Surgery

Knee Replacement Surgery

Knee SurgeryThe knee is a hinge joint which provides motion at the point where the thigh meets the lower leg. Your knee can become damaged by osteoarthritis resulting from wear and tear over time, by rheumatoid arthritis, psoriatic arthritis, or by injury/trauma to the knee. Rest, medication, and therapy are the first lines of treatment, but knee replacement surgery — also known as knee arthroplasty — can help relieve pain and restore knee function for those whose cartilage is too damaged to respond to conservative measures. Although surgery always comes with risks, knee replacement surgery continues to be one of the most predictably successful of all major operations done for any problem. It is however a major surgery and should only be considered when other nonsurgical options are not adequate.

Knee Replacement Procedure

In general, knee replacement surgery consists of replacing the diseased or damaged joint surfaces of the knee with metal and plastic components shaped to allow continued motion of the knee. Knee replacement would be more accurately called knee resurfacing in that only the surface of the femur and tibia are removed and then capped by metal. The ends of the bone are precisely shaped to exactly match the shape of the artificial components. These artificial components mimic the shape of the normal bone. A highly wear resistant plastic insert is placed as the cushion between the two metal components. Usually a total knee replacement also involves capping the surface of your knee cap (patella) with polyethylene. A good result from the operation is very dependent on the accuracy of contouring of bone and placement of components.

What to Expect From Knee Surgery

Recent improvements in materials and techniques have made total knee replacement a common and highly successful surgery, with around 300,000 being performed every year in the U.S alone. The vast majority of people who undergo knee joint replacement surgery have dramatic improvement in pain and range of motion. Approximately 95% of patients after recovering from knee replacement report enough improvement that they would repeat the decision to have surgery. In addition to routing life activities, such activities as walking, cycling, dancing, golf and tennis are comfortable for the majority of patients.

Knee Surgery Rehabilitation

Post-operative hospitalization averages 1 to 3 nights, depending on the health status of the patient. Most people require crutches or a walker for 1 to 3 weeks and a cane for 1 to 3 weeks after that. The average need to see a physical therapist is for 4 to 6 weeks and the time to a better knee overall than before surgery for most patients is about 4 to 6 weeks. Time to safely driving a car is typically 2 to 4 weeks and average time off work is also approximately 4 weeks.

About Dr. Roberson

James Roberson, MDJames Roberson, MD is professor and chairman of the Department of Orthopaedics at Emory. He specializes in total joint replacement of the hip and knee. Dr. Roberson completed his residency training at Emory University followed by a fellowship at Mayo Clinic. He has been practicing at Emory since 1982.

Related Resources

Total Knee Replacement
Revision of Total Knee Replacement
Unicompartmental Knee Replacement

How is Arthroscopic Hip Surgery Different?

ArthroscopyArthroscopy (also called Arthroscopic surgery) is a surgical procedure by which the internal structure of a joint is examined for diagnosis (and possibly treated) using an instrument called an arthroscope. Arthroscopy gives doctors a clear view of the inside of a joint, and helps them diagnose and treat joint problems. Hip arthroscopy has been slower to evolve than arthroscopy of other joints such as the knee or shoulder, mostly because the hip joint is much deeper in the body and therefore harder to access, but can be very effective at treating certain hip conditions.

Arthroscopic hip surgery is radically different than traditional open surgery, and may be considered before one opts for a full hip replacement surgery. Non-operative measures should always be considered first — rest, behavior modification, physical therapy and anti-inflammatories may work to alleviate reversible disorders. If non-operative measures aren’t effective and you do elect for surgery, a procedure may be done arthroscopically instead of by traditional surgical techniques, as it usually causes less tissue trauma, may result in less pain, and may promote a quicker recovery.

Hip Replacement Surgery 101

hip replacementThe hip is one of the body’s largest and most important joints. It allows us to walk, run and jump, and bears our body’s weight and the force of the muscles of the hip and leg. If your hip has been severely damaged—by a fracture, arthritis, osteonecrosis or other conditions–common activities such as walking or getting in and out of a chair may be painful and difficult. You may even feel uncomfortable while resting.

