Total Joint Replacement

Total knee replacement and total shoulder replacement involve replacing damaged cartilage surfaces of the knee and shoulder with metal implants cemented or press fit into the ends of the bones that form the joint. A piece of dense plastic known as polyethylene is then inserted between these two metal implants to provide a new bearing surface.

You are a good candidate for total joint replacement when pain, disability, and/or instability become so significant that your quality of life is diminished considerably, you are forced to take pain and/or anti-inflammatory medication on a consistent basis, and/or you are forced to give up activities/sports that you otherwise would enjoy participating in. This is especially the case when non-operative treatment measures such as anti-inflammatory medications, injections, physical therapy, activity modification, and arthroscopic surgery have failed to alleviate your symptoms and disability.

Your orthopedic surgeon, your physical therapist, your family physician, and your surgical coordinator will assist you in the preparation for the total joint replacement. There may be bloodwork and cardio-vascular testing required to make sure that it is safe to proceed with the operation. Your Orthopedic surgeon will obtain special x-rays and occasionally MRI or CT scan to assist in the planning of your operation and appropriate sizing of your implant. This might include obtaining a special radiographic test called a 3D Reconstruction CT scan to make custom implants designed exclusively for your knee/shoulder and its unique anatomy. Your physical therapist will give you a comprehensive strengthening and range of motion program to ensure that your knee/shoulder and surrounding musculature are in optimal condition for the procedure so that you will have the best possible rehabilitation postoperatively and outcome in the many years following.

Your total joint replacement will either be performed in an outpatient surgical center or in the hospital. In both facilities, you will be met by nursing staff and anesthesia staff who will place an IV and discuss with you the type of anesthesia that you will receive. You will be treated with regional nerve blocks which numb up the nerves that supply sensation to the joint that is being replaced and the surrounding skin and musculature. These regional nerve blocks are very effective in eliminating or minimizing postoperative pain on the day of surgery so that you may go home within an hour or two after the operation and be able to walk with an assistive device such as a walker or crutches. Most patients go to sleep for the procedure with a general anesthetic, but occasionally your anesthesia team might recommend a spinal anesthetic for a knee replacement. If you undergo a total knee replacement procedure, you will be met on the day of surgery immediately following your procedure by an experienced staff physical therapist who will teach you how to use your assistive devices and how to go up and down stairs and navigate your home surroundings safely. In most cases, you will have equipment brought into the home before the day of surgery such as sequential compression stockings to prevent blood clots, a continuous passive motion or CPM machine that will move your knee through a safe range of motion to prevent stiffness postoperatively, and an automatic cryotherapy machine to minimize swelling through cooling and compression. You will begin a blood thinning medication on the night of surgery, in most cases an adult coated aspirin twice daily. You will begin a narcotic pain medication and anti-inflammatory medication to minimize the pain that you will begin to feel when the regional nerve block and pain pump begin to wear off in one to two days.

You will be advised to place the cold compression unit immediately on your shoulder or knee and to rest and elevate the extremity as much as possible. The first several days are focused on pain management, minimization of swelling, and prevention of blood clots. After total knee replacement, a physical therapist will come into your home to assist you with ambulation for the first 3 to 4 days after surgery. You will then begin outpatient physical therapy in a specialized physical therapy clinic in our facility or near your home.

Returning to normal activities of daily living, work related activities, and recreational activities will occur in the weeks and months following your joint replacement. Depending on many factors, the time it takes to return to these activities varies considerably. In general, most patients can return to many of their activities of daily living around the home within a few short days or weeks. Returning to work that can be done at a desk frequently occurs within a few weeks after the operation. Returning to work that requires physical labor or returning to athletic activities takes 3 to 6 months for most patients.

Millions of total joint replacements are performed safely around the world every year. The great majority of patients receive tremendous pain relief and are able to return to many of the activities that they once enjoyed and had given up prior to their joint replacement. It is easily one of the most reliable and safe procedures that is performed by your surgeon at the Institute For Athletic Medicine. As with all surgical procedures, there are some risks associated with total joint replacement which your surgeon will detail with you at your preoperative visit. Your surgeon has 25 years experience in performing total joint replacement on the knee and shoulder and over 5 years of experience in performing joint replacement on an outpatient basis. At the Institute For Athletic Medicine, no safety measure is overlooked, and every technological advancement is employed so that we may give you the best chance at your best possible outcome.

Zimmer-Biomet is the shoulder implant of choice at the Institute for Athletic Medicine. It is a very technologically advanced and versatile implant system that allows for a significant degree of customization when desired. There is no system on the market with a higher reliability and safety record.

For total knee replacement, Dr. Samani utilizes implants from both the Zimmer-Biomet company and from the Conformis company. Both systems are state of the art and have been proven effective and safe in clinical trials around the world. Depending on your age, desired level of activity post-operatively, and the severity of arthritis, one of these systems will be recommended to you.