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Understanding the Risks of Joint Replacement Surgery

While total joint replacement surgery may be the right solution for some patients, the truth is that there hasn’t been a viable, non-surgical alternative available until now. Because we have accepted surgery as the standard solution for joint pain, most patients don’t even know what to expect from total joint replacement surgery – or what questions to ask before making the commitment.

In this article, we talk with AROmotion’s founder, Robert Dean, M.D., about the potential risks associated with total joint replacement surgery and why it’s so important to get a second opinion.

“Any type of surgery is going to be invasive and carry risk, so it’s always important to talk openly with your doctors, do your research, and seek a second opinion before making the commitment,” says Dr. Dean. “This isn’t meant to scare patients who need surgery away from it because this may be their only path to relief. Rather, this is meant to educate and empower patients who may be able to find relief from our non-surgical solution – so that they can ultimately decide what is best for them along with their doctors.”

According to Dr. Dean, these are the most common risks associated with total joint replacement surgery for patients to consider and discuss with their doctors:

Undergoing Anesthesia

While anesthesia is generally safe, there are common side effects associated with it including nausea, dry mouth, vomiting, muscle aches, and fatigue.

Surgical Implants

There are dozens of different types of orthopedic implants available today, and it is possible for patients to experience severe post-operative infections if the one that’s best suited for them is not used.

Hospital Stay & Lengthy Recovery

Total joint replacement surgery typically requires a 2-4 day hospital stay and a post-operative rehabilitation period of up to 6 months.

Wound Healing & Scarring

The typical incision size for total joint replacement surgery is 5-10 inches, which will require time to heal and will have permanent scarring

Limited Post-Surgery Activities

Most patients must limit their physical activities for a long period of time after surgery, sometimes for life. This includes but is not limited to impact exercises, running, contact sports, sitting cross-legged, and kneeling.

Chronic Post-Operative Pain

Up to 34% of patients experience severe post-surgical pain that can last for up to 5 years.

“In addition to knowing about these risks, it’s also important to know what questions to ask your doctor and orthopedic surgeon regarding the surgery,” says Dean. “I wrote about this extensively in a previous article which is also a helpful resource.”

So, where can patients start once they are told that they may need total joint replacement surgery? According to Dean, it’s always best to start with a second opinion. “Surgery is a huge commitment, and something that will likely have an impact on you for years to come, so it’s very wise to seek out a second opinion. “

The need for a viable alternative to total joint replacement surgery is what drove Dr. Dean to develop AROmotion, a groundbreaking non-surgical solution that stops joint pain fast with lasting results. This is a unique, three-tiered process that starts with an FDA-approved procedure called radiofrequency neurotomy to stop the pain, followed by promoting natural healing in the affected joint with a carefully-selected orthobiologics, and completed with a customized strengthening and reconditioning program.

Individuals who have been told that they may need total joint replacement surgery can contact AROmotion to schedule a free consultation with Dr. Dean, during which he will get each patient’s background to understand the root cause of the pain and to determine if they are a candidate for the AROmotion procedure.

“We are very careful in our screening process to determine who will benefit from our procedure versus total joint replacement surgery,” says Dean. “If a patient will not get the long-lasting pain relief that they want from our procedure, we will be completely transparent and give them any information they need to help determine the best path forward.”

If you are living with knee, hip, shoulder or other joint pain and have been told that total joint replacement surgery is your only option, AROmotion may be able to help. Contact us today to schedule your free consultation with Dr. Dean to see if you are a candidate for our non-surgical treatment that has helped more than 1,800 patients stop their joint pain fast.

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What Causes Joint Pain?

Rendering of Joint Pain in the Knee

Written by Robert Dean, M.D.

Joint pain is one of the most common health-related issues affecting people today, and it often prevents them from enjoying their lives to the fullest. In order to effectively treat joint pain, we must first understand the root cause of it. The causes can vary widely, from something as simple as overuse to inflammation to gout, or even to an infection inside of the joint. In this blog post, we will talk about some of the more common causes of joint pain that bring patients to our offices for our minimally-invasive procedure.

