the causes of your chronic hip pain in this summer blog. 

What is causing my hip pain? 

Dr. Moore sees patients all the time with chronic hip pain. Many of these patients are dealing with serious pain and are reluctant to consider hip replacement, as they’ve heard it is quite difficult. That’s not the case at all. In fact, recovery from hip replacement can be easier than from knee replacement. But that’s for another blog. 

The most common cause of chronic hip pain is arthritis. There are three types of arthritis that impact the hips: 

  •     Osteoarthritis. Life is tough on the hips. If you’ve played sports such as indoor volleyball or tennis; if you’ve been a gymnast or dancer; if you’ve been a runner — all of these activities create a good deal of wear and tear on the hip socket. This all comes due in osteoarthritis, the “wear and tear” form of arthritis, usually after you turn 50. The cartilage on the end of your femur (thighbone) and the cartilage in the hip socket (acetabulum) become torn or worn down to the degree that bone rubs against bone.
  •     Rheumatoid arthritis. The most debilitating type of arthritis, rheumatoid arthritis causes the body to attack its own joints. The chronic inflammation can damage the cartilage, leading to pain and stiffness.
  •     Post-traumatic arthritis. If you’ve seriously injured your hip, the cartilage may become damaged in later years. Post-traumatic arthritis may be triggered by osteonecrosis. When a hip is dislocated (as was Bo Jackson’s during his Raiders’ football days) or fractured, the blood supply to the ball portion of the femur can become restricted. This can lead to the surface of the bone collapsing. Arthritis is sure to follow.
  •     Childhood hip disease. Some children have hip problems where the hips may not grow and develop properly. Even if successfully addressed in youth, this condition will often result in arthritis later in life.

If you have the chronic hip pain described above, there’s no reason to lose sleep and quality of life because of it. Dr. Moore is a board-certified orthopaedic surgeon whose extensive training, experience, and expertise can help you get past the pain with total hip replacement. Call us at (910) 295-0224 to schedule a consultation with Dr. Moore.

When Arthritis Hits Your Kneecap

When you think of arthritis in the knee, you likely think of the cartilage between the bones and ends of the femur and the tibia. But patellofemoral arthritis affects the kneecap, actually the cartilage directly behind it. 

Dr. Moore performs different surgical procedures, if necessary, to address a patient’s patellofemoral arthritis. 

What is involved with patellofemoral arthritis? 

Really, any arthritis involving wear and tear can be lumped under the term “osteoarthritis.” This is the “wear and tear” form of arthritis that affects just about everyone at some point in their life. 

With the kneecap, patellofemoral arthritis affects the cartilage. This cartilage is normally somewhat slippery, enabling the knee to move freely. But when it begins to wear away, the cushioning between bones diminishes. Eventually this will lead to pain. 

Who is at higher risk for developing patellofemoral arthritis? 

  •     Age — This arthritis, as with all areas affected by wear and tear, occurs mainly in people over the age of 40.
  •     Sex — Patellofemoral arthritis is more common in women than men.
  •     Prior injury — Injuries such as a fractured kneecap increase the odds.
  •     Obesity — The increased pressure placed on the knees eventually takes a toll.
  •     Repetitive movement — If a person sustains the same movement for long periods of time, this can lead to patellofemoral arthritis.
  •     Health conditions — Other health conditions, such as gout, rheumatoid arthritis, dysplasia, and Paget’s disease are at higher risk.

What are the symptoms of patellofemoral arthritis? 

Pain is the primary symptom. This pain will usually occur at the front of the kneecap when the person is doing something like climbing stairs. The knee may also crackle when in motion. 

When surgery is necessary? 

Once the damage has been done, there is no way to heal the kneecap and reverse patellofemoral arthritis. Non-surgical treatments, such as wearing a knee brace, having corticosteroid injections, and medications, can reduce the pain during activities. But surgery is often eventually necessary. 

Dr. Moore would have three surgical options in these cases: 

  •     Arthroscopy — This minimally invasive surgery only involves a small incision to gain access. The cartilage is then trimmed and smoothed.
  •     Kneecap alignment — This minor surgical procedure tightens or releases soft tissues around the knee to modify the actual position of the kneecap to reduce pressure and improve comfort.
  •     Knee replacement — In some cases, only the patellofemoral aspect of the knee joint needs to be replaced. However, it’s more likely a total knee replacement is the better option for more severe deterioration.

Do you have chronic knee pain? Call Dr. Moore at Pinehurst Surgical, (910) 295-0224, to schedule an appointment to have him check it out.

