Is your patient ready for a joint replacement?

Pain and previous attempts to relieve pain are among the factors in determining if a patient is ready for joint replacement.

When patients are considering joint replacement surgery, we look at several important benchmarks to see if the patient is ready.

The first consideration is pain. Is the pain they’re experiencing in their knee intermittent, occurring only during strenuous activity, or is it constant and interfering with their daily lives? If it’s only intermittent, the patient may not be ready for joint replacement.

We also want to know what they’ve tried for pain in the past. We have many nonsurgical modalities. Have they taken anti-inflammatories, received steroid or visco injections, or undergone physical therapy? For many, steroid injections can provide excellent temporary or even long-term relief of their symptoms. Unfortunately, over time these injections can become less effective, leading us towards arthroplasty.

X-rays are another important factor. We’re doing joint replacements on younger patients than we have in the past. We don’t want patients living out their golden years in pain. But unless X-rays show moderate to advanced arthritis, we typically won’t consider the patient for joint replacement.

The hardest factor to address with patients is body mass index (BMI). I typically will not do knee replacements on patients with a BMI over 40. The risk of perioperative and postoperative complications is too great. This is tough pill to swallow for some patients.

In patients whose BMI is too high, I talk with them about getting their weight down to a level that will lower the associated risks and allow them to do appropriate physical therapy after surgery. There are physical therapy programs tailored to help them with weight loss. Some patients have been struggling with their weight for years, and occasionally I will refer them to my bariatric colleagues.

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Before knee replacement surgery, I warn my patients that the first couple of weeks after surgery are rough, and they need to be ready to push through the pain during physical therapy as they work on range of motion and strengthening.

For patients undergoing total knees or total hips, the procedures have been streamlined in a way that minimizes time in the hospital. For the appropriate patient, these procedures can be performed on an outpatient basis, but I typically prefer to keep patients overnight.

With knee replacements, Norton Orthopedic Institute surgeons are now using ROSA Knee, a robotic-assisted surgical system that allows additional precision. We are able to assess the bony anatomy and soft tissues intraoperatively and make fine adjustments to our cuts by as little as a millimeter or adjust the implant alignment or rotation by 1 or 2 degrees.

Our surgeons do thousands of knee and hip replacements every year, and Norton Orthopedic Institute is Louisville’s Certified Hip & Knee Replacement Center of Excellence, as designated by DNV GL Healthcare — a world-leading certification body.

Chad Smith, M.D., is an orthopedic surgeon with Norton Orthopedic Institute and Norton Sports Health. Dr. Smith also serves as the head team physician for University of Louisville football.


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Vicki L. Owczarzak, M.D.

Vicki L. Owczarzak, M.D., is a pediatric otolaryngologist at Norton Children’s ENT & Audiology, affiliated with the UofL School of Medicine, and an assistant professor at the medical school.

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