You’ve been experiencing joint pain, perhaps for years, and you’ve had enough. You’re ready to find out more about the cause of your pain—as well as what you can do about it.  That’s where a total joint specialist like Dr. Grimsley comes in.

When you visit a joint specialist for the first time, your doctor will perform a physical examination. Dr. Grimsley will move the joint that hurts to determine its range of motion, or how much it can move.  He will check for swelling and tender points.  Dr. Grimsley also will ask you about your general health and any existing conditions you may have, including heart disease, kidney problems, breathing problems, arthritis, osteoporosis, anemia, diabetes, obesity, high blood pressure, and other ailments that might impact the treatment recommendations he makes.

X-rays will be taken to determine if there is a loss of joint space in the affected knee or hip. Blood and other special imaging tests such as an MRI may be needed to diagnose the cause of your pain when it is not apparent from the x-ray images.

During your first office visit, be prepared to describe any and all pain you’re currently experiencing, even if you’re not sure whether it is connected to the specific orthopaedic condition (for example, knee pain) that prompted you to make the appointment.  Make sure you are able to answer the following questions, as well as the degree to which the pain is interfering with daily functioning such as getting in and out of the car and lying down to sleep:

• Where does it hurt?
• When does it hurt?
• When did it first begin to hurt?
• How long has it hurt?
• Have you seen any swelling?
• What daily tasks are more difficult now?
• Have you ever hurt the joint in an accident or overused it on the job, during sports activities, or in a hobby?
• Have you had any previous injuries that may be playing a role in your current orthopaedic condition?
• Has anyone in your family had similar problems?

The treatment plan Dr. Grimsley develops will be directed to reducing inflammation, reducing pain and stiffness, and improving function. Dr. Grimsley believes that early diagnosis and conservative treatment tailored to an individual’s needs is crucial to slowing or preventing damage to joints. In cases where surgery is warranted, he’ll discuss your options and answer any questions you and your family have.

At the conclusion of the diagnosis phase of treatment, you’ll know whether you have arthritis and, if so, what type of arthritis you have and what you can do about it. The final decision about which treatment options to pursue rests with you.

Please prepare for your initial appointment by bringing:

• Health Insurance Card/Information
• Referral(s) and pre-authorization(s), if required by your health insurance
• Contact information of your primary care physician (if applicable) including name, address and phone number
• If needed, a friend or family member to take notes/help with questions
• A list of all medications you are taking (dosage and frequency)
• A list of your questions /concerns
• A copy of any diagnostic imaging studies (i.e. X-ray, CT, MRI); please bring the actual CD or films
• Copies of records from related treatment
• If you require documents to be sent to another physician, please complete our Medical Release Form

The effective treatment of arthritis starts without surgery. The process begins with listening to the patient and asking very specific questions.  The answers to those questions serve as clues that will help Dr. Grimsley determine what is causing your pain and how it is affecting your life. Often, relatively simple and low-risk interventions can make a big difference. These include:

• Easing the load on your joint. Avoiding excess stress on your joints can help protect them. When lifting and carrying items, for example, let your bigger muscles and joints support the weight. Weight control also helps ease pain by reducing the load on your joints.
• Ice or heat. Heat may help you loosen up your joints before an activity. Ice is a good pain reliever after activity or exercise.
• Exercise. Exercise helps because it makes your muscles stronger, which lowers the stress on your joints. But be sure to talk to your doctor about what kind of activity is best for you.
• Walking aids. There are many devices you can use to take some of the stress off of your joint. These include crutches, walkers, braces, and tape.
• Physical therapy or occupational therapy. Research shows that individuals who receive regular physical therapy treatment experience greater improvement in function and decreased pain intensity.
• Medicine. If your pain is mild, you may need nothing more than over-the-counter pain medication (analgesics) such as Tylenol. Anti-inflammatory medications such as Advil, Aleve, and aspirin also can provide relief. Stronger medications that are used to treat osteoarthritis include Tramadol and narcotics.
• Injections. Corticosteroid (cortisone) injections provide strong anti-inflammatory medication directly into the joint. Vicosupplementation—the injection of so-called joint gels made from hyaluronic acid—provides lubrication and nutritional support for the joint. Such injections can offer significant pain relief with only minimal discomfort.

