- Hip Arthritis
- Knee Arthritis
- Bearing Surfaces for Total Hips
- Partial Knee Replacements
- Hip Resurfacing
- Gender-Specific Joint Replacements
- Revision Hip & Knee Replacements
When doctors talk about the hip joint we are referring to two bones: the top or ball end of the thigh bone (femur) and the bottom or socket of the pelvis. The ball and socket are covered by a complex covering called cartilage. Cartilage is the shiny white surface we see on the end of a chicken leg. Cartilage allows for pain free easy motion of the hip joint. The hip joint has a gasket around it called a labrum. The labrum is very important to the hip: it acts like a shock absorber; it keeps the hip fluid in the joint, and keeps the ball centered in the socket of the hip. Just like a car that has a faulty gasket, a hip with a diseased poorly functioning gasket (labrum) is at risk of seizing up. The cartilage covering on the ends of the ball and socket begin to see wear and tear. Later this leads to raw bone on bone hip pain, which we call hip arthritis.
The early management of this hip pain is nonsurgical. When appropriate we recommend weight reduction, non-impact physical therapy or daily activity (such as biking, swimming, and elliptical), use of over-the-counter supplements such as glucosamine-chondroiten sulfate, acetaminophen (Tylenol), and anti-inflammatories (Indocin, Aleve, Motrin…). Unlike the knee, we rarely recommend injections into the hip joint due to increased risks of infection at the time of future surgery. However, patients with hip pain may be experiencing hip bursitis (inflammation). In these cases we may recommend a steroid injection along the outside of the hip joint.
When these nonsurgical options do not alleviate the patient's symptoms we may recommend a hip replacement. A hip replacement places metal implants within the diseased hip ball and socket, restoring patient's motion with a dramatic reduction in their pain.
When doctors talk about the knee joint we are referring to three bones: the end of the thigh bone (femur), the top of the shin bone (tibia) and the knee cap (patella). The surface of these three bones is covered by a complex covering called cartilage. Cartilage is the shiny white surface we see on the end of a chicken leg. Cartilage allows for pain free easy motion of the knee joint. In order to protect this precious covering we have a pad inside the knee called a meniscus. Once this pad has lost its function as a shock absorber, the cartilage begins to wear down — this is what is known as knee arthritis. Bone begins to rub on bone causing pain for these unfortunate patients.
The early management of this knee pain is nonsurgical. When appropriate we recommend weight reduction, non-impact physical therapy or daily activity (such as biking, swimming, and elliptical), use of over-the-counter capsaicin cream and supplements such as glucosamine-chondroiten sulfate, acetaminophen (Tylenol), anti-inflammatories (Indocin, Aleve, Motrin…), and injections of steroids or a joint gel.
When these nonsurgical options do not alleviate a patients symptoms, we may recommend a knee replacement. Obviously many patients do not understand what a knee replacement means. It is not really a replacement of the entire knee — it would be better understood if we call it a knee resurfacing. The ends of the bones are trimmed of the diseased bone (about a quarter of an inch) and then size-specific metal implants resurface the ends of the bone.
A total hip replacement creates a new ball and socket (cup) which replaces the arthritic joint. In most cases a stem in the femur and a cup in the pelvis is made out of metal which are mechanically wedged into your bone. Over a few weeks biologic fixation occurs by the bone growing into or onto the porous metal surfaces of the implant. On the femoral side there is a ball placed on the stem. Inside the metal cup in the pelvis a liner is inserted. We have different options for what the ball and the liner are made out of to replace the previous arthritic surface.
Most hip replacements use the conventional surfaces of metal ball inside a special strong plastic liner. For some patients we may feel that a ceramic-on-ceramic or metal-on-metal or a ceramic-on-ceramic surface may be a better choice for your new hip. There are advantages and disadvantages for each surface. If you do need a total hip, your surgeon will discuss these options so an informed decision may be made by you.
Learn more about metal-on-metal replacements »
Learn more about ceramic-on-ceramic replacements »
Most orthopedic surgeons are unable to offer you the benefit of partial knee replacements. The Joint Replacement Center surgeons have taken special training and have surgical experience that may allow you to get the pain relief you are looking for without the invasiveness of a total knee replacement.
When we see you in the office we will take a history of your pain. You will be able to point to where your knee is painful. We will then perform an exam and review x-rays of your knee. If the conservative treatment we offer for your knee arthritis is not successful we may inform you of surgical options to help with your pain. We divide the knee up into three compartments: the knee cap joint (patello-femoral), the inner side of the knee (medial compartment) and the outer side of the knee (lateral compartment). If two or more of these compartments are the source of your pain we will recommend a total knee replacement. We call it a total knee replacement but in fact it is a resurfacing of the three compartments of the knee and we save the outer ligaments to the knee. If your arthritis is confined to only one of the three compartments to the knee we may offer you a partial knee replacement. During this surgery we only resurface a single compartment of the knee. The benefits of this surgery is that it is less invasive. The patient usually recovers faster and the knee feels more "natural".
Click here to view a short animation video demonstrating a Biomet Oxford® partial knee replacement.
There has been considerable interest in recent years for the hip resurfacing procedures. The difference between a hip resurfacing and a total hip is the amount of bone that is removed on the femoral side. In a total hip the ball of the hip is removed and the fixation is achieved in the top of the femur by a stem that goes inside the hollow portion of the femur. In hip resurfacing only a small portion of the ball is skimmed away so that a metal cap can be placed on the top of the ball. Many people try to "sell" this procedure as less invasive. It is true that the procedure conserves bone on the femoral side, but the exposure is much more invasive then most total hips. More tissue needs to be cut in order to get the exposure to perform a resurfacing. The patients activity is also usually delayed for the first 6 months to prevent a break of the hip below the resurfaced ball. We do not believe that there is a difference in range of motion, clinical outcome, patient satisfaction, or dislocation risk (ball falling out of the socket after surgery).
Most patients are not a candidate for hip resurfacing due to many issues (hip dysplasia, avascular necrosis, female gender, or certain anatomy differences seen on x-rays). However it is a procedure that may be best suited for some patients (i.e. poorly aligned previous fractures or previous metal plating of the bone which prevent use of standard hip stems) We have performed the necessary FDA training in order to perform this surgery if we feel that it is the best option for our patients.
It is true that women and men have anatomic differences that we must account for in surgery. Our joint replacement surgeons are well aware of these potential differences on both the hip and the knee replacements. Unlike most orthopedic surgeons performing joint replacements we do not use a single system to address all problems. For example, it is not uncommon for our joint replacement surgeons to use three or four different hip replacement stem designs during a day of surgery. Our only desire is to perform a surgery in which you will be satisfied with the clinical outcome and will serve you well for as many years possible. Allow us to review your x-rays and chose a system which will be best for YOU! As always feel free to ask any questions you may have.
Despite hip and knee replacement being one of the most successful surgeries all of medicine has to offer, there are times that they do not "work" right. This may be evident to a patient during the first year or it may take twenty years for them to "wear out." The Joint Replacement Center at Stony Brook is a main referral site for these difficult cases. Our Director performs more revision hip and knee replacement surgeries than any other surgeon on Long Island.
The range of these cases is very broad. It can range from a simple plastic change on a hip or knee that takes an hour or could be a very complex 5 hour surgery. We do not refer out cases – if it can be done, we know how to do it.
If you are having a problem with your joint replacement please schedule an appointment to see if we can help.