Center for Orthopedics

Recognized by the Arthritis Foundation for Excellence In Programming

Patient Education
Patient education is an essential component of the Center for Orthopedics. Prior to joint replacement surgery, the nursing staff provides the patient with an individualized consultation including personalized pre-operative teaching and a tour of the Center. The nursing staff continues to provide resources during and after the patient's stay in the hospital.

In addition, the Center for Orthopedics is hosting free bi-monthly seminars on hip and knee pain at the hospital. These seminars provide participants with information regarding the causes of arthritic knee and hip pain, soreness and morning stiffness. Non-surgical treatments, arthritis medications, nutrition, exercise, knee and hip replacement and resources available in the community are also discussed at the seminars.

Arthritis Self-Help Course (ASHC)

Self-help involves the willingness to learn about and to assume responsibility for the daily care of your arthritis. It includes all the decisions you must make and actions you take to keep arthritis under control and to stay as independent as possible. Consistent with this self-help philosophy, the Arthritis Self-Help Course is designed to give you the knowledge, confidence, and skills needed to take a more active part in your arthritis care.

Who can participate?
Any person having one of the more than 100 types of arthritis may attend the Arthritis Self Help Course (ASHC). A spouse, other family member or friend may accompany you as a registered member of the class. In fact, participation by significant others is encouraged, as these people not only play an important role in the support and care of the person with arthritis, but also feel a personal impact from being so closely associated with the disease.

Participants receive a copy of the Arthritis Helpbook and a set of handouts and pamphlets distributed by the Arthritis Foundation. Course participants are usually charges a $20 fee to cover program expenses. Scholarships may be available.

The PACE Recreational Exercise Program
PACE (People with Arthritis Can Exercise) is community- based, non-clinical program that involves group participation. While it includes activities designed to improve certain physical parameters such as endurance and joint mobility, the group exercise experience also encourages peer interaction and socialization.

PACE offers several advantages over generalized community exercise programs. It is designed specifically for persons with rheumatic disease taking into consideration the pain, fatigue, decreased strength and motion which often accompany the disease. The program includes accommodations for individual limitations and does not encourage activities which might aggravate, rather than relieve, arthritis symptoms. In order to assure safe performance of the exercises, instruction about basic principles of arthritis exercise, correct body mechanics, and joint protection is included.

This arthritis exercise program has been designed to accommodate for the many types pf rheumatic disease and their manifestations. It offers the instructor flexibility in choice of programs depending on the target audience.

The program consists of two levels - a basic range of motion level and an advanced level. To encourage variety and flexibility in meeting different target audience's needs, a total of 72 exercises, performed while sitting, standing, or on the floor are included n the Instructor's Manual. Also included are a variety of endurance building activities, games, relaxation techniques and health education topics.

Both levels of the program are usually conducted in eight-week series, usually two to three times per week. Sessions last about an hour. During each session, about 20-30 activities are led by trained personnel called instructors.

Arthritis

Arthritis is not just a single disease. It is a term used to describe over 100 different conditions that affect the joints in the body. The word arthritis actually means inflammation of a joint. Almost every animal that can walk is susceptible to this inflammation.

Although many types of arthritis have some common aspects, each type has its own pattern of symptoms and affects different people in different ways.

Two major forms of arthritis are rheumatoid arthritis and osteoarthritis. In cases of rheumatoid arthritis, the body's immune system appears to go awry and attacks healthy parts of the body, particularly the joints. In severe cases, the joints become deformed and internal organs are adversely affected.

What is osteoarthritis?
Osteoarthritis, the most common form of arthritis, is also called degenerative joint disease or “wear and tear” arthritis. Almost everyone is affected by it to some extent as they grow older. It most frequently occurs in weight-bearing joint, mainly knees, hips and ankles.

This form of arthritis slowly and gradually breaks down the cartilage that covers the ends of each bone in a joint.

Normally, cartilage acts as a shock absorber, providing a smooth surface between the bones. With osteoarthritis, the smooth surface becomes rough and pitted. In advanced stages, it may wear away completely. Without their normal gliding surfaces, the bones grind against one another, causing inflammation, pain and restricted movement. Bone spurs may form.

In osteoarthritis of the knee, the shape of the bone and appearance of the leg may change over the years. Many people become bow-legged or knock-kneed.

What are the symptoms?
The number one symptom is pain. The pain is caused by irritation and pressure on nerve endings as well as muscle tension and fatigue. The pain can progress from mild soreness and aching with movement to severe pain, even when resting.

The second symptom is loss of easy movement, such as bending or rising normally. Morning stiffness is a problem for many people. This lack of mobility, in turn, often causes the muscles serving the knee or hip to weaken and overall body coordination suffers.

How is it diagnosed?
A simple x-ray and examination by a skilled orthopedic doctor will determine if you have osteoarthritis. Time-consuming and costly diagnostic procedures are not required.

What is the treatment?
There is no cure for arthritis, but the past decade has seen dramatic new ways to manage the pain, lack of mobility and fatigue that are among its most disabling symptoms. During the early and middle stages, a treatment program of medicines, cortisone shots, ice treatments, exercise and physical therapy can be very effective in reducing symptoms and improving mobility.

