![\"Total](\"https:\/\/2025divi.cortho.org\/wp-content\/uploads\/2020\/09\/1.2.410.200049.2.1.100.20000510.3.1.20170620130454530.46880.jpg\")
Total knee replacement X-ray<\/p><\/div>\n
Why It Happens \u2013 Causes (Etiology and Pathophysiology)<\/h3>\n
The most common cause of hip pain and degeneration is osteoarthritis. In this condition, the cartilage in the hip joint breaks down, causing the bones to rub together and resulting in pain and stiffness. Other causes of hip joint degeneration include:<\/p>\n
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Rheumatoid arthritis<\/strong>: An autoimmune disease that causes inflammation and damage to the hip joint.<\/p>\n<\/li>\n
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Post-traumatic arthritis<\/strong>: Arthritis following a previous hip injury or fracture.<\/p>\n<\/li>\n
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Avascular necrosis<\/strong>: The loss of blood supply to the femoral head, leading to bone death.<\/p>\n<\/li>\n
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Hip fractures<\/strong>: Severe fractures of the femoral head or acetabulum may lead to joint dysfunction and arthritis.<\/p>\n<\/li>\n<\/ul>\n
How the Body Part Normally Works? (Relevant Anatomy)<\/h3>\n
The hip joint<\/strong> is a ball-and-socket joint formed by:<\/p>\n
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The femoral head<\/strong> (the ball) at the upper end of the femur<\/strong> (thigh bone).<\/p>\n<\/li>\n
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The acetabulum<\/strong> (the socket), part of the pelvic bone.
The surfaces of the ball and socket are lined with smooth articular cartilage<\/strong> that cushions the bones and allows for smooth movement. The joint is stabilized by ligaments and muscles surrounding the hip, providing both mobility and support.<\/p>\n<\/li>\n<\/ul>\nWhat You Might Feel \u2013 Symptoms (Clinical Presentation)<\/h3>\n
Patients with hip arthritis typically experience:<\/p>\n
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Severe pain<\/strong> during weight-bearing activities like walking, standing, or climbing stairs.<\/p>\n<\/li>\n
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Stiffness<\/strong> in the hip, leading to difficulty bending or lifting the leg.<\/p>\n<\/li>\n
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Pain at rest<\/strong>, especially at night or after prolonged sitting.<\/p>\n<\/li>\n
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Swelling<\/strong> and discomfort around the hip joint.<\/p>\n<\/li>\n
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Difficulty performing daily tasks like putting on shoes, sitting in a chair, or getting in and out of a car.<\/p>\n<\/li>\n<\/ul>\n
How Doctors Find the Problem? (Diagnosis and Imaging)<\/h3>\n
A comprehensive diagnosis includes:<\/p>\n
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Physical examination<\/strong>: The surgeon will assess the hip\u2019s range of motion, strength, and alignment.<\/p>\n<\/li>\n
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X-rays<\/strong>: These are crucial for visualizing the degree of joint degeneration and bone changes associated with arthritis.<\/p>\n<\/li>\n
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MRI or CT scans<\/strong>: These can provide detailed images of both bone and soft tissues, especially in cases of complex hip conditions.<\/p>\n<\/li>\n
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Bone scans<\/strong>: Sometimes used to assess the extent of damage to the bone.<\/p>\n<\/li>\n<\/ul>\n
Procedure Types or Techniques (Classification)<\/h3>\n
There are different approaches for total hip replacement surgery:<\/p>\n
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Cemented vs. Cementless<\/strong>: The femoral stem and acetabular components can either be press-fit into the bone or secured with bone cement.<\/p>\n<\/li>\n
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Minimally invasive techniques<\/strong>: Smaller incisions and specialized tools are used to minimize trauma to surrounding tissues.<\/p>\n<\/li>\n
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Anterior vs. Posterior Approaches<\/strong>: The surgery can be performed through various access points, depending on the surgeon\u2019s preference and patient anatomy.<\/p>\n<\/li>\n<\/ul>\n
Other Problems That Can Feel Similar (Differential Diagnosis)<\/h3>\n
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Trochanteric bursitis<\/strong>: Inflammation of the bursa on the outer side of the hip.<\/p>\n<\/li>\n
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Sciatica<\/strong>: Nerve pain radiating from the lower back to the hip and leg.<\/p>\n<\/li>\n
