Return to Work, Play…Life: How Modern Joint Replacement can restore your life
By Hal S. Crane, M.D., Orthopedic Associates, East Denver LIVING WELL Magazine
On today’s medical stage, the role of hip and knee replacement take star billing. Never before in the 50-year history of hip and knee replacement have these operations been more widely sought out by patients.
One of the reasons that their use has continued to expand is that the surgical techniques have progressively evolved and improved. Each year they become easier to tolerate and quicker in their recovery. This has, in part, come from our surgical techniques, which are less traumatic to the muscles, ligaments and bone. These tissue-preserving techniques have been referred to as minimally invasive surgeries. Initially our focus was on the size of the surgical incisions, but as our experience has grown, we have learned that for surgeries to be less invasive, we must focus most on the reduction of trauma to the surrounding muscles, ligaments and bone. It is less dependent on the size of the incision, as was previously thought.
Accompanying these trends for less traumatic surgery has been the advent of sophisticated new regimens of medications to control the pain associated with these surgeries. These encourage mobility and walking soon after the operation. The pain management regimen improves with preemptive dosing. This means giving medication before the patient experiences pain. We now use various nonnarcotic (nonsedating) medications, which allow patients to be more alert. Anesthetic techniques better manage pain and nausea and continue to be more effective, allowing easier and less stressful recovery.
On the technology side, the quality and durability of our parts has improved. While older generations of these devices have proven effective with decades of use, these new materials, known as highly cross-linked polyethylene greatly improve wear and durability. With 10 years of monitored use, this new material is providing much improved wear when compared to the previous generation of materials. Unfortunately, however, we are seeing some technical difficulties with some of the all metal hips manufactured by several orthopedic companies. In spite of rigorous pre-market testing, these devices have developed problems after two to five years of use. Increased rates of failure have caused manufacturers to withdraw these products from the marketplace. If you have one in your body, it does not mean that it is destined to fail, only that more have failed than expected and closer monitoring of these may be required. With new products appearing frequently, it is appropriate for the patient to ask their doctor, “What is the track record with this device.”
The activities that these devices allow have further increased their desirability. It is possible for one to participate in most lower-impact activities, such as walking, hiking, biking, swimming, bowling, golf, fishing and skiing. At the insistence of many patients, some physicians are allowing their patients to participate in impact activities, such as running and jumping; however, it is still discouraged by many surgeons who feel that these activities may reduce the longevity of the device. In any case, the activities that patients may engage in are far more active and fulfilling than in the past.
Due to expanded connectivity, including cable TV, internet and social networking, patients come to meet their doctors with large amounts of information about the choices that they have before them. I am glad to say that patients today are better informed than ever before and this has helped their understanding of their condition and the options for treatment. Patients who are better prepared physically, intellectually and emotionally will have much improved outcomes in every aspect of their recovery. Despite the claims of the superiority of one device over the next, few medical studies have shown any clear distinction, except in the cases of unexpected premature failure of these products. The consistent finding in most medical studies is that the success of most surgical outcomes and techniques is directly related to the volume of the procedure in the hospital in which they are performed and the experience of the surgeon performing these procedures.
Never before in medical history have we seen higher levels of activity and patient satisfaction with these wonderful operations, which have continued to evolve and mature over the last 50 years of use. I expect that in the future we will see further improvement in these operations, which have so substantially improved patients’ quality of life.
Hal S. Crane, M.D. is director and founder of Rose Institute for Joint Replacements, along with being a Colorado Physician Education Program Examiner, Colorado Board of Medical Examiners Reviewer, and the American Board of Orthopedic Surgery (ABOS) Board Examiner. You may reach Orthopedic Associates at 303-321-6600 or via denverortho.com.