If other alternatives such as medications, the use of walking supports, or changes to daily activities do not effectively help your symptoms, hip replacement may be a viable solution and you should consult with your physician to learn more. Generally, hip replacement surgery is a safe and effective procedure that can help you get back to enjoying everyday activities.

Hip Surgery: Hip Arthroscopy 101

Hip arthroscopy is a surgical procedure that is performed through small (about 1 centimeter) incisions using an arthroscope (camera used to visualize the inside of the joint) inside of a hip joint. Hip arthroscopy is typically performed in an outpatient setting, so patients can usually go home the day of surgery after a one to two hour recovery in the outpatient recovery area. Although it will take about 6 months to return to sport activity, close to 85-90% of patients will return to their normal activity after they recover from their hip arthroscopy surgery.

Emory Orthopaedics, Sports & Spine has a great team of operative and non-operative physicians who are specialized in treating athletes who need hip arthroscopies. Watch this short video to find out more about our unique program.

Dr. Maughon Discusses the Ins & Outs of Joint Replacement Surgery

Joint replacement surgery is a procedure that should only be recommended when all other modes of treatment to eliminate your pain have been exhausted. Almost any joint in the body can be replaced, but most commonly replaced joints are the knee, shoulder and the hip. If you are referred for joint replacement the goal at Emory Orthopaedics, Sports & Spine is to get an athlete back to a similar level of play or activity after a surgery. In an aging athlete, joint replacement is typically done for pain relief so the patient is allowed to lead an active life. Although, many patients will be able to do all the activities they did before the joint replacement, we recommend doing activities that do not put a lot of pressure on the joint such as swimming, ice skating and doubles tennis. Watch this short video about joint replacement and details on what makes joint replacement surgery at Emory different.

Emory Sports Medicine patient, Susie Hemphill: A Story of Recovery

Susie HemphillIn August 2008 I fell and hurt my ankle. Over the course of four years, I was treated by two different orthopaedic surgeons and was not able to participate in tennis or any other sports. This was devastating for me because I am an avid and accomplished tennis player. I was recruited out of high school in Illinois to play collegiate tennis at the University of Alabama at Birmingham. But as a result of my ankle injury, I struggled to walk. I almost gave up hope that I would ever play again after two failed ankle surgeries. It was so hard to even perform daily tasks that I was contemplating applying for disability benefits. I was miserable with life because I was in so much pain on a daily basis.

According to Emory Orthopaedic surgeon, Dr. Sam Labib, I had a condition in my ankle where there was no cartilage between my foot and ankle bone. Dr. Labib gave me hope and said he could repair the damage by taking cartilage from my knee and putting it in my ankle. On, August 23, 2012, I had cartilage repair surgery at Emory Orthopaedics & Spine Center in Atlanta with Dr. Labib. It’s been a little over a year and a half since the surgery and I just keep getting better and better. Now, I am happy to say that I am pretty much as good as new and back to playing tennis as much as I want. I even recently made it to the City Finals playing Atlanta Lawn and Tennis Association AA1 Women’s Tennis. It is hard for me to believe that I was unable to do anything for almost four years.

Thanks to Dr. Labib, I am also now back to doing what I love professionally. I am a United States Professional Tennis Coach. It is so great to be back playing and coaching. I owe it all to Dr. Sam Labib. Dr. Labib is a caring, compassionate, exceptional, talented, driven doctor and I owe him the world for fixing me and giving my life back. I highly recommend Dr. Labib to any patient who has a similar condition.

About Dr. Sameh (Sam) Labib

Dr. Sameh Labib

Sam Labib, MD, is a sports medicine fellowship-trained surgeon and director of the foot and ankle service at Emory. Dr. Labib started practicing at Emory in 1999. He is an Associate Professor of Orthopedic Surgery.

