Offering the Stanford Health Care experience with the convenience of a local community clinic, our doctors specialize in diagnosis and treatment of sports injuries and arthritis, and joint replacement.
Whether you're meeting with your physician for the first time or heading in for your follow-up, you likely have many questions about your procedure, recovery and health.
What should I know about my upcoming procedure?
Many surgeons advertise minimally invasive approaches, but change nothing but the size of the skin incision. A true minimally invasive surgery is a much more technically demanding procedure than traditional approaches. Without appropriate training, equipment and an experienced surgical team, patients could experience complications that affect the long term function of the treated joint. Your surgeon will describe what is needed for your specific procedure, but here are a few general questions to start with.
Is minimally invasive hip or knee replacement right for me?
Because of advancements in instrumentation and surgical technique, a vast majority of patients can now elect to undergo a minimally invasive joint replacement. There is no weight, size or age limit for these procedures. However, more complicated hip and knee replacements with significant joint deformity and revision (re-do) joint replacements often require larger incisions with a more traditional approach.
How big will my incision be?
In a minimally invasive surgery, the incision is usually 3-4 inches in length—less than half of the 8-12 inches usually required for a traditional hip or knee replacement. In some cases the incision may be lengthened to allow for adequate visualization to do the surgery properly. Ultimately, the size of the incision will be as long as it needs to be for your surgeon to safely and accurately perform your procedure.
What are the benefits of minimally invasive surgery?
Currently, long-term outcome data for minimally invasive surgeries are limited, because the techniques and instruments used to perform these surgeries have been evolving over the last 10 years. There are many short-term benefits to patients, including:
Faster recovery in the first 2-4 weeks after surgery
Less blood loss at the time of surgery
Less pain and pain medication usage
Shorter hospital stays
Faster return to walking with a cane or without any assistive device
Faster return to work
It is important to remember that by 3 months, all joint replacement patients generally achieve 90% of their ultimate recovery regardless of whether they have a traditional or minimally invasive surgery. Current studies of long-term results of hip and knee replacements suggest that 90-95% of reconstructed joints are still successful 20 years after surgery.
What are the risks of minimally invasive surgery?
Minimally invasive approaches to joint replacement are more difficult to perform correctly than standard approaches to hip and knee replacement, so it is extremely important to select a surgeon with experience and appropriate training to perform these procedures. Specific modifications to surgical instrumentation and technique must be made to safely and reliably perform a minimally invasive approach. Simply making a shorter incision without significant surgical adaptations can result in poor results and severe complications. Without appropriate surgical exposure or visualization, errors in alignment and sizing of components, damage to nerves and arteries, and poor soft tissue balancing can compromise the end result for the patient. It is important to talk to your surgeon about their training and experience performing minimally invasive procedures.
What about newer alternatives, like the anterior approach for hip replacements?
There are many approaches a surgeon can take to a hip replacement. When done properly by an experienced hip surgeon, both anterior and posterior approaches to hip replacement should have a less than 1% risk of dislocation. Unfortunately, marketing efforts have implied that there is no need for hip precautions after an anterior approach and that the risk of dislocation is lower.T his is not supported by medical evidence.
While trained in anterior, antero-lateral, direct lateral, and posterior approaches to the hip joint, Dr. Miller recommends a mini-posterior approach for almost all primary hip replacements. No matter what approach is used, all patients undergoing a total hip replacement need to avoid specific movements for a period of 6 weeks to avoid dislocations while the soft tissue around the hip heals. After this time, most patients can return to full range of motion activities without worry of dislocation.
What injuries or conditions are treated with arthroscopy?
Arthroscopic surgery is a minimally invasive surgery most often used to treat a sports injury to a joint. The majority of the surgery is done with the assistance of a microscopic camera that is placed into the joint through a small incision. This allows your physician to both see and evaluate the entire joint while treating any injured parts, such as the ACL (anterior cruciate ligament) ormeniscus in the knee, the labrum or rotator cuff in the shoulder, and pain due to a FAI (femoroacetabular impingement) or a labral tear in the hip.
Is arthroscopic surgery right for me?
It is important that you thoroughly discuss any discomfort, pain or injuries with your physician. Together, you and your trained orthopaedic surgeon will be able to determine the best course of treatment. The most critical step to take before beginning any treatment is ensuring that you have the proper diagnosis. Keep in mind that not all injuries require surgery and not all surgical procedures can be done arthroscopically.
However, if a qualified orthopaedic specialist determines that there is serious damage to your joint, or if you are experiencing pain that prevents you from engaging in your normal level of activity, arthroscopic surgery may be a good option for you.
What are the benefits of arthroscopic surgery?
Arthroscopic surgery offers several key benefits to patients who need a damaged or injured joint repaired. Years ago arthroscopy was used only to diagnose a joint injury and help plan for open surgery. Advances in technology now allow surgeons to view, evaluate and operate on injured joints simultaneously, so there are fewer procedures for a patient to endure.
