July/August 2000

CONTENTS Back to Cover About Cattails Don't forget your feet: foot care is an important health consideration Magnet therapy: Does it really work? Marshfield Clinic seeks volunteers for cancer pain control study Total joint replacement excellent option for some patients When to call the doctor about your sick child New faces Marshfield Clinic Calendar of Events

Total joint replacement excellent option for some patients

Joint replacement is one of the most gratifying surgeries David Simenstad, M.D., performs.

"It's one of the most cost-effective and improving operations," said Dr. Simenstad, an orthopaedic surgeon at Marshfield Clinic-Lakeland Center. "It has an impact on a person's state of being and gives an improved ability to function in society."

Walking is excellent exercise for people with hip and knee joint replacements.

That improvement often is dramatic, said John Kozisek, M.D., also an orthopaedic surgeon at Lakeland Center. "From a surgeon's standpoint, you see someone who was crippled, you do surgery and six weeks later they're moving around very well," he said. "They're back to playing golf and walking."

Although total joint replacement surgery has been done for more than 30 years, improvements in technique and in the materials used in the new joint make it more effective today.

To a person with pain in their hip or knee, joint replacement is often the only way to restore many activities from earlier life. But it's an option of last resort, Dr. Simenstad said. "We try medication and crutches, a cane or a walker," he continued. "Joint replacement is used when patients can no longer function at a level they're happy with."

The need for joint replacement is caused partly by genetics and partly by wear and tear. More patients are having the surgery in part because people are living longer, according to Dr. Kozisek. "They're not willing to sit back, even at age 70, and stop doing what they want to do," he said. "They want to get something done."

A patient cannot simply have joint pain and have the operation, Simenstad cautioned. First, an x-ray must show that the patient's joint is completely worn out. "It must be bone on bone," Simenstad said. And, the patient must be over 50 and usually over 60 years old before they are considered good candidates for joint replacement. That's because about 10 percent of the replaced joints wear out after 10 years. As more time passes, the risk of the joints wearing out increases.

There are other risks to the surgery. It's nearly impossible to promise that both legs will be the same length after the surgery. And surgery brings risk of nerve or vessel damage and infection, Dr. Simenstad said.

Those are some of the risks he explains to patients to help them make a decision about surgery. Joint replacement also means the patient will have to make some changes in their activity for the rest of their lives, he said. For example, no running, but patients are encouraged to walk as much as they want.

Knee Replacement

"If you run on a knee, you'll wear it out," Dr. Simenstad said. Heavy lifting also is out. But for those patients in extreme pain, joint replacement offers a chance to return to many normal activities.

Dr. Simenstad, Dr. Kozisek and others at Marshfield Clinic-Lakeland Center in Minocqua have developed a protocol for joint replacement surgery that improves results. That protocol was part of the national recognition of Howard Young Medical Center, where physicians perform surgery as a benchmark hospital in joint replacement.

HCIA-Sachs, a healthcare information company, listed the hospital as one of the top-100 hospitals for both knee and hip replacement.

After the decision is made to have the joint replacement, patients go to physical therapy before surgery. This way they can learn their exercises while their mind is clear. Immediately after surgery patients are under the effects of anesthesia. The addition of physical therapy right after surgery has been one of the biggest changes in the nearly 20 years Dr. Kozisek has been doing the total joint replacement. It is proven that patients who attend physical therapy before surgery, and faithfully do their exercises after surgery, not only improve more quickly, they also make more progress.

"In the past, a total knee replacement would have required a two- to three-week hospital stay," Dr. Kozisek said. "Now, a patient is out of the hospital in less than four days." Twenty years ago, the theory was to rest the joint after major surgery, he continued. Now, most of the time patients are moving the joint the day of surgery.

The kind of exercises required for physical therapy vary, said Maureen Hartzheim, a physical therapist at Marshfield Clinic-Lakeland Center.

"If the patient's motion is good, if they're walking well and if they can make a good contraction of the thigh muscle, they might end up doing exercises on their own at home," Hartzheim said. "But if they're stiff or limping quite a bit, they probably would come to therapy two to three times a week for a few weeks."

Pain after surgery can make it difficult to do therapy, she said. But patients soon learn that moving will help them feel better in the long run.

Hip Replacement

For hip replacements, most patients do not have formal physical therapy at all. Instead, they are told to walk, first with a walker -- and then on their own. That's the most important action, Simenstad said.

During their hospital stay, patients also learn how to move with their new joint, Hartzheim said. "It's a matter of teaching them the precautions," she said. "We don't want them to bend the hip beyond 90 degrees while it's healing."

The surgery itself takes between one and two hours, depending on the difficulty, Dr. Simenstad said.

"It's hard to imagine the surgery," Dr. Kozisek said.

"When you tell somebody you're going to replace their knee, a lot of people think you're going to cut above and below and put something foreign in," he said. "That's not how it is."

The bearing parts that move against each other in the joint are replaced or resurfaced, he said. But the rest of the body is intact.

During surgery, the worn out joint is replaced with a metal or plastic component. For example, in a hip replacement, the surgeon removes the ball joint and replaces it with a synthetic joint. The parts are attached to the body for strength.

See Related Article:

• Marshfield Clinic physicians invent new hip replacement device