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Frequently Asked Questions (FAQ)

Our frequently asked questions on orthopedic health issues provide you with information on specific joints and our services. Please browse through the questions — and answers — about:


Osteoarthritis of the Hip and Knee

What is osteoarthritis?
Osteoarthritis, the most common form of arthritis, is also called degenerative joint disease or “wear and tear” arthritis. Almost everyone is affected by it to some extent as they grow older. It most frequently occurs in weight-bearing joints, mainly knees, hips and ankles. This form of arthritis slowly and gradually breaks down the cartilage that covers the ends of each bone in a joint. Normally, cartilage acts as a shock absorber, providing a smooth surface between the bones. But with osteoarthritis, the smooth surface becomes rough and pitted. In advanced stages, it may wear away completely. Without their normal gliding surfaces, the bones grind against one another, causing inflammation, pain and restricted movement. Bone spurs may form.

What are the symptoms of osteoarthritis?
The number one symptom is pain. The pain is caused by irritation and pressure on nerve endings, as well as muscle tension and fatigue. The pain can progress from mild soreness and aching with movement to severe pain, even when resting. The second symptom is loss of easy movement, such as bending or rising normally. Morning stiffness is a problem for many people. This lack of mobility, in turn, often causes the muscles serving the knee or hip to weaken, and overall body coordination suffers.

How is osteoarthritis diagnosed?
A simple weight-bearing X-ray and examination by a skilled orthopedic doctor will determine if you have osteoarthritis. Time-consuming and costly diagnostic procedures are not required.

What is the treatment for osteoarthritis?
There is no cure for arthritis, but the past decade has seen dramatic new ways to manage the pain, lack of mobility and fatigue that are among its most disabling symptoms.

  • Hyaluronate: The new treatment lubricates the knees and can reduce pain for nine to 12 months. It’s the first major breakthrough in 20 years for arthritis knee pain. Hyalgan is the brand name, and five injections are given into the knee one week apart.
  • Medicines: Coated aspirin helps relieve pain and has few side effects. Nonsteroidal anti-inflammatory drugs (NSAIDS), such as Voltaren, Feldene, Naprosyn and Clinoril, are prescription drugs for pain and inflammation. Do not take aspirin if you are taking NSAIDS.
  • Cortisone shots: Cortisone shots are given for inflammation. For many people, joint arthritis is often made symptom-free for months or even years after cortisone shots. Four to six shots a year can be given without any dangerous side effects.
  • Diet: There is no evidence that any specific foods will prevent or relieve arthritis symptoms. However, it’s important to maintain a healthy weight because excess weight aggravates arthritis by putting added pressure on knees and hips.
  • Exercise and rest: Prolonged rest and days of inactivity will increase stiffness and make it harder to move around. Motion is lotion for arthritis! At the same time, excessive or improper exercise can overwork your arthritic joint and cause further damage. A balanced routine of rest and exercise is best.

What about surgery?

  • Arthroscopy: Arthroscopic procedures are not generally helpful for arthritis. In some cases, a “flap” of torn knee cartilage can aggravate arthritis and cause additional pain. The cartilage flap can be removed by arthroscopy.
  • Knee or hip replacement: Knee replacement or hip replacement may be a very positive solution to the pain and disability of advanced osteoarthritis. The rough, worn surfaces of the joint are relined with smooth-surfaced metal and plastic components.

Hip Replacement

What is hip replacement?
It is a metal and plastic covering for raw, arthritic bone ends. It replaces cartilage that has worn away over the years. Hip replacement can eliminate pain and allow you to move easily with less discomfort.

Who should have a hip replacement?
When arthritis hip pain severely limits your ability to walk, work or perform even simple activities, hip replacement may be considered.

Is there an alternative to hip replacement?
Hip replacement is only recommended after careful diagnosis of your joint problem. It is not likely that anti-inflammatory drugs or cortisone injections will give you the same long-term relief that hip replacement will.

Should my hip replacement be cemented?
Hip replacements are successfully performed with all cemented components as well as with a combination of uncemented and cemented components. Your surgeon will discuss which technique is best for you.

How long is the hospital stay?
The average hospital stay for a hip replacement patient is around three to four days. Nearly 70 percent of our patients are able to go home on the third postoperative day with continued therapy.

How long is recuperation?
Recovery varies with each person. You will use a walker for approximately one week after the operation. You can drive a car in two to four weeks. Most people gradually increase their activities and may play golf or doubles tennis in 12 weeks. More active sports, such as singles tennis and jogging, are not recommended. 
After discharge, there is usually no need for a nursing home. Some patients may require a short stay at a rehabilitation center for a few days after they leave the hospital. This will depend on how you progress in the hospital; keep in mind that healing and recovery times vary with each person.