If you’re still in pain after all conservative treatment options have been exhausted, your condition may warrant surgery, There are several common surgical procedures that Dr. Grimsley may recommend. These include:

Arthroscopy. This minimally invasive procedure utilizes specialized instruments and a tiny camera to fix tears in soft tissues, repair damaged cartilage, and remove loose bodies. Arthroscopic surgery is performed as outpatient surgery and typically entails a short recovery time. Although arthroscopy can offer reduced joint pain and improved range of motion, there are no long-term studies to support the notion that the procedure prevents further joint deterioration or cartilage loss. <<Link or embed Knee arthroscopy and hip arthroscopy videos from YPO

Partial Joint Replacement:  Also referred to as joint resurfacing, this surgery replaces only the diseased or damaged surfaces of the joint while preserving as much of the natural joint as possible. Patients having this procedure generally experience a quicker recovery and less pain after surgery, but may need further joint surgery in the future if arthritis develops in the parts of the joint that have not been replaced.

In knees, this procedure is also known as unicompartmental knee replacement, and is appropriate when advanced osteoarthritis is limited to a single joint compartment. In hips, the procedure is known as hip hemiarthroplasty; the head of the femur is removed or covered with a protective plate, while the pelvic portion of the hip (the acetabulum) is left in place. Partial joint replacement is more common and appropriate in the knee, but is seldom an optimal choice for the hip. <<Link or embed uni knee replacement and hip resurfacing videos from YPO

Total joint Replacement (TJR): During this procedure, the damaged joint is replaced with a prosthetic implant that mimics the motion of the natural joint.  All surfaces of the joint are replaced. TJR has a strong, proven track record for safety and success; patients having the procedure typically report significantly reduced pain, improved mobility and function, and dramatic gains in quality of life.  Minimally invasive total joint replacement uses shorter incisions than traditional TJR and spares more muscle, but the procedure can have a higher complication rate and the best candidates are active, normal-weight individuals younger than 50 years old. <<Link or embed total knee replacement and total hip replacement videos from YPO

Joint Revision: Implants can last 20 years or longer, but there are specific instances when a prosthetic must be replaced. Joint revision surgery is performed to remove a failed, infected, or worn-out implant and replace it with a new one.  Because of the alterations surgeons must make to bones during a joint replacement, revision surgery is more complicated and typically less successful than the initial joint replacement operation; such cases should ideally be performed by surgeons like Dr. Grimsley who have advanced specialty training in this procedure.

<<Link or embed revision knee replacement and revision hip replacement videos from YPO

The decision to have joint replacement surgery is a difficult one. Patients are right to be concerned about the procedure’s risks, and the potential pain and length of the recovery process.  But if you’ve reached the point where less-invasive treatment options are no longer effective, and you can no longer live your life as actively as you would like, total joint replacement surgery can offer significant reductions in pain and discomfort, and clear gains in both quality of life and overall health.

Dr. Grimsley will meet with you and your family or support network to ensure you understand every step of the surgical process, and are comfortable with your treatment plan.  You will receive extensive pre-operative preparation for surgery, including our “Prehab” class where patients learn about their particular orthopaedic surgery, the realities of recovery, and exactly what will be needed to make the transition back home.

Your surgery will be performed in a state-of-the-art operating room using the most advanced equipment, techniques and implants in the world. Advanced pain management techniques will be utilized. During your procedure, Dr. Grimsley will replace the damaged cartilage and bone with prosthetic components that mimic the shape and movement of your natural joint. Dr. Grimsley and the highly trained operating room and anesthesiology teams, and pre-operative and post-operative nurses and technicians will work together to ensure that you have the best possible outcome.

Following your surgery, you’ll be transferred to the Post-Operative Care Unit, where dedicated nurses, physical therapists and patient-care technicians will oversee your recovery and track your progress. Since the best medicine after joint surgery is to get you out of bed as quickly as possible, you’ll join your fellow patients on the orthopaedic floor for Joint Camp, a series of classes that get you moving and on the road to recovery.

Your stay in the hospital will be short, and your recovery will be continued after discharge. The care team will work with you and your family to plan for each stage of your recovery—from inpatient to home care through physical therapy and rehabilitation.

Our team’s shared goal is to ease your pain, restore your quality of life, and quickly and safely get you moving freely again.

