Center for Orthopaedic Excellence at Syosset Hospital

When someone suffers from arthritis related to degenerative, congenital, inflammatory, or traumatic causes, it may be hard for them to perform even simple tasks such as walking or climbing stairs. They may even feel pain when sitting or lying down. A painful joint can often prevent patients from enjoying daily activities such as walking, shopping, traveling and recreational sports, leading to a sedentary life. If medications, changing everyday activities and the use of walking aids are not helpful, joint replacement surgery may be an option.

Joint replacement implants are metal and plastic coverings for raw, arthritic bone ends. They replace cartilage that has worn away over the years. Total joint replacement surgery can help relieve pain and get patients back to enjoying normal everyday activities. Replacement implants are made from materials such as titanium or other metal alloys, ceramics, plastics or other newer substances. The goal is to eliminate bone-on-bone friction to create a new, smoothly functioning joint that will last for years.

In a total hip replacement, the surgeon removes the arthritic ball of the thighbone (femur) and the damaged, inflamed cartilage in the hip socket. The ball is replaced by a metal or ceramic ball attached to a stem, placed into the thighbone. A metal cup relines the socket, creating a new, smooth and durable joint.

In a total knee replacement, the arthritic rough surfaces at the end of the thighbone and shinbone are replaced with polished metal inlays. A space-age plastic cushion separates the inlays, acting as an artificial cartilage. The kneecap (patella) is preserved and, if worn, is resurfaced with a similar plastic cushion.

After all the clinical data is reviewed, your doctor will decide on the optimal surgical procedure for the joint replacement. Different patients require different surgical options, so your treatment plan is tailored to your specific needs and will be presented in great detail so you understand what is involved.

Surgical options include:

• Minimally invasive techniques—The center's surgeons are skilled in using smaller incisions to perform repairs to the knee and hip.
• Revision surgery—Prosthetic joints used in joint replacement surgery have a finite life span. When that time comes, revision surgery replaces previous worn out joint replacements. These revision surgeries are even more complex than the original surgery and demand the highest level of surgical skills that orthopedic surgeons, such as those at our center, can provide.
• Anterior approach to hip replacement surgery—The anterior approach means that the surgeon reaches the hip by going between two muscles, rather than by removing and then reattaching a muscle. This can allow for less postoperative pain and faster rehabilitation and recovery.
• Robotic total joint replacement—A minimally invasive procedure performed through a small incision using a robot-guided system.

The surgical experience

The hospital will call you the day prior to surgery to remind you of the time to arrive at the hospital for the procedure. On the day of surgery, after checking in to the hospital, your records and all consent forms will be reviewed by the nursing staff and you will be brought to the presurgical holding area.

The surgeon will personally mark the specific site of surgery and the anesthesiologist will again review the options for anesthesia. The majority of joint replacement surgery is performed under regional anesthesia, however, in some instances general anesthesia is preferred. The final decision is made by you and the anesthesiologist. For those patients undergoing regional or epidural anesthesia, additional sedation can be given during the surgery.

For routine joint replacements, the actual surgical procedure generally takes less than one hour. Immediately after the surgery, you will be taken to the Post Anesthesia Care Unit (PACU) where you will be monitored for several hours before being brought to the hospital room. Your family will be notified once surgery is complete and you have been transferred to the PACU.

Rehabilitation following joint replacement surgery starts in the hospital within just a few hours of the procedure. Physical therapists and rehabilitation specialists will prescribe exercises to help you get out of bed and regain strength as safely and rapidly as possible. Most patients spend one day on the orthopedic surgical floor and are able to walk with a cane or walker and use the stairs independently when leaving the hospital.

The Northwell Health Rehabilitation Network offers results-oriented, comprehensive rehabilitation. The team members serve as your partners in care, dedicated to a safe, healthy and rapid recovery. The options include:

• Acute inpatient rehabilitation—This is designed for people who need close daily physician monitoring, 24-hour registered nurses and intensive physical, occupational and/or speech therapy to maximize recovery. We provide comprehensive programs for therapy, and other treatments for neurological disorders, cardiac conditions and orthopedic and spinal cord injuries.
• At-home rehabilitation—Northwell Health At Home provides comprehensive, specialized joint replacement home care services with an emphasis on rehabilitation, wellness and recovery in the home setting. Physical therapy will begin within 24 hours of discharge, ensuring a seamless transition from the inpatient facility to the home. Therapy intensity and duration of services will vary depending on the patient's needs, abilities, and insurance coverage. A rehabilitation nurse coordinator will serve as a liaison between the patient's physician and all home care disciplines, enhancing communication and coordination of care.
• Outpatient rehabilitation—There are many outpatient facilities across Long Island, Queens, Manhattan, Staten Island and Westchester.
• Sub-acute inpatient rehabilitation—This is short-term inpatient rehabilitation for recovery from an accident, injury or illness. It also includes skilled nursing (nursing home) services.