Ask the Expert: Dr. Friedrich Boettner, Orthopedic Surgeon, Answers Your Questions About Total Knee & Hip Replacements & Resurfacing

by Dr. Friedrich Boettner
Dr. Friedrich Boettner, Orthopedic Surgeon

Q1. I am in my 50s and enjoy running marathons. Will the impact from this activity eventually hurt my knees to the point where I may need a knee replacement?

Not everyone who runs marathons will need knee replacement. However, if knee pain is something you experience after running I would recommend discussing it with your doctor. If you already have cartilage damage in your knee running may hasten the need for surgery. You also might be at greater risk for cartilage damage from running if you are obese or your knees are rather bowed (varus deformity). Both conditions will increase the load on your inside cartilage and this could over time result in arthritis.

Q2. How often can one get an injection of Synvisc to relieve knee pain before it doesn’t work anymore?

Everyone is different. If someone has had a few months of pain relief from the injection, but then the effects start to diminish, an option could be to repeat the injection. However, if the injection does not provide relief I would recommend to talk to you doctor about other ways to relieve your pain. Usually I do not recommend more than one Synvisc injection a year. You also need to know that Synvisc consists of chicken protein and repeat injections have been associated with local allergic reactions and painful swelling of the knee.

Q3. Does PRP help for knee pain from osteoarthritis?

I think the current literature does not support the routine use of PRP for arthritis. Most insurance companies do not cover the cost of the injection because of a lack of supporting research. In general there are always patients that benefit from treatments like this, however, the overall percentage is not high enough to generally recommend PRP injections for people with arthritis of the knee.

Q4. My hip hurts now even when I sleep. How do I know if I should consider a hip replacement? I hate to miss time off from work.

Once your doctor has told you that your x-ray shows a considerable amount of arthritis and you have attempted non-operative treatments like anti-inflammatories (etc.) pain waking you up at night is usually a sign that you should consider a hip replacement. In any case you should now take the time to discuss this with your orthopedic surgeon.

Q5. How long after a knee replacement can I drive again? Why do I have to wait if it’s not the knee I use for the pedals?

I recommend waiting an average of 3-4 weeks after a knee replacement to drive. Most patients use narcotic pain medication in the first four weeks after surgery. You can not drive while you are on these medications since they interfere with your ability to drive. Also, after the surgery there are specific exercises which need to be done to keep the knee flexible. Sitting in a driving position for a long time could potentially cause swelling and stiffness, no matter which knee is used for the pedals.

Q6. I will be having knee replacement operation shortly. With news every day of devices being recalled, should I ask my doctor for a record of which device my doctor uses?

With the recent news of recalls, it is reassuring for you to know what type of implant will be used. However, implants that have been recalled from the market are no longer available for implantation. Therefore your risk of receiving a recalled implant is very low. Every surgeon has a preferred type of implant and it makes little sense to ask your surgeon to use a specific implant because you like it or heard an advertisement about it. In general differences between implant designs are marginal and not all you hear in TV and print ads is really true. It is better to go for the surgery with the surgeon you like and trust than with a surgeon that uses a particular implant. The greatest concern we all have is that an implant we use today is going to be recalled in the future, therefore, it makes sense not to go with some very new or unproven technology.

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The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.

Comments

James R. Barnes says:

I am looking at possibly having a third tkr, however, I have had extensive damage to the bones and my Dr. says it doesn”t look good. Could you share some insight into my situation. I realize you have not seen any X-rays, but have you encountered this in the past? I am a male 66 years old, 6”,250 and was in good health until I just had my fourth tkr. Thank you, JIM

HSS on the Move says:

Hi James, We’re sorry you’re having knee trouble. Orthopedic surgeon Dr. Friedrich Boettner says, “It is not unusual to develop some bone loss once the cartilage is worn away. Usually this goes along with an increasing deformity in the knee. Most patients with this problem can still have a regular total knee replacement and only occasionally does the degree of bone loss require special considerations at the time of surgery. Please discuss this with your surgeon prior to surgery.” If you’d like to make an appointment with an HSS physician, please contact our Physician Referral Service at +1.877.606.1555 or https://www.hss.edu/secure/prs-appointment-request.asp?pageid=6463.

I had my hip replaced at Hss,my left side in Oct 2010 occasionally I get pains while sleeping on my left side sometimes really good pain , is that a concern? as my right hip , which was replaced in 2001 at another hospital, I never feel any pain from it. Thank You

HSS on the Move says:

Hi Bruce, We’re sorry to hear you’re having pain. Please email us at socialmediacontact@hss.edu.

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