Helping You Manage Your Osteoarthritis

Arthritis is a broad term that covers a group of over 100 diseases. The basic definition of arthritis is inflammation of the joints. At Pinehurst Surgical, we deal primarily with a particular type of arthritis, known colloquially as “wear and tear arthritis” — osteoarthritis. This type of arthritis usually affects patients in their older years and can be a result of repetitive use, such as from certain sports, or just from the day in and day out use over the years. Osteoarthritis is the most common form of arthritis. 

What is osteoarthritis? 

Osteoarthritis involves the breakdown of cartilage in the joints. While it can occur in most of the body’s joints, it is most common in the weight-bearing joints: the hips, knees, and spine. Osteoarthritis doesn’t usually affect other joints unless there was a traumatic injury, excessive stress on the joint, or a problem with the cartilage in the joint. Osteoarthritis tends to get worse as wear and tear continues with additional passing years. 

What are the symptoms of osteoarthritis? 

Symptoms develop slowly with time. These are the common symptoms: 

  •     Pain after activity involving the joint
  •     Stiffness following periods of inactivity
  •     Joint swelling
  •     Tenderness
  •     Loss of flexibility
  •     Grating sensation or clicking sound when joint is used

Diagnosing osteoarthritis 

In addition to a thorough physical exam and referencing of the patient’s family history, Dr. Moore will often include these diagnostic tests: 

  •     X-rays
  •     MRIs
  •     Blood tests
  •     Analysis of joint fluids

Treating osteoarthritis 

In these situations, Dr. Moore will try a variety of treatment methods before we even consider any replacement surgery on the knees or hips. The goal of these treatments is to relieve pain, increase mobility, and restore quality of life. Short of surgery, these are the treatments we use: 

  •     Weight loss for obese patients
  •     Exercise to strengthen the muscles surrounding the joints
  •     Medications (anti-inflammatory drugs)
  •     Creams or gels with ingredients such as capsaicin
  •     Joint injections such as cortisone
  •     Assistive devices such as orthotics, canes, or braces

Cortisone is a steroid that when injected directly into the joint can provide effective anti-inflammatory relief, which leads to pain relief. Cortisone’s effects can last from a few weeks up to a few months. 

If the above treatments don’t seem to provide relief, the next step is joint replacement. Dr. Moore is an expert with total knee and hip replacements. 

If you’re suffering with any of the symptoms of osteoarthritis, call the team at Pinehurst Surgical, (910) 295-0224, and let’s get you back to moving without pain.

What expectations can I have with total knee replacement?

Last month we talked about how the prevalence of joint replacement is increasing in the U.S. population. Last year in the U.S. alone, over 700,000 people received new artificial knees.

But when patients meet with Dr. Moore talking about their chronic pain and what they hope to gain with knee replacement, they often don’t know what they can expect from the procedure. What will they be able to do moving forward, for instance?

Let’s get into that in April.

Expectations for your surgery and your new knee

As a patient moves forward toward having knee replacement, Dr. Moore wants his patients to have realistic expectations for these replacements. The human knee is a miracle machine of both function and durability. While today’s artificial replacements are excellent, they still have some limitations.

Over 90 percent of people who have total knee replacement report a dramatic decrease in pain and a significant increase in the ability to perform common activities such as walking. But your artificial knee won’t make your knee superhuman.

With normal use and activity, every knee replacement implant begins to wear in the plastic spacer. Not respecting your new knee speeds up this wear. Placing too much impact or gaining lots of weight can cause the knee replacement to loosen and become painful. That’s why the high-impact sports and activities need to be replaced by low-impact or no impact exercises and activities.

But when patients follow their rehabilitation guidelines and do the necessary work on their part the vast majority of our Pinehurst Surgical Orthopaedic knee replacement patients are quite happy with their new knee.

What kinds of activities can I do after I have a knee replacement?

Our knee replacement patients from across the Carolinas are excited by the feeling of freedom after having this surgery. That’s because their knee pain was causing them to have to miss out on more and more activities such as hiking or even walking around the block.

You’ll be walking at just 1 to 3 weeks, but you’ll use a walker. From there you’ll move to crutches, and then a cane. In 4-8 weeks, you should be walking without support.

Many Carolinians equate “activities” with sports. Here are some dos and don’ts moving forward. Again, Dr. Moore stresses these guidelines toward the goal of the longest duration for your new knee.

  • Swimming, cycling, and golf can resume after the surgical wound is healed.
  • Jogging, basketball, and volleyball are likely out, as they put pressure on your new knee and will cause it to wear out more quickly.
  • Tennis should probably change to doubles only, and at a relaxed pace. Or consider switching to pickleball.
  • Downhill skiing, skating, and sports where there is a risk of falling can be resumed, but the patient should have been proficient prior to their surgery, and you need to understand the risks.

