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“The number of patients who require joint replacement surgery is increasing,” says Richard Rosa, M.D., attending orthopedic surgeon at Saint Barnabas Medical Center. “Many patients fear the unknown regarding surgery and may be living with severe pain. As a surgeon, it is very satisfying to help these individuals return to their lives. Most patients are very happy with the results of their surgery.” Total Hip Replacement: New Advances Improve Recovery Famed golfer Jack Nicklaus has undergone hip replacement surgery, just like the estimated 375,000 Americans a year who receive this procedure, according to the American Academy of Orthopaedic Surgeons (AAOS). A painful hip can severely affect an individual’s ability to lead an active life. Osteoarthritis, the most common cause for hip replacement surgery, can occur with no previous history of injury to the hip joint. Initial treatment includes knee injections, weight loss, pain medications and walking aides. When pain can no longer be tolerated, hip replacement surgery may be recommended. Major advancements in hip replacement have greatly improved the outcome of the surgery. Surgical advances include improved materials for implantation. New alternative bearing surfaces for the hip last 15-20 years or more, as compared to the 10-year life span of a hip replacement in past years. Also, new minimally invasive surgical techniques have resulted in a quicker recovery with less postoperative pain for many patients. “Minimally invasive surgery for hip replacement requires a smaller incision and less damage to muscles and soft tissue,” reports Dr. Rosa. “This allows the patient to more rapidly return to function.” Hip replacement surgery involves replacing the “ball” of the thighbone with a metal ball. The ball attaches to a metal stem that is implanted in the thighbone. The damaged socket is replaced with a prosthetic in the pelvic bone. The prosthetic parts fit together and function like a normal hip joint. Artificial hip joints come in one of the three bearing surfaces -- metal balls and polyethylene sockets, metal balls and metal sockets, or ceramic on ceramic replacements. The choice of surface depends on a variety of factors, including the patient’s hip structure, weight and activity level. “Ceramic-on-ceramic joint replacements meet the greater demands of younger, more active patients,” says Dr. Rosa. “The metal on metal and ceramic on ceramic bearing surfaces could potentially last much longer than 20 years. With older patients who may have lower activity demands, there is less concern about the prosthetic wearing out.” Patients stay in the hospital for three days following surgery and require approximately six weeks of rehabilitation to return to normal function. Most return to work after three weeks. “Patients always ask, ‘Am I too old for hip surgery?’ and my response is, ‘Are you too old to live with the pain you are having?’ says Dr. Rosa. “When a patient’s quality of life has deteriorated, it is very satisfying for the surgeon to help him or her return to normal function without pain.” Total Knee Replacement: As the demographics of today’s total knee replacement patients change, the procedures used by orthopedic surgeons are transforming to ensure patient safety and improved outcomes, according to the AAOS. At their 72nd Annual Meeting, AAOS members discussed how the profile of today’s average knee replacement patients has shifted from sedentary individuals in their late 60s and early 70s, to active adults in their 50s. These younger patients come to surgeons’ offices with higher expectations than previous generations – particularly as it relates to the function of the new knee. Improvements in durable prosthetics and more minimallyinvasive surgical techniques have helped knee replacement patients to recover more quickly and to have a longer life expectancy for the knee replacement. “The new minimally invasive surgical techniques use a tissue-sparing approach that preserves the strength of the knee,” says Michael Rieber, M.D, attending orthopedic surgeon at Saint Barnabas Medical Center. “Less tissue is injured so the recovery is faster.”
New prosthetics have improved bearing surfaces, which results in knee replacements that last longer than ever before. Dr. Rieber says today’s knee replacements are expected to last 15 to 20 years, which could mean a one-time replacement for a 70 year old. The main reason for joint replacement is osteoarthritis, also known as degenerative joint disease, which wears away the cartilage. In the beginning of the condition, orthopedic surgeons recommend the use of rest, pain medications and injections to address the debilitating effects. When pain interferes with daily activities, surgery is the next option. For knee replacements, surgeons remove the damaged joint of the knee, and then insert a prosthesis between the shinbone and thighbone. Patients typically spend fewer than three days in the hospital and undergo physical therapy three times a week for three months. Dr. Rieber quotes a study in “Journal of Bone and Joint Surgery” (www.ejbjs.org/) that found that patients with joint replacements live longer than those without. He explains that after replacement surgery, patients are more likely to stop using pain medications and to resume exercise, which may extend their lives. “Ecstatic is the word my patients use after the surgery,” says Dr. Rieber. “They wish they had done it earlier. It makes my day every time they come back and say how good they feel. It really helps to improve their quality of life.” Both Dr. Rosa, who also specializes in knee replacements, and Dr. Rieber perform partial knee replacement surgery, a minimally invasive surgical procedure where only one of the knee compartments is replaced. Patients require little or no physical therapy after this procedure, as compared to the three months of intensive therapy following total knee replacement. Partial knee replacements last about 10 years before further replacement is required.
There are 50 attending orthopedic surgeons at Saint Barnabas Medical Center. For a referral to one in your area, please call [ top ] |
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New research from the American Academy of Orthopedic Surgeons (AAOS) forecasts an upsurge in the next 25 years in the demand for artificial joint replacements. The study projects a 673 percent spike in total-knee replacements and 174 percent increase in first-time totalhip replacements by 2030. The increase coincides with the oldest group of baby boomers who are about to turn 60.
When Robert DeGraaff had his first arthritic knee replaced three years ago, the recovery took four to six months. When his other knee was replaced by Dr. Rieber in June 2006, minimally invasive surgical techniques were used, which resulted in a greatly accelerated recovery for Mr. DeGraaff. While climbing stairs had taken three months after the first procedure, Mr. DeGraaff climbed them in three weeks the second time. “My physical therapist said that in 35 years of work she never saw anyone come back the way I did,” says Mr. DeGraaff. “I can’t rave enough about this procedure. If you saw me walking you would never know I had this done. I attribute the second recovery to Dr. Rieber and I thank him for giving me my life back again.”
Although Jeanne Quartell’s family had a long history of hip problems leading to hip replacements, she hoped to avoid the same fate by staying active and walking five miles a day. Unfortunately, Ms. Quartell, who is in her early 50s, felt a strong pain in her left hip during a walk in October 2004 and that pain never left. By the end of March the pain was so strong that the busy nurse could barely climb a flight of steps. After meeting with orthopedic surgeon Richard Rosa, M.D., she decided to have hip replacement surgery in June 2006.