At AROmotion, our patients present with knee, hip, or shoulder “joint” pain. However, often these pain symptoms are not truly inside of the joint, but rather outside and around the joint. They may involve the overlying tendons, ligaments, or bursa that live next to and around the actual joint. So, the most important first step in evaluating a person’s pain is to determine whether it is truly the joint that is source of the pain!

A “true joint” is composed of the two bones and lubricating fluid inside of a joint capsule. It is important to know that the bones are covered with a hard ceramic/Teflon-like coating called Hyaline Cartilage (click the link here to dive deeper into the topic with Science Direct). Hyaline Cartilage is critical since bone is alive with sensory nerve endings and blood vessels. So, for any condition to cause joint pain, it must agitate or stimulate those pain-sensing nerves that are inside of the bone underneath of the hard Hyaline Cartilage. (By the way, this Hyaline cartilage that I’m describing, this hard Teflon like coating, is the same type of cartilage you will see on the end of a chicken bone! That hard rubbery cartilage on the tip of the bone is in fact the Hyaline cartilage.)

Joint pain typically involves inflammation or swelling inside of this joint capsule, which puts pressure on the Hyaline Cartilage coating the bone. When the pressure is severe enough, the pain-sensing nerves inside of the bone will be agitated and transmit pain signals to your brain. So, for example, if you do a lot of yard work like raking and digging, you overuse the hip and shoulder joints. This overuse will cause inflammation and swelling inside the joint capsule. This puts pressure on the Hyaline Cartilage and the nerve endings underneath. Pain signals will transmit to your brain stiffness and soreness and if severe enough actually pain.

Hyaline Cartilage
Image of Hyaline Cartilage

There are many conditions that lead to symptoms of joint pain. So, in the end, it is the pressure and agitation to these sensory nerves that tell you that the joint hurts!

Simple injuries, like accidentally dropping something on your hand or twisting/spraining your knee or ankle can also cause joint pain. This is because there’s a direct force to Hyaline Cartilage and to the bone underneath, agitating those pain-sensing nerve endings. The painful nerves trigger inflammatory cytokines that will cause the joint to swell. Cytokines in an acute setting or one-time setting, like a knee sprain, are actually a useful part of the healing process. In chronic arthritic syndromes, however, it is this pain that perpetuates the cycle of inflammatory cytokines via a neuropeptide called Substance P which is secreted by the agitated sensory nerve endings. Nerve pain – Substance P - Inflammatory Cytokines  swelling that leads to more nerve pain. The cycle of pain and inflammation smolders as a feedback loop in chronic joint pain conditions!

Summary:

From garden variety Osteoarthritis to more complex diseases like Rheumatoid Arthritis, infection, or even cancer, joint pain is always the end result of the agitated sensory nerve endings inside of the bone.

The most important point is that most joint pain is our body’s response to something irritating the sensory nerves inside of the bone. There’s always a cause and an effect. The only way you’re going to have true joint pain is by irritating and stimulating the pain-sensing nerves in the bone underneath of the protective Hyaline Cartilage. 

Any other pain that you may be experiencing from a “joint” is most likely outside of the joint and not truly joint pain. Rather, it is a result of painful tendons, ligaments, or bursa near or around the area. So first the diagnosis of joint pain needs to be correctly made and then the workup and diagnosis of the underlying cause of the pain will direct proper medical treatment.

This is where AROmotion comes in. If you are experiencing joint pain and have been told to either treat the pain with over-the-counter medications or that you may need joint replacement surgery, contact us today for a free consultation. One of our board-certified physicians will talk with you and determine if you are a candidate for our minimally-invasive procedure that stops joint pain and gets you in and out of our office the same day, with minimal recovery time. Simply fill out the form below to request your free consultation with us today.

By entering your information and clicking Submit, you are consenting to be contacted by our company representatives by phone, email, text/SMS, and through the use of automatic telephone dialing systems and prerecorded messages at the number(s) and email address(es) listed above even if your number provided on the form above is on a National or State Do Not Call List. Your consent does not require you to purchase any goods and/or services and you understand that you are not required to sign this authorization to receive services.