A successful surgery is only one part of a patient’s hospital experience. Dr. Grimsley proudly partners with St. Vincent’s and Baptist Medical Centers to give his patients a superior hospital experience and personalized, end-to-end orthopaedic care. Both hospitals have received national recognition for the quality and demonstrated expertise of their total knee and total hip replacement surgical programs. More knee replacements are performed at St. Vincent’s Medical Center than any other hospital in the state of Florida.

Recovering from joint replacement surgery takes time. The post-operative phase focuses on helping you regain motion, strength, and overall function in your replacement joint and your body as a whole.

Planning ahead and understanding the process is key to minimizing stress and optimizing your outcome. Dr. Grimsley expects you to be an equal partner in your recovery—this means making a commitment to follow directions, taking special precautions to avoid falls and injuries, and communicating with Dr. Grimsley and his staff if you feel something isn’t right. Participating in physical therapy is especially important; how well you regain strength and motion in your new joint is, in part, dependent upon how well you follow your exercise regimen. This part of your rehabilitation is something that you must do for yourself; no one else can do it for you.

Activity: Exercise is a critical component of post-op recovery, particularly during the first few weeks after surgery. You should be able to resume most normal activities of daily living within three to six weeks following surgery. Some pain with activity and at night is common for several weeks after surgery. Your activity agenda should include both your assigned therapy exercises, and a graduated walking program to slowly increase your mobility, initially in your home and later outside.

Most individuals resume driving about four to six weeks after surgery. For knee patients specifically, driving usually begins when your knee bends sufficiently so you can enter and sit comfortably in your car and when your muscle control provides adequate reaction time for braking and acceleration. At your request, Dr. Grimsley’s staff will be happy to assist you in preparing the paperwork you’ll need to request a temporary Disabled Parking Permit from the Department of Motor Vehicles.

The first six weeks after major joint replacement surgery is the most crucial time for healing and recovery. It is generally recommended that strenuous physical activity be limited during this time. The Recovery Guide you receive during your Prehab classes will have extensive information about which activities are, or are not, appropriate during this period; it also provides guidance about caring for your incision, watching for signs of infection or blood clots, and managing swelling. If you have any questions about your post-op responsibilities, it’s important that you discuss them with the doctor.

Keep your eyes on the prize. The demands of joint replacement surgery can seem daunting, but if you make the effort to understand the risks involved, they can be minimized to make your joint replacement even more successful.  Keep in mind the tremendous benefits of successful joint replacement: the great reduction or elimination of pain, the significant reduction or elimination of the need for medications and their unwelcome side effects, the potential for improving your fitness, health and lifestyle, and the ability to take part in activities that, until now, have been impossible.

You’re ready to get back to living. Recovery from a total joint replacement varies from person to person depending on their level of pain and activity prior to surgery. The first six months after surgery is considered the active recovery phase, so it’s important that you pace yourself and not try to take on too much too soon. However, if your surgery and rehabilitation have been successful, by the end of three months you will be coping well with most normal activities.  You will begin to feel like your old self—but without the pain.

The key is to living well with your new joint is to stay active while avoiding things that place excessive stress on it.

Today’s advanced joint implants are designed to mimic your natural joint.  That means that, just like a natural joint, an artificial joint actually needs exercise to function optimally. Since good muscle strength and coordination are needed to provide the necessary stability and sensation of normal joint function (especially after a knee replacement), it’s important that you commit to a sensible activity regimen that blends weight-bearing exercises and cardiovascular training.

Weight-bearing exercises will help strengthen the muscles around your new joint, and maintain or even increase your bone density, which in turn will improve the fixation and stability of your new joint. Exercise will also improve your balance and coordination. Daily activities such as walking, bicycling, swimming, golf, moderate hiking, yoga and ballroom dancing will help maintain your joint’s flexibility and overall health—benefits that are icing on the cake, given that returning to such activities probably played a role in your decision to undergo joint surgery in the first place!

Ideally, your new joint will function well and last you for the rest of your life. Unfortunately, some joints do wear out and become loose.  How long your new joint lasts will depend on many factors, including your physical condition, your weight, and your activity levels. The best course is to stay active, keep your weight under control, and avoid contact sports or sports that create high joint loads in the replaced joint.

The pain relief achieved by total joint replacement is benefit enough for most people, but when combined with a balanced regimen of exercise and activities, this will do even more to improve your overall health.

You’ve gotten through the hard part. Now it’s time to celebrate your success and enjoy a future with less pain and more possibilities.