Arthroscopy is generally an outpatient procedure. Depending on the location and extent of the injury, the surgery generally takes about 1 to 2 hours to complete. Patients can typically return home to begin their recovery the same day as their surgery. In addition to a faster procedure and shorter hospital stay, people usually recover from arthroscopic surgery much faster than open joint surgery.
What are the risks of arthroscopic surgery?
There are risks associated with any surgery, including the risk of infection, complications from anesthesia and bleeding. Arthroscopy is less invasive than open surgery and, when performed correctly by a trained orthopaedic surgeon, it is often extremely successful.
When can I expect to return to my normal level of athletic activity?
Rehabilitation takes place over the course of several months. Your recovery and rehabilitation time can vary based on the surgeon, surgical technique, kind of graft used and type of activity you are trying to resume. Because of this variability, the timing of surgery is often very important for many athletes to be able to return to play in a timely manner.
What should I ask my physician?
Do you have specific training in minimally invasive surgery or arthroscopic surgery?
Minimally invasive surgical procedures are fundamentally different than open surgery in both technique and instrumentation. This technique is not something a surgeon can learn at a weekend course and immediately incorporate into their practice. Without appropriate training, the surgery can lead to poor outcomes with serious complications.
Dr. Miller completed an additional year of training at Rush University Medical Center to learn minimally invasive orthopaedic surgical techniques from the innovators of the procedures.
Dr. Vaughn completed a fellowship for subspecialty training in Sports Medicine at Stanford University, where he received extensive training in minimally invasive and arthroscopic surgical techniques. This included experience in arthroscopy of the hip, knee, shoulder, elbow, ankle and wrist.
How many minimally invasive surgeries have you performed?
The amount of experience a physician has with minimally invasive and arthroscopic surgeries can directly impact the success of the surgery, as well as the comfort and recovery time for the patient. Additionally, as the number of cases a surgeon performs grows, the more reliable patient outcome data will be.
Dr. Miller has performed more than 2,500 orthopaedic surgeries. More than 400 have been minimally invasive hip and knee replacements.
Dr. Vaughn has performed more than 3000 orthopaedic surgeries, the majority of which are arthroscopic surgeries.
What kind of anesthesia do you use with patients?
For many years, general anesthesia was the most commonly administered form of anesthesia for orthopaedic surgeries. One drawback to general anesthesia is that it can take patients longer to recover from general anesthesia than it would to recover from a local or regional anesthesia, delaying the start of physical therapy and ultimately prolonging your overall recovery time.
At the Stanford Orthopaedic Surgery Clinic – Los Gatos, we use a spinal anesthetic when possible for our joint replacement surgery, combined with regional techniques that allow patients to participate with therapy right after surgery. For arthroscopic surgery, a very limited general anesthetic is often given. This limited general anesthetic allows for the surgery to take place effectively and with minimal risk of common side effects from prolonged deep general anesthesia.
What kind of implants will you be using to replace my damaged joint?
It is important that your surgeon chooses implants with a proven track record of clinical success. Your surgeon should have access to registries that demonstrate which implants have the best outcomes.
At our Clinic, we routinely use a knee prosthesis that has the lowest rate of revision in large total joint registries. The hip implants we select are based on individual variations in anatomy. These are fine tuned to adjust for gender differences and patient size to best recreate a patient's anatomy. The arthroscopic implants are highly variable and will depend upon the specific requirements of your injury. These can be discussed in detail with you during the planning of your surgery.
What will my recovery look like?
How long will I need to be in the hospital?
Arthroscopic surgeries are usually performed on an outpatient basis—you will be able to return home and begin your recovery on the same day as your surgery.
Patients undergoing minimally invasive joint replacement stay in the hospital 1-3 days before going home. The length of stay depends on your medical conditions and your level of physical fitness before surgery. Usually, even the most fit and healthy patients need to stay at least one night after joint replacement surgery for medical observation. Despite advancements in recent years, minimally invasive joint replacement is still a major orthopaedic surgery and can have significant complications that your medical team will be watching for during your hospital stay. The majority of these complications are observed within the first 72 hours after surgery.
How long before I can drive?
This is highly variable based on the type of surgery performed. It may be as quickly 1 day after surgery, but may be several weeks.Most patients can drive safely in as few as 2-6 weeks after minimally invasive joint replacement surgery. Each patient's recovery is different after joint replacement. To be able to safely drive, you must discontinue narcotic pain medication and have the strength and reaction time to safely operate a vehicle without endangering others.
How long will I need to be in physical therapy?
Rehabilitation takes place over the course of weeks or months. Your recovery and rehabilitation time will vary depending on the surgeon, surgical technique, kind of graft or implant used and type of activity you are trying to resume.
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