All the Facts on Total Joint Replacement

I'm Patrick Moriarty, Orthopedic Surgeon. I grew up in Brookings, went to school here through college. Enjoyed my time here very much. Needed to go away for training and experience. I've gathered that. I have 19 years being an orthopedic surgeon at a community hospital providing general orthopedic services. So, I've returned to my hometown of Brookings to get back closer to family and provide my services here.

What Is a Total Joint Replacement?
 
Total joint replacement involves replacing the surfaces of a joint. To begin with, a normal joint has articular cartilage, that's a joint surface layer that's very specialized material, is very slippery when wetted with a special lubricant called joint fluid. The articular cartilage does not have nerves. The bone does have nerves. The joint capsules have nerves. So it's an insensate, meaning it has no feeling, the joint surface cartilage, and it's a very slippery cushion. Absorbs shock, protects a bone from shock. Dissipates the forces across an area.
 
As we age, with wear and tear or with injuries, that cartilage deteriorates, gets thinner. They start to have more load being transferred directly to the bone and in a smaller area. As it gets thinner, you don't have as much protection. It's like the sole of your shoes and as you wear through the sole of your shoes, it's thinner, the rocky road injuries are perceived by your foot.
 
And so what joint arthroplasty does is replaces those surfaces with metal, and metal does not have nerves. The metal is polished and round and smooth again and in between the metal surfaces, there's plastic. The plastic also doesn't have nerves. It's rounded again because, as it wears, it wears flatter, and you have bare flat areas, and some areas still have articular cartilage, but the most used areas are barren subchondral bone we call it, but bare bone area. So we restore the surface to roundness and to the insensate state. And with articular cartilage, with not having nerves and metal and plastic not having nerves, that's how it relieves the pain.

How Does a Total Joint Replacement Compare to a Less Invasive Procedure?
 
We always recommend the least evasive care. We start with conservative measures, activity modification, splints, sometimes injections, anti-inflammatory medications and we watch and observe and hear back from the patients to see if it's acceptable relief or not acceptable relief. They tend to advance in the wear and when those more conservative measures aren't sufficient to provide a quality of life, a reasonable comfort, then we move the options forward towards things that are more potentially invasive, more surgical.

What Is the Recovery Process for a Total Joint Replacement?
 
Orthopedic tissues are slow tissues. They're slow to heal. They are also slow to quiet down. I, kind of, tell people that 12 weeks orthopedic tissues heal and quiet down to the state of tolerating the light demands that they were designed for, whether it be a tendon in your finger, or your knee, or a broken bone of your wrist, or your finger or your hip. 12 weeks. That's a season project.
 
They continue to get better for all the seasons of the year. If they're a year out, they'll tell you they were better at the year than at six months. If you talk to someone that is five years off from a joint replacement, generally, they will tell you they're also better at two years than they were a year. Because, first, you have to get over the surgery, and then you have to climb back as best you can from the loss you've had over the extended period before the surgery.

How Long Is Surgery for a Total Joint Replacement?
 
The length of surgery is whatever time it takes to do a good job. We're not racing. We don't waste any time. We're set up before the surgery starts with the back table. Everything is checked and rechecked. Everything is in order, laid out and then the surgery starts. On average, I would say a hip or a knee, you know, 75 minutes. You know, start to finish, incision, bandage on.

What Risks Are Associated With This Surgery?
 
The risks are there for blood clot, pneumonia, heart attack, stroke. We minimize those by early mobilization. The night of surgery, we set them up on the edge of the bed, we help them. They sit and dangle their limb, so they rest their knee in a bent position and we have them move their ankles. We have compressive devices that are airbagged, sort of, that pump the feet to keep the blood moving better, so reduce the risk of blood clot. They take an anti-coagulant after surgery for procedures on the lower extremities anyway, such as hip replacements and knee replacements, and sometimes, hip fractures as well.

What Results Do Patients Typically See From This Procedure?
 
Outcome studies have shown that patients that are having joint replacement, when they're surveyed a distance out from their surgery, a year, they will have outcome studies where above 90% rate their result as good or excellent. That's on surveys done with different providers, different facilities, you know, all comers. Nothing is 100%, you know. It's a better outcome than many procedures enjoy, you know.

Why Would You Recommend Brookings Health System for a Total Joint Replacement?
 
Because we have the skills, the facilities and the experience to do a very good job here. One can be closer to home, have visitors that they're familiar with, from their family and friends, and in a caring environment with nice Brookings people.