What is the success rate?
Hip replacement surgery is recognized as a miracle of modern surgery. Most orthopedic experts consider hip replacement to be the best method of handling arthritis in the hip. At Suburban Hospital, our success rate is about 96 percent. Hip replacements have literally put hundreds of thousands of Americans back on their feet and added life to their years.

Are there complications?
As with any surgery, there is a risk of complications after hip replacement surgery. However, they are quite rare (driving on an interstate highway is probably more dangerous). To reduce the risk of infection, we take special precautionary measures in the operating room and use powerful antibiotics. Our personnel are limited to fully trained and experienced nurses and technicians.

What about pain?
Thanks to advances in medication technology, we are able to keep you very comfortable after surgery. After surgery, any temporary discomfort does not compare to the pain of arthritis endured by most people in months and years before surgery. 
And because hip replacement patients are not “sick,” you will not be treated as such. You will wear your own casual clothing after surgery, not a hospital gown. You’ll also join other joint replacement patients for therapy in our on-site gym.


Knee Replacement

What is knee replacement?
It is a metal and plastic covering for raw, arthritic bone ends. It replaces cartilage that has worn away over the years. Knee replacement can eliminate pain and allow you to move easily with less discomfort. For those that have become bow-legged or knock-kneed over the years, it can also straighten your legs to a more natural position.

Who should have a knee replacement?
When arthritis knee pain severely limits your ability to walk, work or perform even simple activities, knee replacement should be considered.

Is there an alternative to knee replacement?
Knee replacement is only recommended after careful diagnosis of your joint problem. Arthroscopic or microscopic surgery is not helpful once arthritis is advanced. Also, it is not likely that anti-inflammatory drugs or cortisone injections will give you the same long-term relief that knee replacement will. 

Should my knee replacement be cemented?
Knee replacements are successfully performed with all cemented components as well as with a combination of uncemented and cemented components. Your surgeon will discuss which technique is best for you. 

How long is the hospital stay?
The average hospital stay for a knee replacement patient is around three to four days.  Nearly 70 percent of our patients are able to go home on the third postoperative day with continued therapy. 
In some cases, fixing one knee reduces the stress on the other knee, thus giving it another two or three years if the arthritis is not too advanced. Each individual case is different. 

How long is recuperation?
Recovery varies with each person. You may use a walker for approximately four weeks after the operation. You can drive a car in two to four weeks. Most people gradually increase their activities and may play golf or doubles tennis in 12 weeks. More active sports, such as singles tennis and jogging, are not recommended. 
After discharge, there is usually no need for a nursing home. Some patients may require a short stay at a rehabilitation center for a few days after they leave the hospital. This will depend on how you progress in the hospital; keep in mind that healing and recovery times vary with each person. 

What is the success rate?
Knee replacement surgery is recognized as a miracle of modern surgery. At Suburban Hospital, our success rate is about 96 percent. Most orthopedic experts consider replacement to be the best method of handling arthritis in the knee. Knee replacements have literally put hundreds of thousands of Americans back on their feet and added life to their years. 

Are there complications?
As with any surgery, there is a risk of complications after knee replacement surgery. However, they are quite rare (driving on an interstate highway is probably more dangerous). To reduce the risk of infection, we take special precautionary measures in the operating room and use powerful antibiotics. Our personnel are limited to fully trained and experienced nurses and technicians. 

What about pain?
Thanks to advances in medication technology, we are able to keep you very comfortable after surgery. After surgery, any temporary discomfort does not compare to the pain of arthritis endured by most people in months and years before surgery. 
And because knee replacement patients are not “sick,” you will not be treated as such. You will wear your own casual clothing after surgery, not a hospital gown. You’ll also join other joint replacement patients for therapy in our on-site gym.


Patellofemoral Pain Syndrome

What is Patellofemoral Pain Syndrome?
Patellofemoral Pain Syndrome (PFPS) is a condition of the kneecap characterized by a rough or soft spot on its cartilage surface. In the past, it has been called chondromalacia patella, runner’s knee or dashboard knee. 

What are the symptoms of PFPS?
It causes pain, giving way, stiffness and a feeling of catching or grinding. Going up and down stairs is a bit difficult, and sitting with your knees bent or squatting is very uncomfortable. It makes the knee “give out,” grind or pop loudly.

Who gets PFPS?
Many people may have PFPS, but only about 10 percent have a long-lasting pain or disability because of it — a fact not clearly understood by the medical profession. Overactivity, excess weight or injury sometimes initiate the symptoms. This condition is often seen in adolescents, manual laborers and athletes.