He has lectured both nationally and internationally at many orthopedic meetings. His research has been published in several journals, including the JBJS, Arthroscopy, Foot and Ankle International and the American Journal of Orthopedics as well as numerous video presentations and book chapters. Dr. Labib is Board Certified in orthopedic surgery with additional subspecialty certification in Sports Medicine Surgery.

For the past 5 years, Dr. Labib has been nominated by his peers as one of “America’s Top Doctors” as tracked by CastleConnelly.com. Dr. Labib has a particular interest in problems and procedures of the knee, ankle, and foot. He is the head team physician for the athletic programs at Oglethorpe University and Spelman College, and an orthopaedic consultant to the Atlanta Falcons, Georgia Tech and Emory University.

About Emory Sports Medicine
The Emory Sports Medicine Center is a leader in advanced treatments for patients with orthopedic and sports-related injuries. From surgical sports medicine expertise to innovative therapy and athletic injury rehabilitation, our sports medicine physicians and specialists provide the most comprehensive treatment for athletic injuries in Atlanta and the state of Georgia. Constantly conducting research and developing new techniques, Emory sports medicine specialists are experienced in diagnosing and treating the full spectrum of sports injuries.
Our sports medicine patients range from professional athletes to those who enjoy active lifestyles and want the best possible outcomes and recovery from sports injuries. Our doctors are the sports medicine team physicians for the Atlanta Falcons and Georgia Tech and provide services for many additional professional, collegiate and recreational teams. Appointments for surgical second opinions or acute sports injuries are available within 48 hours. Call 404-778-7777 for an appointment.

Related Links

Understanding Rotationplasty – Alternative to Limb Sparing Surgery

Rotationplasty Child Limb Sparing Surgery AlternativeRotationplasty is a surgical option for young children who have been diagnosed with a variety of malignant or benign conditions. Rotationplasty is most commonly used as a treatment option for osteosarcoma or Ewing’s sarcoma in the distal femur or proximal tibia. This procedure can also be used in the proximal femur for rotationplasty in the hip, but this is much less common than the knee.

In rotationplasty, the bone cancer and surrounding tissues are removed and the remaining lower section of the leg is rotated before reattaching to the healthy upper section.  Rotationplasty is typically recommended when a portion of the limb is injured or diseased.

During the leg rotationplasty procedure, the ankle becomes the knee joint.  A prosthesis is built that allows the foot and ankle to function as the patient’s knee.  This prosthesis is different than a typical prosthetic device since it requires consideration of an anatomical ankle to act as the knee.  The ankle (new knee) requires structural support so that the patient does not overextend the ankle.  Prosthetic fit and function are very critical and should only be performed by a skilled prosthetist.

Patients who undergo rotationplasty as a surgical option for treatment require intensive physical therapy to gain motion and strength in the reconstructed limb. A physical therapist and prosthetist who are skilled in this specific design/procedure should work very closely with the patient’s orthopedic surgeon to guide the exercise program and prosthetic fitting.

Other surgical options for young patients with sarcomas such as osteosarcoma or Ewing’s sarcoma are:

When making the decision whether to receive rotationplasty versus the other treatment options, parents should take into consideration the age of the child, the location and size of the cancer, medical diagnosis and prognosis as well as the “functional outcomes” that the parents/child/physician agree on.

Rotationplasty is a good option for young patients who have not finished growing and have a malignant bone tumor around the knee joint.  Because their legs have not grown completely, the leg length difference will not be as great.  Also, the young patient will be able to run and jump and keep up with their friends and classmates.  The patient can participate in most sports even those with jumping and high impact.  Because the ankle joint is a natural joint functioning as the “new knee,” the patient has greater control of the “knee” with sensation of how it is moving as well as the position of the knee as the patient walks and runs.

At Emory Orthopaedics & Spine, we work closely with the resources at Children’s Healthcare of Atlanta’s Aflac Cancer and Blood Disorders Center, one of the largest childhood cancer programs in the country. Our continuum of care features pediatric experts in orthopedic surgery, radiation oncology, social work, case management, physical therapy and prosthetics.