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Osteonecrosis<\/strong>: Bone death due to interrupted blood supply to the femoral head.<\/p>\n<\/li>\n
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Hip labral tear<\/strong>: Damage to the cartilage around the hip socket, causing pain and instability.<\/p>\n<\/li>\n<\/ul>\n
Treatment Options<\/h3>\n
Conservative treatments<\/strong>: Medications, physical therapy, weight management, and joint injections are often used before considering surgery.<\/p>\n
Surgical treatment<\/strong>: Total hip replacement surgery is recommended when conservative treatments fail.<\/p>\n
Recovery and What to Expect After Surgery<\/h3>\n
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Hospital Stay<\/strong>: Most patients stay in the hospital for 1-3 days, depending on their health and recovery progress.<\/p>\n<\/li>\n
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Physical Therapy<\/strong>: Therapy typically begins the day after surgery to help with mobility, strength, and reducing the risk of complications like blood clots.<\/p>\n<\/li>\n
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Pain Management<\/strong>: A multimodal approach (including non-opioid medications) helps manage pain during recovery.<\/p>\n<\/li>\n
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Full recovery<\/strong>: Most patients regain normal function and mobility within 3-6 months, although full recovery may take longer in older patients or those with other health conditions.<\/p>\n<\/li>\n<\/ul>\n
Possible Risks or Side Effects (Complications)<\/h3>\n
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Infection<\/strong>: Infection can occur in the wound or around the prosthesis, potentially requiring more surgery.<\/p>\n<\/li>\n
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Blood clots<\/strong>: DVT or pulmonary embolism can occur, which is why patients are encouraged to move as soon as possible.<\/p>\n<\/li>\n
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Dislocation<\/strong>: The prosthesis may dislocate, particularly in the first few months after surgery.<\/p>\n<\/li>\n
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Leg length discrepancy<\/strong>: Some patients experience minor length differences between legs after surgery.<\/p>\n<\/li>\n
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Implant loosening<\/strong>: Over time, the implant may loosen due to wear, necessitating a revision surgery.<\/p>\n<\/li>\n<\/ul>\n
Long-Term Outlook (Prognosis)<\/h3>\n
With proper care, most patients experience significant pain relief and an improved ability to perform daily activities. The implants typically last 15-20 years, although some patients, particularly younger, more active individuals, may require a revision surgery if the implant wears out or loosens.<\/p>\n
![\"Knee](\"https:\/\/2025divi.cortho.org\/wp-content\/uploads\/2020\/09\/IMG_1231.jpg\")
Prosthetic parts of total knee replacement<\/p><\/div>\n
Out-of-Pocket Costs<\/h3>\n
Medicare<\/strong><\/p>\n
CPT Code 27130 \u2013 Primary Total Hip Arthroplasty (Replacement of Both Acetabulum and Femoral Head): $303.45<\/p>\n
CPT Code 27132 \u2013 Conversion to Total Hip Arthroplasty (Conversion of Prior Hip Surgery to Total Hip): $394.09<\/p>\n
CPT Code 27134 \u2013 Revision THA (Both Components, Acetabular and Femoral): $448.00<\/p>\n
CPT Code 27137 \u2013 Revision THA (Acetabular Component Only): $345.69<\/p>\n
CPT Code 27138 \u2013 Revision THA (Femoral Component Only): $359.01<\/p>\n
CPT Code 27125 \u2013 Hemiarthroplasty (Partial Hip Replacement, Replacement of Femoral Head Only): $268.14<\/p>\n
Medicare Part B typically covers 80% of the approved cost for these procedures once your annual deductible has been met, leaving you responsible for the remaining 20%. Supplemental Insurance plans such as Medigap, AARP, or Blue Cross Blue Shield generally cover that remaining 20%, minimizing or eliminating out-of-pocket expenses for Medicare-approved surgeries. These plans coordinate with Medicare to fill the coverage gap and reduce patient costs.<\/p>\n
If you have Secondary Insurance, such as TRICARE, an Employer-Based Plan, or Veterans Health Administration coverage, it serves as a secondary payer. These plans generally cover any remaining balance, including coinsurance or small deductibles, which typically range from $100 to $300, depending on your plan and provider network.<\/p>\n
Workers\u2019 Compensation<\/strong><\/p>\n