How is PFPS diagnosed?
Cartilage contains no calcium, and as a result cannot be seen by ordinary X-rays. A patient’s history and a physical examination suggest the diagnosis. If there is any doubt, we will suggest arthroscopy to look behind the kneecap and check to see that there is no other injury or abnormality.

How long does PFPS last?
It may last several months, but fortunately it is usually a self-limiting problem. If you are born with an abnormal kneecap, it may last indefinitely. You may even need an operation to correct it, though this is unusual.

What is the treatment for PFPS?
Small doses of anti-inflammatory medicines can often decrease swelling, stiffness and pain. Other treatments may include injections, ice, rest and physical therapy. Taping and a brace to stabilize the kneecap also can be helpful. 

Now for the good news…
The good news is that although PFPS can be uncomfortable, usually it is only a short term nuisance and inconvenience. It also generally does not lead to arthritis or any other joint condition.


Shoulder Surgery

Who gets shoulder problems?
After age 25, most problems are caused by the effect of repeated overhead motions for a long period of time. Weekend athletes and do-it-yourselfers are especially vulnerable to overuse problems in the shoulder. The leading causes of shoulder pain are bursitis, tendonitis and irritated rotator cuff. This group of conditions is called shoulder impingement syndrome.

What is bursitis?
The bursa is a fluid-filled sac that cushions the rotator cuff tendons from the shoulder bone. An irritated bursa is caused by an inflamed rotator cuff. When irritated, the bursa produces extra fluid, the sac expands, and the pressure creates pain.

What is tendonitis?
Deep in the shoulder are a group of tendons and muscles called a rotator cuff. They help stabilize the upper arm bone in the shoulder joint and rotate the arm. The biceps tendon is also present in front of the shoulder. When the arm is raised repeatedly over the head, the tendons rub against the underside of the shoulder bone and become irritated. The tendons swell, leaving even less space between tendons and bone. The irritation creates more irritation. It is much like a rope being drawn again and again across a craggy rock.

What is an irritated rotator cuff?
Excessive wear on the rotator cuff can lead to severe irritation, roughening and eventually ulceration and tearing of the cuff. An irritated rotator cuff is felt as a clicking or popping in the shoulder from a ragged piece of the cuff sliding under the shoulder bone and arm weakness. Occasionally, injuries or infections can all lead to arthritis, although arthritis of the shoulder is less common than in the knee or hip. Arthritis in the shoulder causes a roughening of the joint from worn cartilage and loose fragments of bone.

What are the symptoms?
Bursitis, tendonitis, irritated rotator cuff and arthritis are all inflammatory reactions to overuse. With any of these problems, a continuous dull ache in the shoulder can become a sharp pain when you try to move your arm, especially over your head. The pain may be worse at night after a heavy day of activities using your shoulder.

What is the treatment for shoulder impingement?

  • Rest: Avoid strenuous activity and any motion that causes pain. In some cases a shoulder sling is helpful to rest fatigued muscles and inflamed tendons.
  • Ice: An ice pack on the affected shoulder can help ease inflammation when combined with gentle motion.
  • Oral medicines: Anti-inflammatory medicines such as Motrin, Feldene, Voltaren, Naprosyn or aspirin will help reduce inflammation.
  • Cortisone injections: Cortisone is a natural hormone and a very powerful medicine for inflammation. When injected directly into the inflamed area, it can be effective in decreasing the swelling and inflammation that cause pain.

How can physical therapy help?
Once the pain and inflammation are under control, a program of exercise, ice, heat, electrical stimulation, ultrasound and massage is used to help you regain motion. 

When is surgery helpful?
Thanks to recent advances in arthroscopy, many shoulder problems can be corrected using the same techniques that revolutionized the treatment of knee problems. Arthroscopy is an outpatient procedure requiring three tiny incisions closed with one stitch each. This procedure allows the surgeon to see and work inside the shoulder joint.

Problems that can be treated through arthroscopy include impingement syndrome, irritated rotator, torn cartilage and unstable joints. In some cases, however, if the rotator cuff is severely damaged and leads to arthritis, the only option for pain-free motion is a shoulder replacement. Shoulder replacements require a one- to two-day hospital stay.

What kind of anesthesia is used?
For maximum comfort, general anesthesia is preferred. Regional anesthesia is an option for some patients. Your surgeon will discuss which type is best for you.

How long does it take?
Shoulder arthroscopies are performed as an outpatient procedure. Many people return to their normal activities within four to five days. People with physically demanding jobs can usually return to work in two to three weeks.

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