Do you have chronic knee pain that’s impeding your life? Call Dr. Moore at Pinehurst Surgical Orthopaedic & Joint Replacement, (910) 295-0224, to schedule a consultation.

Joint Replacement Becomes More Mainstream

One consequence of a population whose average lifespan has increased 10 to 15 years over the past quarter century is the question if the machinery, particularly the joints, can take the extra decade or two of work. That explains the continuing increase in joint replacement as the U.S. population ages; our joints need a little help keeping up.

At Pinehurst Surgical, Dr. Moore is a board-certified orthopedic surgeon, so you couldn’t be in any better hands for your total hip and total knee replacement surgeries. Of course, replacement surgery is always the last treatment option, but it is a treatment that is becoming more and more common.

Here’s some information on joint replacement trends.

More frequent

Joint replacement has become a common surgery and it comes with low complication rates. In most cases, pain relief and functional improvement are nothing short of night and day. More and more of these surgeries are being performed as outpatient procedures, such as Dr. Moore performs at our Surgery Center. Twenty years ago, many of today’s surgery options didn’t even exist, and if they did recovery was measured in weeks, not days.

Last year in the U.S. roughly 700,000 knee replacement procedures were performed. Add to that another 400,000 total hip replacements. That combination is projected to swell to 3.5 million annual procedures by 2030 as the population ages.

The trend is to move these surgeries and their initial recovery out of the hospital setting and to outpatient centers, such as The Surgery Center of Pinehurst. Pain management protocols must be followed, but almost all patients would rather be in their own bed rather than the hospital. Home health (following our instructions for movement and the like) and physical therapy are both crucial to facilitate successful outcomes.

Joint procedures performed

At Pinehurst Surgical, Dr. Moore specializes in total knee and total hip replacement. They are the two most popular joint replacement procedures. These are the other common joint replacements:

  • Total shoulder replacement
  • Reverse total shoulder replacement
  • Total elbow replacement

If you have continuing joint pain, call us at Pinehurst Surgical Orthopaedic & Joint Replacement Center, (910) 295-0224.

How Osteoarthritis and Rheumatoid Arthritis Affects the Joints

Arthritis is simply the clinical term for joint inflammation. Various types of arthritis are common, and they lead to pain and stiffness in the joints. Two of the most common forms of arthritis are osteoarthritis and rheumatoid arthritis, yet they affect the joints in different ways.

Since we’re all about your joints here at Pinehurst Surgical, let’s spend this blog noting how these forms of arthritis affect your joints.

A joint

A joint is simply the place where two bones meet. The muscles surrounding a joint move the bones. Muscles are joined to the bones with tendons. At the ends of the bones are layers of cartilage that provide cushion and shock absorption between the bones and prevents them from rubbing against each other. The joint is surrounded by a membrane, called the synovium, which produces a thick fluid that lubricates the joint. The synovium is enclosed by the capsule, which holds the joint together with fibrous bands called ligaments.

Osteoarthritis and your joints

Osteoarthritis affects the entire joint, all of the above pieces. This “wear and tear” arthritis breaks down the cartilage, making it flaky and rough. Pieces may come loose and float about in the synovial fluid. This deterioration in the cartilage leaves the bones unprotected.

As the cartilage thins, the bones around it thicken and may develop bone spurs on the ends. Microfractures may occur in the ends of the bones. The joint capsule and ligaments stretch and may thicken in an attempt to stabilize the changing joint. This can cause inflammation throughout the joint to all the soft tissues.

Osteoarthritis commonly affects these joints: knees, hips, neck, lower back, and the hands.

Rheumatoid arthritis and your joints

Whereas osteoarthritis is due to age and wear and tear, rheumatoid arthritis is an autoimmune disease, where your immune system attacks the tissues in the joints, causing inflammation. Rheumatoid arthritis particularly affects the synovial membrane. This creates an overproduction of synovial fluid, which causes the joints to swell and the capsule to stretch. This causes pain and affects mobility in the joint.

This inflammation causes damage to the cartilage and even the bone ends. The inflammation, if left unaddressed, can result in destruction of the joint. Adjoining tendons can also become inflamed and wear down.

Rheumatoid arthritis commonly affects these joints: wrists, hands, fingers, ankles, toes, shoulders, and the knees.

If you have joint pain, you may have one of these forms of arthritis. This isn’t something to “soldier” through. Call Dr. Moore and our team at Pinehurst Surgical, (910) 295-0224, to make your appointment.