If your hip replacement or revision surgery is required due to a work-related injury, Workers\u2019 Compensation will cover all associated medical expenses, including surgery, rehabilitation, and follow-up care. You will not have any out-of-pocket expenses, as the employer\u2019s insurance carrier directly covers all approved treatments.<\/p>\n
No-Fault Insurance<\/strong><\/p>\n
If your hip surgery is needed due to an automobile accident, No-Fault Insurance will typically cover the full cost of treatment, including surgery and postoperative care. The only potential out-of-pocket cost may be a small deductible or co-payment depending on your insurance policy.<\/p>\n
Example<\/p>\n
Thomas Johnson required a primary total hip arthroplasty (CPT 27130) due to arthritis, with an estimated Medicare out-of-pocket cost of $303.45. Later, he required a revision of both components (CPT 27134) with an estimated out-of-pocket cost of $448.00. Since Thomas had supplemental insurance through Blue Cross Blue Shield, both amounts were fully covered, leaving him with no out-of-pocket expenses for the procedures.<\/p>\n
Frequently Asked Questions (FAQ)<\/h3>\n
Q. How long will my new hip last?<\/strong>
A. Most implants last 15-20 years, with some patients experiencing even longer durability.<\/p>\nQ. Can I run after hip replacement?<\/strong>
A. High-impact activities such as running are discouraged after surgery. Low-impact activities like walking, swimming, and cycling are ideal.<\/p>\nA recent study examined the impact of osteoporosis on outcomes following total hip arthroplasty (THA), focusing on bone mineral density (BMD) and the associated risks of complications such as periprosthetic fractures (PPFs) and implant loosening. The research highlights that osteoporosis and osteopenia are prevalent among THA candidates, particularly the elderly, with a significant percentage of osteoporosis cases remaining undiagnosed preoperatively. The study found that osteoporotic patients are at an increased risk for poor surgical outcomes, including higher rates of PPFs and revision surgeries. Additionally, the study emphasizes the importance of preoperative screening and appropriate treatment to mitigate these risks, noting that the use of cemented femoral stems can reduce the incidence of PPFs in osteoporotic patients. The findings underline the need for comprehensive management strategies, including pharmacological interventions and optimal surgical techniques, to improve outcomes in this high-risk population. Study of osteoporosis in THA – See PubMed.<\/p>\n
\n![\"Total](\"https:\/\/2025divi.cortho.org\/wp-content\/uploads\/2020\/12\/1T5A0299.jpg\")
<\/p>\nTotal knee replacement components (front view)<\/p>\n
![\"Total](\"https:\/\/2025divi.cortho.org\/wp-content\/uploads\/2020\/12\/1T5A0300.jpg\")
Total knee replacement components (back view)<\/p><\/div>\n
The above images show the prosthetic knee replacement components from the front and the back. The femoral component (posterior stabilized) has a cam mechanism which allows posterior translation of the femur on the tibial post of the bearing surface. The femoral rollback aids in achieving deeper flexion which in a normal knee is done by the knee ligaments. The polyethylene insert is made of highly cross linked polyethylene, which is resistant to wear and tear.\u00a0 The keel of the tibial component is fixed in the upper part of the shin bone using bone cement.<\/p>\n
![\"Revision](\"https:\/\/2025divi.cortho.org\/wp-content\/uploads\/2020\/12\/1T5A0360.jpg\")
Revision knee modular components<\/p><\/div>
![\"\"](\"https:\/\/2025divi.cortho.org\/wp-content\/uploads\/2020\/12\/1T5A0363.jpg\")
Revision knee modular components<\/p><\/div><\/p>\n
The modular components shown in the images above are used in revision knee surgery or complex knee replacement. Depending upon the knee anatomy and bone loss, the surgeon is able to achieve greater stability of the prosthetic implant using modular components.<\/p>\n
![\"\"](\"https:\/\/2025divi.cortho.org\/wp-content\/uploads\/2020\/12\/1T5A0330.jpg\")
Tibial cone augment<\/p><\/div>\n
Metal cone resembling trabecular bone may be used to fill in bone gaps encountered in the metaphyseal region intraoperatively. The trabecular surface pattern of the tibial cone ensures biological union of the component.<\/p>\n
Summary and Takeaway<\/h3>\n
Total hip replacement is a highly effective procedure for individuals suffering from severe hip pain due to arthritis or other joint diseases. The surgery can dramatically improve quality of life by reducing pain, increasing mobility, and enabling patients to return to their normal activities.<\/p>\n
Clinical Insight & Recent Findings<\/h3>\n
Who Performs This Surgery? (Specialists and Team Involved)<\/h3>\n
Orthopedic surgeons specializing in joint replacements typically perform total hip replacement surgeries, supported by a team of anesthesiologists, nurses, and physical therapists.<\/p>\n
