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Monday Medical: Faster recovery for joint replacements

Susan Cunningham
For Steamboat Pilot & Today

If you need a knee or hip replacement, there’s good news: with the enhanced recovery after surgery protocol, patients feel better faster after a joint replacement.

“The goal is to get people back to being active as quickly as we can,” said Dr. Bobby Howarth, an orthopedic surgeon in Steamboat Springs and a member of the medical staff at UCHealth Yampa Valley Medical Center. “Joint replacement has traditionally required a hospital stay of three to seven days. But now, we can get patients walking and home that day.”

Benefits of faster recovery

There is a wide range of benefits to moving soon after a joint replacement, including losing less muscle, experiencing less pain and preventing issues such as blood clots.

“The sooner you can get someone back to standing upright, walking and doing things normally, they have less risk,” Howarth said. “There’s less risk of blood clots, they can breathe more deeply, and they feel better.”

Preparing from the start

The work begins as soon as a patient decides to move forward with a hip or knee replacement.

“We get them as much information as possible beforehand, so when they’re out of surgery, they’ll know what to do,” Howarth said. “It’s like a game plan, and it starts with the very first visit.”

The patient is connected with a physical therapist to strengthen core muscles, learn exercises that will be used after the surgery and review the importance of staying active.

“We don’t want them to be afraid of moving,” Howarth said. “We want them to be active, to get out and do more things rather than less.”

A team effort

Using an enhanced recovery after surgery approach requires an entire team. From the orthopedic surgeon and physical therapists, to the anesthesia team and nurses, everyone plays an important role. That support continues when the patient goes home through support from a spouse, partner or friend.

“It’s not just about having an easier surgery, but it’s involving everyone who will help,” Howarth said.

Howarth aims to keep his surgeries as minimally invasive as possible, by working through a small incision and keeping muscles intact.

“When you don’t cut muscles, someone who’s up and about will feel better,” Howarth said. “When patients see their X-rays after surgery, they can’t believe something that big was put in through such a small incision.”

The surgery is quick, often taking less than an hour. Instead of general anesthesia, which affects the entire body including the brain and nervous system, the anesthesiologist may use medication to help a patient relax and sleep, and a spinal block to numb the lower extremities. And while opioids may be used to address pain, Howarth prefers to keep them to a minimum.

“The more opioids someone takes after surgery, they don’t feel as great and their bowels may get stopped up, and some patients may struggle with addiction,” Howarth said. “If you can keep a patient off opioids from the get-go, there can be some benefits.”

Joint health, not age

If you’re in your 40s or 50s and suffer from knee or hip pain, joint replacement may be something to consider.

“Joint replacements are lasting 30 years, so it’s a different era,” Howarth said. “If people are active and healthy, but have beat up on their joints, we want them to understand total joint replacement is for someone who’s young and wants to continue to stay young. What we don’t want is for your life to be limited by arthritic symptoms.”

Moving without pain

The reward for Howarth is helping people live an active life without pain.

“I can’t tell you how many patients have said, ‘I can’t believe how much pain I was in,’” Howarth said. “It all changes after you have a knee or hip replacement. Suddenly that pain is gone. It’s wonderful to help someone change their life so they can continue to be active.”

Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at cunninghamsbc@gmail.com.


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