Robert Dean, M.D., is board-certified in internal medicine and leads the practice at AROmotion. Since 1997, Dr. Dean has helped patients in clinical practice and has given numerous talks at various medical conferences. He has traveled around the world with the Starkey Hearing Foundation helping to give the gift of hearing. He. was voted one of the Top Doctors in Florida by his peers and is known for his ability to simplify conditions and treatments from confusing medical jargon for his patients.

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Rehabilitation After Hip Replacement Surgery

Couple walking dog outdoors in the fal

Rehabilitation After Hip Replacement Surgery

Hip replacement surgery is a major surgery performed inside of a hospital. It requires significant recovery, rehabilitation, and wound healing. It also carries intrinsic risk of infection and complications from anesthesia.

The goal of a total hip replacement surgery is to replace the ball joint, where pain is occuring because of chondromalacia. Chondromalacia is an osteoarthritic condition where the hard cartilage offering a protective coating for the bones in the joint wears down, leaving thin areas or “potholes” in the coating. Because your bones are alive and have nerve endings that can feel pain, when you put pressure on these potholes, it hurts. The pain actually releases inflammatory proteins that perpetuates more inflammation and swelling, which cause more pressure and more pain, and on and on the cycle continues. A hip replacement solves this problem by cutting out the nerve endings by removing the joint completely, but at a cost. There are risks involved, that is why it is done in a hospital and pain-free motion is not guaranteed. What’s more, hip replacement surgery is disruptive to your lifestyle. Recovery is longer than most patients realize.

Here’s why – one of the most important parts of hip replacement surgery is rehab. You need to strengthen and stretch the muscles around the hip joint so that you regain proper motion and the right amount of strength. Then you can resume your natural gait (how you walk), because this will affect your back, your knees, your hip, and everything else. This rehabilitation process can take six months or more. Unfortunately, a significant number of people who undergo hip replacement end up with chronic pain for the rest of their lives even if the surgery goes well. Once you have a hip replacement, your range of motion is restricted from certain movements in order to protect the mechanical implant. You should be aware of this, especially if your surgeon doesn’t give you all of the details prior to you having the surgery.

Here at AROmotion, we offer minimally invasive alternatives to total hip replacement surgery, alternatives that allow you to keep your natural joint and that will get you up and moving without pain within a day or two. These require very little downtime as far as recovery. We have helped thousands of patients suffering from joint pain to avoid replacement surgery by combining the technologies of radiofrequency neurotomy , orthobiologics, and physical reconditioning to stop the pain, promote healing, and restore pain-free motion.

To schedule a consultation and find out if you are a candidate for any of our minimally invasive procedures or treatments, contact us today or visit aromotion.com

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What Should You Expect After Having A Total Knee Replacement Surgery?

Young woman running outside

What Should You Expect After Having A Total Knee Replacement Surgery?

Total knee replacement is a hospital-based surgery. Essentially, what the surgeons are doing is opening up your whole joint (requiring about a ten inch incision), flipping over your kneecap, and cutting out both ends of the bone. This is where the hyaline cartilage has been compromised from chondromalacia, which are little worn out or divot potholes. Think of cavities in a tooth enamel. The nerve endings exposed from the cavity hurt!

Knee replacement surgery is similar to a dental cap or crown procedure, where the surgeon is cuts and grinds down the ends of your bones to create a “post” and then fasten the titanium implant like a cap or crown. Then they flip the knee back over, staple the incision, and voila! Your surgery is done.

It’s not quite that simple – obviously that is a summary, as this takes a few hours and requires a certain level of expertise by the surgeon when it comes to choosing the right implant, etc. Of course, this is done in a hospital because this is a large surgery. There are risks associated with anesthesia, infection, and more. After the surgery, you have to undergo rehab therapy. There’s incisional healing; the wound has to heal. The tissue inside the joint that has been cut and replaced has to heal. The muscles and ligaments will need to heal, and time is depending on how fit or how weak you were prior to having this knee replacement.