Related Resources:

About the Experts

Dr. David MonsonAbout Dr. Monson
David K. Monson, MD, assistant professor of Orthopaedic Surgery and Chief of Orthopaedic Surgery at Emory University Hospital Midtown, started practicing at Emory in 1988. Dr. Monson is an expert in the treatment of rare tumors (sarcomas of the bone and soft tissue). Dr. Monson’s specialties are Orthopaedic Surgery (Board certified since 1990) and Orthopaedic Oncology. His areas of clinical interest are orthopaedic tumors, sarcoma, and limb reconstruction.

 

Dr. Shervin OskoueiAbout Dr. Oskouei
Shervin V. Oskouei, MD, assistant professor of Orthopaedic Surgery at Emory University, is an expert in the treatment of musculoskeletal (extremity) tumors, total hip and total knee replacements and revisions. Dr. Oskouei started practicing at Emory in 2004. Dr. Oskouei is board-certified and fellowship trained in orthopaedic surgery. Combining his experience and interests with the state-of-the-art facilities of Emory University and the Winship Cancer Institute of Emory University allows Dr. Oskouei to treat patients with the latest modalities using a multi-disciplinary approach.

About Emory Orthopaedic Oncology
Dr. Monson and Dr. Oskouei lead the Emory Musculoskeletal Oncology and Limb Reconstruction program at Emory.  The world – class program treats a variety of conditions, including benign and malignant tumors of the extremities and spine, as well as metastatic disease. Together, they offer a combined 34 years of clinical practice experience. They care for both pediatric and adult aged patients.

Both of these physicians belong to the Musculoskeletal Tumor Society which requires fellowship training in orthopaedic oncology.  Physicians belonging to this group must also have a primary clinical focus in orthopaedic oncology.  This is important for patients because it means the specialist you are seeing has had extra training in this area and is viewed by peers as an expert in the care of orthopaedic oncology. Patients should take the time to research physicians in their area to determine if they are seeing an orthopaedic oncology specialist that belongs to this organization.

Does Your Broken Wrist Need Surgery?

Wrist fractures are the most common broken bone for people under 65 years old.  In fact, one out of every 6 fractures treated in the ER are wrist fractures!

Wrist Fracture Symptoms:

  • Wrist Pain
  • Swelling of or around the wrist
  • Deformity of the wrist

Wrist Fracture Treatment

Broken Wrist

Treatment for a wrist fracture can vary on a case by case basis.  Some wrist fractures can be treated in a cast.  Physicians can reset the fracture and cast it and the bones can heal themselves.  There are cases though when a wrist fracture needs surgery.    Physicians take into consideration other factors to determine whether a patient needs surgery such as:

Advancing the Possibilities in Orthopedic, Sports Medicine & Spine Care

Emory University Orthopaedics & Spine Hospital AtlantaEmory Healthcare is known for its strong focus on patients and families, as well as its sharp attention to detail in Orthopaedics, Sports Medicine and Spine Care. At Emory, we have the most highly trained orthopaedic and spine specialists in the country working together to diagnose and treat a wide variety of orthopaedic, spine and sports medicine conditions. Our physicians use innovative approaches to care – many of them pioneered via research right here at Emory – to ease your pain and get you back to the life you love. We bring all aspects of musculoskeletal diagnosis, treatment and rehabilitation together in one location – from state-of-the-art CT and MRI to a world-class outpatient surgery center and physical therapy suite– at the Emory University Orthopaedics and Spine Hospital (EUOSH).