Medicines
Coated aspirin helps relieve pain and has few side effects. Non-steroidal anti-inflammatory drugs (NSAIDS) such as Voltaren, Feldene, Naprosyn and Clinoril, are prescription drugs for pain and inflammation. It is recommended that all medication be taken under the advice of a physician. Over-the-counter medications recommend seeing a physician if taken over an extended period of time.

Cortisone Shots
Cortisone shots are given for inflammation. For many people, joint arthritis is often made symptom-free for months or even years after cortisone shots. Four to six shots a year can be given without any dangerous side effects.

Ice Treatments
Ice packs on the knee (three times daily, 10-20 minutes at a time) are helpful for inflammation and temporary relief of pain and soreness. Heat applications in either the knee or hip can make osteoarthritis worse.

Diet
There is no evidence that any specific foods will prevent or relieve arthritis symptoms. It's important to keep thin, because excess weight aggravates arthritis by putting added pressure on the joints.

Exercise and Rest
Prolonged rest and days of inactivity will increase stiffness and make it harder to move around. Motion is lotion for arthritis. At the same time, excessive or improper exercise can overwork your arthritic joint and cause further damage. A balanced routine of rest and exercise is best.

What about surgery?

Arthroscopy
Arthroscopic procedures are not generally helpful for arthritis. In some cases a flap of torn knee cartilage can aggravate arthritis and cause additional pain. The cartilage flap can be removed by arthroscopy.

Knee or hip replacement
Knee or hip replacement is a very positive solution to the pain and disability of advanced osteoarthritis. The rough, worn surfaces of the joint are relined with smooth-surfaced metal and plastic components.

How can I schedule an evaluation?
You can call Clark Memorial Hospital's Center for Orthopedics for more information about knee and hip replacement at (812)-285-5888.

What are knee and hip replacements?
Replacement provides a metal and plastic covering for raw, arthritic bone ends. It replaces cartilage that has worn away over the years. Replacement can eliminate pain and allow you to move easily and without pain. For many people who have knee arthritis, it also straightens the leg.

Who should have a knee or hip replacement?
When arthritis knee or hip pain severely limits your ability to walk, work or perform even simple activities, knee or hip replacement should be considered.

Is there an alternative to replacement?
Knee or hip replacement is recommended only after careful diagnosis of your joint problem. Arthroscopic or microscopic surgery is not helpful once arthritis is advanced.

It is not likely that anti-inflammatory drugs or cortisone injections will give you the same long-term relief as either knee or hip replacement.

Should my knee or hip be cemented?
Cement has been used for both knee and hip replacement for over 125 years with generally excellent results and predictable durability. A cemented prosthesis is considered reliable for long-lasting pain relief in the majority of patients.

How long is the hospital stay?
The average hospital stay for either knee or hip replacement is 3 to 5 days.

The average stay for two knees is 5 to 7 days. If both knees require replacement, it may be best to have both done at the same time. That way the total disability will be only slightly longer than the operation for one knee and the problem will be solved in the least amount of time.

In some cases, fixing just one knee or hip can save the other for two to three years, if the arthritis is not too advanced. Each individual case is different.

How long is recuperation?
Recovery varies with each person. You may use a walker for up to four weeks after the operation. You can drive a car in 4 to 6 weeks. Most people gradually increase their activities and can slow dance in 6 to 8 weeks and play golf, doubles tennis or bowl in 12 weeks. More active sports, such as singles tennis and jogging, are not recommended.

After discharge, there is usually no need for a nursing home or live-in companion. Some patients who live alone like the convenience of staying at a rehab center for a few days after they leave the hospital.

Keep in mind that healing and recovery times vary with each person.

Will I need blood?
The need for blood is often a possibility with many surgeries. We suggest you discuss the different options for blood transfusion with your doctor.

What is the success rate?
Both knee and hip replacement are recognized as miracles of modern surgery. Most orthopedic experts consider replacement to be the best method of handling advanced arthritis in the knee or hip. Joint replacements have literally put hundreds of thousands of disabled Americans back on their feet and allowed them to enjoy their golden years.

Are there complications?
As with any surgery, there is a risk of complications, but complications after knee or hip replacement are rare -- driving on an interstate highway is probably more dangerous.

To fight infection, we use extra precautions in the operating room and the most powerful antibiotics known to control the environment. Our personnel are limited to fully trained and experienced nurses and technicians.

What about pain?
Thanks to advances in medication technology, we are able to keep you very comfortable after surgery. Best of all, you won't have the groggy, not-in-control feeling associated with narcotics. Any temporary discomfort does not compare to the pain of arthritis endured by most people in the months before surgery.

You may wear casual clothing, not hospital gowns, while you are in the hospital. You'll also visit The Sunny Side Room just down the hall from your own room where you will join other knee or hip replacement patients for lunch, television, cards and games.

Can I talk to someone who has had hip or knee replacement?
Yes! We'll gladly give you the names and telephone numbers of some of our patients who have new knees or new hips. They have volunteered to talk on the phone with people who are considering surgery and are happy to share their experiences with you.

To speak to someone who has had a knee or hip replacement just call our office and ask for our “Voices of Experience” list.

For more information, visit the Arthritis Foundation web site.

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