Total Joint Replacement
By Dr. Stephen Lucie
Total Joint Replacement Surgery
Millions of Americans have arthritis of the hip and knee. Conservative treatment with rest, heat, ice and anti-inflammatory medications can be successful. The pain and loss of mobility begin to affect the patient’s lifestyle and even his ability to work. Sometimes small procedures such as arthroscopy or arthroscopic cartilage transplantation procedures can help. With advanced arthritis, joint replacement becomes the best option to eliminate severe pain and restore patients to their usual lifestyle.
To watch a video about total knee replacement, please click Video. Total joint replacement procedures include:
The total hip replacement may be one of the best operations in the past century. It can actually restore a patient’s function to a level that they forget that they even have a joint replacement. They usually require 3-5 days of hospitalization. Then 1-2 weeks of inpatient rehabilitation.
Total Joint Replacement Surgery- Total Hip Designs
Total hip replacement has undergone several design innovations beginning with introducing highly cross-linked polyethylene in the socket. One of the biggest problems with total hip replacement was the wear of the plastic socket. The wear particles from the plastic caused the loosening of the entire joint replacement. Newer plastics offer the promise of much less wear and longer life.
The newer designs are constructed with aluminum oxide ceramic, which promises a lower breakage incidence and wears. Early reports of these ceramic-on-ceramic devices show extremely low wear rates and minimal particle release from wear. The FDA approval did not come in this country until 2003. These implants look very promising for young people.
Total Joint Replacement Surgery- Total Knee Designs
Total knee replacement offers more normal flexion and improved wear rates. And can last to last 15 to 20 years. Some of the newer designs, such as the DePuy rotating platform, offer rotational motion and flexion and extension to reduce wear, and designs by Zimmer and some of the other companies have improved flexion to the degree that approaches that of the normal knee.
Many patients’ knees began to wear only on the inside half of the knee, with the outside portion and the knee cap portion remaining good.
For the patients who do not desire a complete total knee replacement and only have worn in the inside portion of the knee, this offers a desirable surgical option. This can be done in patients regardless of their weight. Patients can be up walking, full weight bearing on these spacer devices immediately, and back to their usual lifestyle in three months. Due to the Unispacer device’s interest and its subsequent direct-to-patient marketing, patients have flocked to physicians in search of easier alternatives to the full joint replacement surgery.
Minimal Incision Surgery
Minimal incision surgery offers patients a small incision and an earlier return to function and, in many cases, allows the rehab to progress quicker with less pain. In a total knee replacement, these small incisions are designed not to violate the quadriceps muscle, which is the muscle on the front part of the thigh that controls the knee’s extension. By not cutting into this muscle, the patient’s rehab goes much faster. They can weight bear with less pain with an early return to walking.
Minimum incision total hip replacement is still in its infancy, but early reports are encouraging. Minimal incision total hips may lead to less scarring, smaller incisions, less blood loss, and earlier rehabilitation than traditional total hip replacement. Both total hips and total knees demand precision in the implementation, and not all patients are candidates for this type of surgery. Those who are overweight or have severe deformities of either the hip or knee are not candidates for minimal incision type surgery.
Direct-to-consumer marketing of orthopaedic implants has begun. The public is getting used to multiple advertisements in their favorite magazines for blood pressure and arthritis drugs. We are now seeing famous, aging golfers pitching certain types of total hip replacements. For patients seeking joint replacement advice, discuss with their Orthopaedic surgeon and decide which is right for them. If any, the choice of which of these new technologies is best left in the hands of an experienced Orthopaedic surgeon knowledgeable in joint replacement.