The goal of the surgery is to replace the hinge of the joint, by removing the ends of the bone where the nerve endings have been compromised. Everything else that might be causing you pain (the weakness in your quadricep muscles or your hamstrings or the different muscles that help you move your knee around) isn’t just going to magically disappear. You have to work hard at rehabilitating and strengthening those muscles. And it takes hard work and a lot of time to make sure that the implant bends close to 90 degrees and straightens completely. Most of the orthopedic studies that look at function and pain improvement after replacement surgery will wait six months to determine what someone’s new baseline pain and function is going to be. Sadly, a significant percentage of people who have this surgery, even if everything goes perfectly, end up with chronic pain that requires interventional and non-interventional pain management for the life of that joint.

But a total knee replacement isn’t your only option. If there is pain and you are walking with no or minimal assistance then it is likely that your joint is still in good mechanical condition. Chondromalacia – the thinning of the hard cartilage protecting the bones in the knee joint. The unprotected sensory nerve endings are the reason for your knee pain. When this hard cartilage wears down, the nerve endings in your bone are exposed, and it hurts when you walk or put pressure on them. This pain fuels the arthritis inflammation by releasing inflammatory proteins, sort of how heat fuels a hurricane. Without this heat the hurricane dissipates. This is why there are not hurricanes in the winter months. Because your knee is an encapsulated joint (a closed space), the more inflamed the joint gets, the more pressure is put inside of the joint, further compressing the sensory nerve endings causing more pain, which leads to more inflammation. It’s a vicious cycle. However, cutting out the bones to remove these nerve endings entirely is an extreme solution. If you can find a way to turn off the pain, you can stop the osteoarthritis cycle and heal the joint.

That’s what AROmotion is – a FDA approved microprocedure that combines the technologies of radiofrequency neurotomy, orthobiologics, and physical reconditioning to stop the pain, promote healing, and restore your motion. Our minimally invasive procedures can help you avoid a large joint replacement surgery if you are a candidate. To learn more about our treatments and what we do here at AROmotion, and to discover whether you qualify for our procedures, contact us to schedule a consultation or visit aromotion.com

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Why Would You Need A Hip Replacement Surgery?

Young woman with lower back pain

Why Would You Need A Hip Replacement Surgery?

Total hip replacement surgery is a major operation, though it can be a very good operation if performed appropriately. What causes you to have enough pain in your hip that you would undergo this invasive, inpatient surgery, and are there any other options?

People enjoy running, walking, and participating in daily activities. At some point, your hip – which is a ball and socket joint with a hard, Teflon-like cartilage coating – wears down over time. If you experience injuries, like a fall or an accident or a sports injury, you can wear down that hard cartilage that’s protecting the ball and socket. This can lead to the formation of little potholes (divots or worn spots in the cartilage).

Why is that important? Because this hyaline cartilage is like Teflon, protecting the bone underneath. Bones are alive; they have nerve endings and blood vessels. When you don’t have protection over those nerve endings, and you put pressure on them, it hurts.

So when your orthopedic doctor views your X-rays and tells you that you have narrowing on one side of your hip joint, and that you are “bone on bone” or “almost bone on bone”, what they are really implying is that you’ve worn out some of that hard, Teflon-like cartilage. You have an area of thinning on that X-ray that’s suggestive of exposed nerve endings.

The only surgical solution to this problem known as chondromalaica is to cut out the joint and remove the nerve endings. That’s what hip replacement surgery accomplishes. It removes your entire natural joint and replaces it with a mechanical implant. It sounds like a big surgery for a very simple problem because it is! Surgery at any hospital has intrinsic risks associated with it. Note that a hip replacement doesn’t last forever. It’s not a bionic hip; you’re not going to be running at 50 miles per hour. It lasts about 10 – 15 years, per the package inserts from the people that make these implants. Are there any alternatives?

The answer is that it depends on what your hip joint looks like.