Many of our musculoskeletal inpatient procedures occur at EUOSH, which is unlike any other facility in Georgia. When planning for this hospital, doctors, nurses and patients presented their wish lists, and we worked tirelessly to bring our patients the care that set the standards and raises the bar higher than ever. The hospital has been completely renovated to provide our orthopaedic, spine and sports medicine patients with access to exceptional service and the most advanced, sophisticated technology tailored specifically to their unique needs. The combination of our unique facility amenities at EUOSH and our team’s dedication to truly patient- and family-centered care allow us to provide an unparalleled level of musculoskeletal care to the Atlanta and Georgia communities. Find out more in the video below:

We pride ourselves on being uniquely focused on patient satisfaction and comfort. In fact, we call upon 75 various patient committees and have adopted listening practices to ensure that we fully understand the needs of the patient. Further, we make it a point to avoid being married to any sort of protocol; for example, there’s no limit on patient visiting hours, and family members are welcome to sit with patients right up until the time of surgery.

Our efforts have not gone unnoticed—we’re proud to say that we have over a 90% satisfaction rate among our patients. Every room is equipped with everything a patient could possibly need for a comfortable recovery, including an interactive television that offers hospital information, a “my education” feature, access to the patient’s chart, health notes, and of course, regular TV channels and movie options.

Emory truly strives to exceed patient expectations every day. Learn more about our Orthopaedic, Spine and Sports Medicine care by watching this short video.

Minimally Invasive XLIF Spine Surgery Can Speed Recovery Time

Dr. Tim Yoon, spine surgeonDr. Jim Rothermel, a retired ob/gyn, had been living with back and leg pain for more than three years. He was told that he needed extensive open spinal surgery. However, he came to the Emory Spine Center for another opinion and met with Dr. Tim Yoon, an internationally recognized spine surgeon and expert in minimally invasive techniques. Dr. Yoon diagnosed Jim with stenosis and scoliosis. His condition would typically require complex open spinal surgery, but Dr. Yoon determined that using a less invasive method, the XLIF technique, would reduce the stress on his body and reduce recovery time.

XLIF (eXtreme Lateral Interbody Fusion) is an approach to spinal surgery in which the spine surgeon accesses the intevertebral disc space and fuses the lumbar spine from the side rather than from the front or the back. By going through the side of the body with a small incision rather than through a large abdominal incision, much less soft tissue is traumatized, resulting in a faster recovery. XLIF may be an option for patients who have scoliosis, spondylolisthesis (where the vertebrae have slid in relation to one another), or spinal stenosis. These diagnoses typically causes leg pain and back pain.  When XLIF is used to perform a simple one-level fusion surgery, the patient often is able to go home the next day.

The XLIF technique can also be used to access multiple different discs and may be combined with other procedures, such as minimally invasive screws, to handle more complex cases, like Jim’s. This less-invasive approach can make surgery an option for people who, in the past, might not have been chosen surgery because of the prolonged recovery time or because the doctors thought the surgery was too invasive for a frail patient. Therefore, XLIF allows surgeons to treat more spinal conditions and different types of patients.

Emory spine surgeons have extensive experience performing a wide variety of spine surgeries. They know when the minimally invasive approach won’t be effective or should be combined with a bigger surgery. “Not everybody is going to be best treated by an XLIF, but I know who will be, and I choose those people,” Dr. Yoon says. “That way, you maximize the best results and minimize any likelihood of complications.”

Jim and his wife, Midge, couldn’t be happier with Dr. Yoon and their experience at the Emory University Orthopaedics & Spine Hospital. Jim says, “Dr. Yoon spent quality time with me. He thought he could do this XLIF procedure with a three-level fusion. He explained it in detail and then referred me to a website. I looked at the procedure carefully and thought it sounded like the proper way to go about doing it. He scheduled the surgery for two stages. We did the XLIF on a Monday, and he was able to do it in a manner that wasn’t muscle cutting. The recovery time was markedly improved.” Three days later, Dr. Yoon performed the second stage of the surgery, and a few days after that, Jim went home.

“Jim was extremely uncomfortable for over three years, and to see the difference in him now is just an absolute miracle. He’s happy. He’s always been a big teaser and silly, and I’ve got him back again,” Midge says.Have you had XLIF spine surgery, or would you like to learn more about spine surgery at Emory? We welcome your questions and feedback in the comments section below.