Top Doctors: Hip and knee replacement

Dr. James Capozzi, chairman of the Department of Dr. James Capozzi, chairman of the Department of Orthopedic Surgery at Winthrop University Hospital. (August 16, 2011) Photo Credit: Barry Sloan

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Knees and hips take a lot of abuse, especially if someone is overweight or overactive. The time may come when aspirin and some downtime aren't enough to keep you going.

That's where hip and knee replacements come in. Damaged parts of the joint are replaced with plastic or metal substitutes. According to the American Academy of Orthopaedic Surgeons, about 581,000 knee replacements and 193,000 hip replacements are performed each year in the United States. Ankle, shoulder, elbow and finger joints can be replaced, too, but hips and knees are the most common.

Here's what you should know if you're thinking about a joint replacement -- or already have one:

1. THE BENEFITS CAN BE MAJOR

"People worry about how painful it will be afterward," said Dr. Richard J. D'Agostino, chief of orthopedic surgery at St. Francis Hospital in Roslyn. "But 90 percent of people who have a joint replacement say, 'This feels so great, I don't know why I waited so long to get this done.' "

The biggest benefit is pain relief, allowing people to return to an active lifestyle, said Dr. James Capozzi, chairman of orthopedics at Winthrop-University Hospital in Mineola. But side effects such as infections and joint dislocations can occur, and people are urged not to overextend themselves physically with high-impact sports. "Patients have to respect their joint replacement," he said.

2. KNEE AND HIP REPLACEMENTS SHOULD LAST LONGER THAN IN THE PAST

Materials used for the replacement joints -- metal, plastic and ceramic -- have gotten better and more durable so "we're hoping to get five to 20 years more than we got before -- maybe up to 30 or 40 years of wear," Capozzi said. The new generation of replacement joints hasn't been around long enough to know whether that's realistic, he said, but 20 to 30 years is a reasonable estimate.

3. SHOP AROUND

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Orthopedic surgeons use a variety of approaches in joint replacement procedures, D'Agostino said. "The thing about orthopedics is that there's more than one way to do these things," he said. "We do procedures differently because we're trained differently."

That means you have options. For instance, minimally invasive surgery is sometimes used instead of traditional surgery. The replacement joint can be cemented to the bone or designed so the natural and artificial parts fit together without cement. Ask how many surgeries are done at the hospital you're considering. A study in June in Arthritis & Rheumatism reported that serious complications occurred more often after hip and knee replacement surgery at hospitals that do relatively few surgeries.

"If the patient has any questions, they should always get a second or even a third opinion," D'Agostino said.

4. DON'T JUDGE YOUR RECOVERY BY OTHER PEOPLE'S

It may take you months to get back to normal after a joint replacement surgery, while your neighbor may be out speed-walking in a couple of weeks. "Don't panic as long as things are moving in the right direction," Capozzi said. "Recovery is highly variable."

Exercise helps the body adjust to the implants, he said, so "if patients are motivated and do the exercises with the therapist or at home, they'll do much better than those who don't do therapy."

In general, most people can return to work in four to six weeks and play sports by six weeks, he said, although recovery may take longer for those with other medical problems.

5. GET CHECKED IF YOU'RE WORRIED ABOUT SAFETY

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Medical problems such as tissue and bone damage have been reported in some people with metal-on-metal hip replacements. According to published studies, microscopic metal particles migrate into the body as the joint wears. In some instances, this has led to the all-metal joint being replaced with a metal-and-plastic model.

D'Agostino said that people with metal hips who have concerns can be tested to determine metal levels in their body. High levels and symptoms could lead to removal of an implant. But if you have high metal levels and no symptoms, it may be difficult to figure out what to do, he said. "The jury is still out on that."

 

Orthopedists

 

This is the ninth installment of a 26-week series in which Newsday presents Castle Connolly's list of top L.I. doctors. Today: orthopedists

Dr. Scott Alpert

379 Oakwood Rd.

Huntington Station

631-423-4090

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Dr. Stanley Asnis

600 Northern Blvd.

Great Neck

516-627-8717

Dr. James Capozzi

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1300 Franklin Ave.

Garden City

516-747-8900

Dr. Richard J. D'Agostino

600 Northern Blvd.

Great Neck

516-627-8717

Dr. David Dines

935 Northern Blvd.

Great Neck

516-482-1037

Dr. Thomas Dowling

763 Larkfield Rd.

Commack

631-462-2225

Dr. Samuel Kenan

300 Old Country Rd.

Mineola

516-280-3733

Dr. Craig Levitz

36 Lincoln Ave.

Rockville Centre

516-536-2800

Dr. Ronald Lewis

Pediatric Orthopedics of LI

205 E. Main St.

Huntington

631-923-2370

Dr. Thomas Mauri

865 Northern Blvd.

Great Neck

516-918-6300

Dr. Carlos Montero

2920 Hempstead Tpke.

Levittown

516-735-4048

Dr. Daniel Rich

585 Plandome Rd.

Manhasset

516-627-1525

Dr. Nicholas Sgaglione

600 Northern Blvd.

Great Neck

516-627-8717

Dr. Raymond Shebairo

1575 Hillside Ave.

New Hyde Park

516-437-5500

Dr. Barry Simonson

825 Northern Blvd.

Great Neck

516-773-7500

Dr. Jonathan Ticker

Island Orthopedics & Sports Medicine

660 Broadway

Massapequa

516-798-0111

Dr. Richard Tabershaw

375 E. Main St., Suite 1

Bay Shore

631-665-8790

 

How they were picked

 

Castle Connolly Medical Ltd. is a health care research and information company founded in 1991 by a former medical college board chairman and president to help guide consumers to America's top doctors and hospitals. Castle Connolly's established survey and research process, under the direction of a doctor, involves tens of thousands of doctors and the medical leadership of leading hospitals.

Castle Connolly's team of researchers follows a rigorous screening process to select doctors on national and regional levels. Using mail and telephone surveys, and electronic ballots, they ask physicians and the leadership of top hospitals to identify exceptional doctors. Careful screening of doctors' educational and professional experience is essential to the committee. Not every good physician makes the list. Rather, the list is a way for patients to get started on their search for the best medical professional. Newsday is not part of the selection process.

Doctors do not and cannot pay to be selected and profiled as Castle Connolly Top Doctors.

 

To see the whole list . . .

 

Who else is on the list of Top Doctors? More than 6,000 listings are in the New York Metro Area edition of "Top Doctors," published by Castle Connolly Medical Ltd. The softcover list price is $34.95. For more information, go to castleconnolly.com, or call 800-399-DOCS.

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