Joint Replacement - Airell Nygaard, MD

Ask A Doctor
Airell Nygaard, MD
Joint Replacement

Q: I have had to scale back my activity level because of pain in my knee joint. What are some options I might have?
A: We have joint pain for many reasons. The first step is to find out why. A health history, physical exam, and X-ray will determine the source of the joint pain. Treatment options can range from supplements, medications, exercises, and physical therapy; to injections, arthroscopy, or other minor surgery; to major joint replacement. Many patients assume they have to live with the pain, but lots of times there are simple things to do to improve their pain.

Q: What is a joint and what is joint replacement surgery?
A: The ends of two bones, connected together by ligament tissues, form a joint. For example, your hip is a ball and socket joint, formed by the upper end of the femur or thigh bone (the ball) and a part of the pelvis called the acetabulum (the socket). Your knee joint is formed by the tibia or shin bone and the femur. Joint replacement is used to treat painful, arthritic knees, hips, and shoulders; an arthritic joint is prepared by removing worn and damaged joint surfaces and replacing or resurfacing the joint surfaces with a metal and plastic artificial joint.

Q: Are there common injuries that lead to the need for joint replacement?
A: Ligament injuries of the knee and shoulder were not as effectively treated in the 1950s, 1960s, and 1970s, and patients are now returning with severe arthritis requiring joint replacement. Major advances have occurred with arthroscopic surgical techniques for treating ligaments and joint injuries, and are now much more effective. We therefore expect the frequency of arthritis to be much less.

In addition to advances in surgical procedures, rehabilitation techniques have also improved outcomes for knee and shoulder injuries. A normal joint needs constant range of motion to preserve health and function. In the past, many joint injuries or fractures were treated with prolonged immobilization using casts or braces. Over the last 15 years, rapid range of motion and rehabilitation have proven to reduce recovery problems with knee and shoulder injuries.

Q: How has the technology of implants for joint replacement changed?
A: The general design of joint implants has not significantly changed in the last 10 years. Surgical technique has changed – smaller incisions, “less invasive” approaches, and less surgical exposure have led to less post operative pain and easier rehabilitation. Improvements in anesthesia and pain protocols have resulted in easier initial recovery from surgery and shorter stays in the hospital. Rehabilitation techniques have also improved.

Newer designs of some artificial joints without longer term follow-up studies have shown problems, and have been associated with shorter lifespan of the joint, as well as recalls of joint replacements. Patients should ask their orthopedic surgeon about long-term results for the prosthetic device they are considering. Current artificial joints being used have been in use for 15 years or more, and artificial hip joints for example are anticipated to last 20 to 25 years based on lab simulation studies.

Q: How common are shoulder replacements?
A: Shoulder problems are very common in Tuolumne County. Having practiced in Denver prior to moving to Sonora 9 years ago, I have seen more shoulder problems, such as rotator cuff tears, bursitis, tendonitis and arthritis, here than I did in Colorado. Joint replacements for shoulders are now consistently very good to excellent even for people with unrepairable rotator cuff tears. Changes in surgical exposure, pain management, and rehabilitation have likewise improved the outcomes for total shoulder replacement.

Q: What level of activity can I anticipate following a total joint replacement?
A: Current procedures allow most patients to be active around the house within 7-10 days after surgery. There is variability with swelling and pain; some patients recover quickly while others require more time and care. Following recovery and rehabilitation, there are no restrictions with normal, day-to-day activities including walking, easy hikes, gardening, exercise classes, biking, swimming, golf, fishing, and “social games of tennis.” More vigorous activities such as hiking in steep terrain, skiing, softball, and basketball involve a higher degree of risk with potential for accelerating wear of the artificial joint components. Patients may still perform these higher-risk activities, but they may shorten the life of their joint replacement.

Q: At what age do most people consider joint replacement to treat joint pain?
A: The attitude in the past was to delay joint replacement surgery for people in their 40s and 50s; they were considered too young. Now there is a cautious willingness for joint replacements in younger patients, understanding that revision (replacement of the artificial joint) will likely be necessary in the future as the artificial components wear out. The youngest patient I’ve treated with joint replacement was 28 and I’ve treated more than a dozen in their 30’s. Patients may no longer have to suffer through their younger active family years waiting for joint replacement.

Bio:
Airell Nygaard, MD, grew up in the Midwest, studied medicine at Baylor College of Medicine in Houston Texas, and completed his residency in orthopedics at the University of Colorado Medical Center. Following his training, Dr. Nygaard started an orthopedic group in Denver, Colorado, where he practiced for 22 years before moving to Sonora. He also served as a team physician for the Denver Nuggets for seven years. Dr. Nygaard has a special interest in artificial joint replacement and has performed over 3,000 hip, knee, and shoulder joint replacements.

Dr. Nygaard moved to Sonora in 2002 and enjoys the rural lifestyle he’s found here. He and his wife raise alpacas and focus on improving the quality of their breeding stock and wonderful fiber they produce.