When to See a Specialist?<\/h3>\n
If hip pain is interfering with your daily life and conservative treatments have failed to provide relief, it may be time to consult an orthopedic surgeon for a thorough evaluation.<\/p>\n
When to Go to the Emergency Room?<\/h3>\n
Seek emergency care if you experience severe pain, swelling, or signs of infection, such as redness or fever, after surgery.<\/p>\n
What Recovery Really Looks Like?<\/h3>\n
Most patients can begin walking with assistance the day after surgery. Full recovery can take up to 6 months, with significant improvements in the first few months.<\/p>\n
What Happens If You Delay Surgery?<\/h3>\n
Delaying surgery may lead to further joint damage, increased pain, and complications that could make the procedure more difficult.<\/p>\n
How to Prevent Recurrence or Failure?<\/h3>\n
Maintain a healthy weight, avoid high-impact activities, and follow your surgeon\u2019s recommendations to ensure the longevity of the implant.<\/p>\n
Nutrition and Bone or Joint Health<\/h3>\n
Adequate intake of calcium and vitamin D is essential for bone health during the recovery period.<\/p>\n
Activity and Lifestyle Modifications<\/h3>\n
Engage in low-impact activities and avoid excessive weight-bearing or high-impact sports to preserve the health of your new hip.<\/p>\n<\/div>\n
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Do you have more questions?\u00a0<\/h2>\n
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[\/et_pb_sidebar][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"
Total Knee Replacement Total hip replacement (THR), also known as total hip arthroplasty, is one of the most successful surgeries in modern medicine. It is designed to relieve pain, improve mobility, and restore function for patients suffering from hip joint conditions, such as arthritis, fractures, or other degenerative diseases. Over the years, advancements in surgical […]<\/p>\n","protected":false},"author":37,"featured_media":10337,"parent":127,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_seopress_robots_primary_cat":"","_seopress_titles_title":"Total Knee Replacement, Knee Specialist in NY | Complete Orthopedics","_seopress_titles_desc":"Total Knee Replacement - Surgical procedure to resurface & replace damaged parts of the knee joint with metal & plastic parts. Highly proficient specialists at Complete Orthopedics.","_seopress_robots_index":"","_et_pb_use_builder":"on","_et_pb_old_content":"
Total knee replacement is a surgical procedure to replace the damaged parts of the knee joint with metal and plastic parts. It is one of the most common surgeries performed by orthopaedic surgeons. Common causes for knee pain include arthritis caused by primary osteoarthritis, rheumatoid arthritis, psoriatic arthritis, and secondary arthritis.\u00a0 The surgery is performed when all conservative forms of management are exhausted.<\/p>
Owing to the success of the surgery, a number of patients are today undergoing total knee replacement. By 2030, knee replacement surgery is projected to grow by 189 percent1. Knee pain due to arthritis can be quite debilitating for patients of all age groups. Knee arthroplasty offers excellent pain relief with increased mobility.<\/p>
Anatomy<\/h2>
The knee joint is a large synovial hinge joint. The joint is formed by the lower end of the thigh bone (femur) and the upper part of the shinbone (tibia). The kneecap (patella) forms a joint with the lower part of the thigh bone.<\/p>
Patella acts as a lever for straightening the leg. It also allows smooth gliding of the bones when straightening or bending the leg.<\/p>
Articulating cartilage is a glistening white smooth tissue covering the end of the bones forming the joint. The cartilage also covers the undersurface of the patella. The cartilage is toughened and flexible to allow smooth gliding of the joint surfaces.<\/p>
The ligaments surrounding the knee provide stability to the joint. The ligaments providing stability at the front and the back are anterior cruciate ligament<\/a> and the posterior cruciate ligament<\/a>. Medial and lateral collateral ligaments<\/a> provide stability on the sides of the knee joint. Tear or laxity of the ligaments lead to instability and damage the joint.<\/p>
Meniscus<\/a> are small pads, one on the inner side and one on the outer side of the knee joint. Both the meniscus cushion the impact on the ends of the bones. They also provide additional stability to the joint. Both the meniscus and the ligaments have limited blood supply.<\/p>