The hyaline cartilage, the Teflon coating, is the same material you see on the end of a chicken bone. When you eat chicken, that hard, white, rubbery cartilage that’s on the tip of a chicken bone? That’s hyaline cartilage. If you’re experiencing “bone on bone” hip pain, what you’ve done, over time, is worn out low areas or little potholes in your chicken bone cartilage. And then the nerve endings underneath don’t have protection, so when you put pressure on the joint through movement, it hurts. The medical term for this condition is chondromalacia. If it’s painful or bothersome to walk, you may change how you walk by limping, shifting a little to the left, etc. You may have a hard time getting out of the car. Your activity depends on the torquing and the pressure put on that low area.

Steroids and anti-inflammatory medicines are ways of reducing the swelling and inflammation inside of the joint. What most patients don’t realize is that the pain they’re feeling in their hip is a symptom of chondromalacia, yes, but it is more than a symptom.The pain is actually perpetuating the inflammation by releasing inflammatory proteins inside of the joint. The nerve endings are stimulating more inflammation because your body is trying to create a fluid cushion, so you don’t keep hitting that pothole.

Your hip is an encapsulated joint (a capsule surrounds it; it is an enclosed space). So as that fluid becomes more and more full, the space becomes tighter, the pressure becomes greater, and the pressure will press on the nerve endings, which stimulates more inflammation. It is a feedback loop that goes on for years. You’ll end up with chronic arthritic pain, stiffness, and change in your mobility, all because your muscles are adapting and shifting to try to protect you from hitting that pothole.

Think of it like you think of major hurricanes. The worse the conditions in the Gulf of Mexico – the warmer the air and the water are – the larger and more violent the storm typically is. There are no hurricanes in January, because the air and water are cold. The conditions aren’t right. When you remove the heat, the storm dissipates. Arthritic inflammation is like that. Nerve pain is like the “heat” and makes the inflammation worse, which in turn destroys more cartilage. The more pain, the worse the conditions for this perfect storm. When you ease the pain, you ease the inflammation, which decreases the visible swelling and associated stiffness.

When you undergo hip replacement surgery, you’re essentially removing the whole joint and replacing it with an implant. And voila! The nerve endings are gone. The pain is gone, and so is the inflammation…and so is the entire joint! That’s how joint replacement treats hip pain for chondromalacia.

But if the ball joint is still mostly intact and has a round shape – if it’s still functioning with just a bit of narrowing – that’s a really big surgery just for joint pain. Ironically, hip replacement surgery is positioned as a very simple solution to your problem. Remember, it is a big surgery that is hospital-based, takes a few hours, and requires six to twelve weeks of rehab afterwards. Obviously, though, there are risks of infection or other complications because of anesthesia.

If your joint is normal in appearance, though, you need to call us. AROmotion performs other, minimally invasive procedures that can help solve chondromalacia nerve pain and inflammation in your joint. Our alternatives to hip replacement allow you to keep your natural joint rather than having it cut out and replaced.

Interested? Call us for a free MRI review or visit aromotion.com to learn more.

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Why Do People Have Knee Replacement Surgery?

Man running with knee pain

The first and most important thing to understand is that when possible a physician’s goal should always be to preserve and heal your natural joint. Knee replacement surgery is not able to accomplish that, and therefore should always be considered as a last resort (for reasons that we’ll explain later in this blog post).

The main reason someone has knee replacement surgery in the U.S. is to solve knee pain. Typically, knee pain is caused by something called “chondromalacia”. Chondromalacia is a medical diagnosis term used to describe the erosion of the hard cartilage that coats the surface of the bones making up the joint. This cartilage, which is made out of the same material you see on the end of a chicken bone, serves to protect the nerve endings and blood vessels that live inside of the bone underneath this hard, “Teflon like” coating.

When you have chondromalacia, it indicates that you have basically worn out parts of this hard cartilage, and the nerve endings are less protected or even exposed. Using your joint puts pressure on these nerve endings and results in pain, which in turn causes swelling and inflammation inside of the joint. This creates tightness and more pressure, causing even more pain….and this cycle or feedback loop is what we commonly refer to as “osteoarthritis”. Your knee joint is an encapsulated joint, so it actually becomes more and more tense as swelling and inflammation increases, and that puts more pressure on the nerve endings as well. This is a cycle that keeps going on and on for months and years, and pain is the driver – it’s not just a symptom, it is actually the underlying cause perpetuating the destructive “arthritis” inside of your joint.

