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Total Joint Replacement Program | Direct Anterior Hip Replacement | Answers to Common Postoperative Questions | Total Hip Patient Pathway | Total Knee Patient Pathway | Blue Center of Distinction | Physicians
Get answers to your total joint replacement questions.
Dr. Sterling’s Bio | Q&A Archive
University of Maryland Orthopaedics provides a comprehensive, multidisciplinary approach to care for the evaluation and treatment of knee and hip joints. Our experienced orthopaedic surgeons Dr. Robert Sterling and Dr. Theodore Manson -- along with our knowledgeable anesthesiologists, nurses, physical therapists, occupational therapists, and social workers -- guide patients from presurgery education through postsurgery rehabilitation and recovery.
Arthritis affects the areas in the body where two or more bones meet, such as the knee and hip joints. The normal joint is enclosed in a capsule and lined with synovium tissue. The synovium lining releases a slippery fluid that helps the joint move smoothly and easily. The ends of the bones are covered with cartilage, a firm, rubbery material that acts as a cushion between the bones and keeps them from rubbing together.
Osteoarthritis causes the cartilage between the joints to break down, leading to symptoms such as pain, swelling, and limited motion. If the affected joint movement is limited due to pain and is not exercised, the muscles surrounding the joint will become weaker and possibly shrink. As a result, the weak muscles may not be able to support the joint and can cause an increase in joint pain. A limp can develop, which is the body's way of reducing the forces of weight bearing between the bones of the hip and knee joint.
This degeneration will lead to a decrease in the range of motion in the joint. As symptoms persist and the condition worsens, the pain may be constant. This can also affect coordination and posture.
Severe arthritis is one of the most common conditions that cause joint pain. Other causes of joint pain include trauma, such as a serious fracture or an injury that doesn't heal properly.
Avascular necrosis is a degeneration of the hip joint. In this condition, the femoral head loses its blood supply and dies. This causes the collapse of the femoral head and degeneration of the joint.
Abnormalities and congenital deformities can also cause degeneration of the knee and hip joints. If treatment options to relieve pain and disability due to aging, disease, or injury have not been successful, state-of-the-art joint replacement procedures can improve function, eliminate pain and reverse the debilitating effects of these problems.
Since no two conditions are exactly alike, we make a careful diagnosis before we begin treatment. Our experience, as well as our expertise in the latest procedures and technology, enables us to provide superior care to patients of all ages.
How Total Joint Replacement Can Help
When the covering that allows a normal joint to move freely and painlessly is worn or damaged, the friction of bone rubbing on bone results in loss of motion and decreases a joint's weight-bearing capacity. Joint replacement means the bone surfaces within the joint are surgically removed and replaced with synthetic materials, usually a prosthesis made of durable, wear-resistant plastic and/or metal. Different procedures and components may be used, depending on factors such as the nature of the disease or injury, the patient's age, and condition of the bone. Most patients can look forward to resuming an active, fulfilling lifestyle following a successful procedure.
Communication With Patients and Referring Physicians
We are committed to providing ongoing communication to both patients and referring physicians. Before, during and after treatment, patients and their families can expect concern and compassion, education and training, as well as injury prevention information.
Joint education classes are held every Monday and Tuesday for the patients and their families before surgery. The patients and families watch an educational video about joint replacement. Nurses, physical therapists and occupational therapists provide information training and demonstration to help patients establish appropriate post-surgical expectations. They are also given handouts and brochures explaining:
For more information on joint education classes, contact Pam Wilson at 410-448-6478.
After surgery, a schedule of therapy and exercise will be established to teach patients how to get in and out of bed safely, walk with a walker or crutches, and improve muscle strength and joint motion. If necessary, occupational therapists can help patients relearn daily living skills, including bathing, dressing and meal preparation. Case Managers are available to arrange home care, home medical equipment, and other support services for the return home.
State-of-the-art Facilities
The orthopaedics team provides surgical, medical, physical and rehabilitative care to patients in state-of-the-art facilities at Kernan Hospital. Kernan is the designated orthopaedic hospital of the University of Maryland Medical System. Nationally recognized for excellence in orthopaedics for more than 100 years, Kernan provides sophisticated orthopaedic services on a beautiful, 85-acre campus that is conveniently located just two miles from the Baltimore Beltway. Home of the William Donald Schaefer Rehabilitation Center, Kernan is the only fully dedicated rehabilitation hospital in Maryland.
About Our Physicians
Our team of physicians includes board-certified orthopaedic surgeons with fellowship training in total joint replacement surgery. They are a well-known and respected physician's resource for consultation, second opinion, diagnosis, and ongoing treatment of patients with musculoskeletal problems. Referring physicians can expect prompt follow-up to patients' tests, and the timely return of patients to their care.
Advantages:
Hip replacement involves removing the ball and part of the socket of the native hip and replacing them with metal and plastic parts. This is one of the most successful operations ever devised, and many surgical approaches (ways to access the bones) have been used over the years. Some of these approaches involve removing some muscle from either the back or the front of the top of the femur to gain access to the bones.
During the past 10 years, the direct anterior hip replacement has gained popularity worldwide as an approach for the surgery. The main advantage of this approach is that no muscles are cut during the procedure because the surgeons work between the muscles in front (anterior) of the hip to access the hip joint. This theoretically results in less muscle damage, quicker recovery, and probably less risk of dislocation (hip popping out of joint). In addition, because of the way patients are positioned during surgery, it makes it easier for the surgeon to judge whether the length of the two legs are equal. These advantages have recently been scientifically validated by randomized clinical trials.
I like the direct anterior hip replacement approach primarily because the patients recover faster than with other surgical approaches. In addition, I believe that the direct anterior hip approach allows for more accurate installation of the socket component of the hip replacement. More accurate socket placement has the advantage of lower wear rates and less hip impingement (binding of the ball on the edge of the socket).
Disadvantages:
Not everyone is a candidate for direct anterior hip surgery. Patients who have had extensive previous hip operations, for example, or who have a very high ratio of body weight to height might be better suited to other hip approaches.
A specific side effect of the direct anterior approach is numbness of a skin nerve on the front of the thigh close to where the incision is made. In the majority of these operations done by expert surgeons, this is a common finding. The vast majority of patients who experience this are not bothered by the numbness, but it is important to understand that this can occur.
If you have any questions about the direct anterior approach or hip replacements in general, feel free to discuss them with me during your visit. My primary goal is to provide you with a stable hip that relieves your pain.
For More Information
To learn more, contact Dr. Ted Manson at 410-448-6400.
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