Synovium is a tissue lining the inner surface of the joint. The synovium secretes a watery thin, clear and sticky fluid known as synovial fluid. Just like machine oil, it acts as a lubricant allowing smooth gliding of the joint. Bursae are small fluid-filled sacs helping in smooth gliding of the structures around the knee joint.<\/p>
Proper alignment between the femur and tibia is necessary for the distribution of joint forces equally. Muscles crossing the knee joint allow for bending and straightening the knee.<\/p>
Causes<\/h2>
Arthritis due to variety of reasons remains the most common indication for total knee replacement. Various types of arthritis are primary osteoarthritis, secondary osteoarthritis, rheumatoid arthritis, or psoriatic arthritis.<\/p>
With growing age, the structures which form the knee joint, including the bones, articular cartilage, tendons, ligaments, meniscus, and muscles degenerate. The changes culminate into tears of the meniscus and cartilage, leading to loss of smooth gliding of the joint. The joint may become inflamed and swollen.<\/p>
Rheumatoid arthritis is a systemic disease often affecting multiple joints, especially the smaller joints. The knee joint may be affected as well and usually, both the knees may be involved. There is extensive destruction of the cartilage and subchondral bone with inflammation of the synovium. The destruction is carried out by the body's immune cells recognizing the normal cells as foreign.<\/p>
Other forms of arthritis such as psoriatic arthritis and gouty arthritis also lead to the destruction of the joint. Arthritis secondary to knee injury is known as secondary osteoarthritis. Injuries such as fractures or tears of the meniscus and ligament may cause incongruity of the joint surface. Young patients with a history of trauma to the injury may present with secondary arthritis.<\/p>
Congenital or residual deformities while growing such bow legs or knock knees cause malalignment of the joint. The unequal distribution of forces leads to the development of early arthritis.<\/p>
Symptoms & Management<\/h2>
Patients with advanced arthritis usually present with knee pain. The knee pain is especially aggravated on activities such as walking, squatting, bending, twisting or turning. They experience difficulty navigating stairs and report stiffness after periods of inactivity. Joint crepitus may be experienced which is described as a grinding\/popping sensation on moving the knee.<\/p>
A wide range of conservative management options is tried before knee replacement surgery. These include heat pads, physical therapist visits, weight loss, or glucosamine and chondroitin sulfate tablets. The patient may receive cortisone injections<\/a> or visco-supplement<\/a> injections in the knee.<\/p>
Unfortunately, arthritis is a progressively worsening condition. The conservative management options may thin out and the pain may become more persistent. The patients who have exhausted all conservative treatment options are candidates for knee replacement.<\/p>
Procedure<\/h2>
Before the procedure, the patients are examined thoroughly for any deformity in the knees. Their medical conditions are assessed for them to be medically fit to undergo the procedure. Routine blood tests and cardiograms are done as a part of presurgical testing. The surgery is usually performed either in general anesthesia or spinal anesthesia.<\/p>
Cross-matching of the patients\u2019 blood is done for blood transfusion if needed. Any kind of blood thinner is stopped a few days before the procedure. Imaging studies usually an X-ray and sometimes a CT scan may be done to assess the degree of bone loss. Preoperative planning is done to assess the correct biomechanical axis of the knees.<\/p>
The joint is opened from the front and the damaged bone along with cartilage is removed. Bone cuts are made with specially designed jigs to prepare the joint surface. Both the anterior and posterior cruciate ligaments are usually sacrificed in posterior stabilized implants. The medial and lateral collateral ligaments are retained and surgically released to balance the alignment.<\/p>
The metal parts are then introduced and are glued with acrylic bone cement. A special high-grade plastic (Polyethylene) is inserted between the metal parts acting as a stabilizer and cushion. The metal parts are made of a cobalt-chromium alloy and are designed to allow smooth gliding. The undersurface of the patella is resurfaced and a special plastic is cemented to the undersurface.<\/p>
The joint is thoroughly irrigated, cleaned and closed. Intraoperative medications may be injected to reduce post-op pain. The patient is shifted to the recovery room where their vitals are closely monitored.<\/p>
After the Procedure<\/h2>
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