Treatments for knee pain have included anti-inflammatory medication like Advil, Motrin, Aleve, Cortisone steroid shots, and maybe even hyaluronic acid viscosupplementation, but these solutions are band aids designed to treat the symptoms rather than break the underlying cycle of pain and inflammation.

The orthopedic solution to this problem is to remove and replace the joint. Total knee replacement surgery is essentially cutting out both ends of the bone and replacing or “capping” them with a titanium and Teflon hinge. That sounds like a really big jump, and it’s something that happens a lot in medicine. However, it’s really the only surgical option to treat it. Think about it…if you have a painful cavity in your tooth, you will likely be offered a filling or maybe a root canal. Grinding the tooth down to a post and placing a cap or crown is only used as a last resort if the tooth is beyond repair. Well, that’s essentially what joint replacement is – grinding the ends off of the bones, thus removing the painful nerve endings and creating a post, then gluing an implant like a dental cap or crown to reconstruct the joint.

Here’s why that is the only available surgical option: as you wear out little potholes in the hard and protective hyaline cartilage (the areas of thin cartilage) and put pressure on those nerve endings beneath, it hurts! Surgically, we have two tools we can use to resolve joint pain; 1) arthroscopy and 2) total joint replacement. An arthroscope is a cutting/grinding instrument. If you have a symptomatic torn meniscus, and the meniscus tear is flapping around and getting stuck like a rock in your shoe, it hurts. An orthopedic surgeon will use arthroscopy to trim away the tear. The way surgeons repair a symptomatic meniscus tear is by cutting out the piece that’s flip-flopping and getting stuck. If you have potholes, or worn out areas of the hard hyaline cartilage coating the surfaces of the bone in the joint, an arthroscopy won’t work. It’s a cutting/grinding instrument that cannot address the potholes. So there’s nothing you can do arthroscopically to treat chondromalacia, or potholes in this hard Teflon cartilage.

However, when total joint replacement is performed, the whole joint is cut out, removing the ends where the hyaline cartilage is and where the nerve endings live. So if your knee hurts, the only solution to fix your “knee pain”, in an orthopedic surgeon’s office, is to remove those nerve endings surgically and then place a new implant or “cap” on top so your joint can function.

Total joint replacement is a drastic solution, a major surgery to treat knee pain, and that’s why good orthopedic surgeons always attempt all other less invasive options first. However, once you have that surgery, your knee anatomy will be permanently changed. You’re going to have a mechanical implant sitting on top of the post created by grinding down the ends of the bone for a knee joint. If all goes well and you follow the restrictions published by the implant manufacturer, it should last 10-15 years. Remember, per the implant manufacturer, there are many restrictions on activities and how you can function with that joint: twisting, torquing, tennis (you’re not supposed to play tennis if you have knee replacement surgery) – and more!

There are other nonsurgical options, though. If for the most part you are suffering from knee pain and stiffness, then it is likely that your joint is mechanically functioning and chondromalacia is the only thing causing your knee pain. When that is the case, a total joint replacement is unnecessary; the good news is that you don’t have to cut out your joint and replace it with an implant! AROmotion is an FDA approved microprocedure that breaks the cycle of osteoarthritis by “turning off” the nerve pain. This helps normalize the environment inside of the joint capsule so you can begin healing.

When you come in for a consultation, you will see one of our Board Certified Physical Medical Doctors who will discuss this FDA approved microprocedure designed to mitigate the pain and break the cycle of arthritis. They will also review the different types of orthobiologics that can be used to augment this natural healing process.

After the AROmotion microprocedure, one of our Board Certified Physical Medicine and Rehabilitation Doctors will prescribe and supervise your customized reconditioning program, so that the muscles and ligaments which move the joint return to proper form and function.

Contact us today for a free consultation or visit our website, aromotion.com , to learn more!