Exploring the Body from the Inside Out: Hip & Knee

In today’s world of orthopedics, people often find themselves wondering what happens behind the procedure.

We partnered with Experience Anatomy, a premier anatomy education provider specializing in training and education with real, preserved human specimens, to bring you another installment of our Orthopedic Anatomy Series: Exploring Your Body from the Inside Out – Hip & Knee edition.

Streaming live on Facebook and YouTube, our panel of five OrthoCarolina surgeons and the experts at Experience Anatomy explored the hip and knee injuries that affect you most and what to know about your body before, during and after treatment.

Watch the Full Live Stream

Featured Topics

• Hip & Knee Pain
• Hip & Knee Replacements
• Arthritis

Hosts

This virtual event was hosted by Dr. Kevin Stanley, MD,  a hip & knee surgeon with OrthoCarolina Mooresville; and Rachel Klaus, an academic program specialist with Experience Anatomy.

Dr. Michael Bates, MD, is a hip & knee surgeon at OrthoCarolina University.

Dr. Brian Curtin, MD, is a hip & knee surgeon at OrthoCarolina Hip & Knee Center and OrthoCarolina South Park.

Dr. Drew Henderson, MD, MSc, is a hip & knee surgeon at OrthoCarolina Winston-Salem.

Dr. Canaan Prater, D.O., is a hip & knee surgeon at OrthoCarolina Gastonia.

Case Study – Hip Replacement

In this mock case study, Dr. Michael Bates, MD, touches on what to do when you have hip pain and what your next steps might be moving forward when consulting an orthopedic surgeon. 

Bio Skills Lab Demonstration – Knee Replacement Surgery

In this surgery demonstration, Dr. Brian Curtin, MD, shows us what to expect during a knee replacement surgery and what happens in the operating room.

Graphic Content Warning: This segment features video footage of a cadaver surgery demonstration. Viewer discretion is advised for 23:05 – 27:34.

Open Q&A

Our panel of experts addressed audience questions during an open Q&A. Watch the complete Q&A discussion from 28:05 – 1:04:12.

Q: If you’ve tried exercise for osteoarthritis and it doesn’t work, what other options should you try?

Dr. Bates: There are lots of options for knee arthritis, like exercise and physical therapy. If you’re a candidate for non-steroidal anti-inflammatory drugs (NSAIDS), they can be quite effective for treating the pain associated with arthritis. Additionally, for a lot of my patients, we will try injections, whether that be cortisone injections or viscosupplementation, which is a thick gel that provides lubrication for the knee. If we failed those conservative measures, then typically we’ll talk to a patient about knee replacement. I would estimate that approximately 80 percent of my practice was able to treat the symptoms of arthritis of the knee with conservative measures and reserved surgery for the 20 percent of patients who have trouble with basic everyday activities.

Q: I’ve heard with total knee replacement surgery, the recovery is easier and faster than other types of knee surgery. Is that true?

Dr. Prater: It’s a difficult question because it depends on what the knee surgery is. If you’re talking an arthroscopic surgery or you just go in for a meniscal trimming I would say probably not. But for other, more traumatic injuries to the knee, the answer is yes. I think it probably falls somewhere in the middle if you look at the whole spectrum of surgeries that can be performed on the knee. I get my knee replacement surgery patients up and walking the same day as surgery. I usually tell people it’s the rule of two: you have two days of being a little sore and stiff, two weeks I’m going to have you up and walking around, and two months most people are back to their pre-surgical level of activity.

Dr. Henderson: I think in general terms, knee replacement is a significant surgery, and it takes some time to recuperate. It is also a tremendously successful operation, but realistically the first few weeks after a knee replacement take some effort, therapy and pain control. If you’re comparing hip replacement versus knee replacement, I think we would all agree hip replacement is a much smoother recovery for many patients, but both groups of patients generally do very well when it’s all said and done.

 Q: Is hip replacement outpatient surgery?

Dr. Curtin: Across the market, you’re starting to see a big push to move patients into outpatient surgery centers, which I think is a good thing. It’s potentially safer for the patient in terms of not having to come into the hospital, they can go home and sleep in their own bed. I probably do 20 to 30 percent of my joint operations for hips now at the outpatient surgery center. I think patients get in and out quicker, and I think it’s a safer environment for them overall. Patients are asking for it at this point. They don’t want to come into the hospital, and they want to get up and get moving. If they’re a healthy, safe patient to do this, I think it’s an excellent option for them. If I wanted my hip done tomorrow, I’d have it done in a surgery center.

Q: How late in life should someone have joint surgery, or is there an age limit beyond which you would not do surgery?

Dr. Bates: Age is an important factor, especially on the hip side. With improvements to the polyethylene component over the past decade or so, we really don’t worry about age nearly as much. Wear on the polyethylene has been reduced so drastically that it allows us to offer the surgery to people at younger ages. Essentially, if a person is suffering and they can’t sleep at night and they’re 55 years old, I think we have enough confidence in our implants now that we would offer them that surgery, whereas 15 to 20 years ago we may have hesitated. So age plays a role, but there’s no limit, and older patients are candidates as well.

Q: Is there anything that people recovering from a knee replacement should not do?

Dr. Henderson: Our goal for the patient for the first few weeks is to protect the wound and to get it to heal, so we would do any and everything necessary to keep the patient from falling if possible. Longer-term though, related to activity, the truth is I don’t actually tell patients there are certain things they cannot do. Anecdotally, I would say the biomechanics of a knee replacement are such that very few people really get back to running, long-distance running in particular, but if a patient is able to do things like skiing, golf, doubles tennis, I don’t consider any of those things out of bounds.

Q: Should physical therapy be used before surgery, and what is the role of physical therapy after surgery with respect to both hips and knees?

Dr. Prater: We use the term pre-hab, and I think it actually is one of the things that is very beneficial. The number one determinant for how much motion people get after surgery, particularly with knee surgery, is their motion before surgery. If anyone has a stiff knee on the front end, I’m a big proponent of trying to get them in therapy to get that knee moving before surgery. Hips can be the same way. They’re still even more studies coming out now showing how therapy is one of the more effective treatments for hip and knee arthritis, so yes, it can be very helpful.

Q: Could you describe what a bone spur is? Is it worthwhile to take out a bone spur on its own?

Dr. Curtin: Bone spurs, or osteophytes, are just extra bone and calcium that’s put down around the rim of the joint surface itself. It’s a way that your body responds to altered forces across that joint. It tries to distribute that force a little bit differently across the surface area. Unfortunately, bone spurs do decrease motion of the knee, and it does irritate the soft tissues. So when you move the knee, those bone spurs underneath the soft tissues cause inflammation and irritation of the soft tissues. Removing bone spurs alone unfortunately does not prevent bone spurs from coming back because it doesn’t actually do anything to adjust the mechanics or fix the cartilage in the knee itself. Now that procedure is not something that’s recommended. Just removing the bone spur is not going to fix the problem.

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