Increasing longevity and sheer numbers are contributing greatly to an increase in joint replacement surgery. As the Baby Boomer generation ages and seeks to maintain healthy, active lifestyles, demand for treatment of arthritic or worn-out joints is escalating.
Joint replacement surgery is the removal of all or a portion of a joint, which may have been damaged by arthritis, the ravages of time, or some type of trauma or disease, and replacing it with a new full or partial joint. Quality of life, recovery time and durability of new joints are often the most important factors that patients consider prior to undergoing joint replacement surgery.
“Joint replacement has become more successful, more reliable, safer than it used to be, and the materials being used are also more durable,” explained Dr. Martin H. Redish of Chattanooga Bone And Joint Surgeons. “Our aging population means that there are a lot more of us that need joint replacements than there used to be. People are living longer, and we are outliving our joints. They are wearing out while we are still alive. We used to say that a replaced joint would last 10 to 15 years, but the durability of the metals and plastics being used now have increased to the extent that we believe they will last 20 or 30 years.”
According to current research, some experts maintain that the number of joint replacements will reach incredible levels in little more than two decades. Approximately 435,000 patients undergo knee or hip replacement surgery annually in the U.S. These numbers are expected to increase dramatically over the next 25 years. Dr. Stephen M. Kurtz, at Philadelphia-based Exponent Failure Analysis Associates, reported at the 73rd annual meeting of the American Academy of Orthopaedic Surgery that total knee replacement procedures in the United States are expected to increase 673 percent to 3.5 million by 2030. Additionally, hip replacement surgery is expected to increase by 174 percent to 572,000 per year.
“One of the trends we are seeing is that age seems less and less a limitation to joint reconstruction,” noted Dr. Tim Ballard of Chattanooga’s Center For Sports Medicine & Orthopedics. “This is true for both young and old. We are seeing younger patients with severe arthritic changes due to old trauma, and we are seeing more older patients that are healthy enough to have their painful joints fixed in their 80s or 90s. Surgery usually takes about an hour, which is a lot faster than it used to be. The patient has the option of going to sleep or having an epidural in their back for anesthesia. Also, 10 years ago patients were in the hospital for a week or more. Now, most are in the hospital for two nights. So, the physical therapy protocol has improved as well.”
According to Dr. Ballard, who has practiced in Chattanooga for 11 years following residency with the University of Iowa and a fellowship in hip and knee reconstruction at Rush Presbyterian Hospital in Chicago, individuals considering joint replacement surgery are usually motivated by the level of pain they experience, while range of motion also may be a determining factor. Alternatives to joint replacement include arthroscopic techniques and injected medications.
“Sometimes people come in with arthritis so bad that they can’t get in and out of a car,” he related. “If the pain is to the extent that it interrupts daily living, not slight or occasional pain, but if it hurts to get out of a chair or to go up and down a flight of stairs, a person should have their joint looked at to treat the problem now and prevent more involved treatment later on.”
During joint replacement surgery, the patient is placed under sedation, and the damaged joint is entirely or partially replaced with an artificial joint, called a prosthesis. The new joint may be cemented, uncemented, or held in place with screws. Often, younger patients whose bone is more likely to grow around the new joint will receive an uncemented replacement. Elderly patients or those with weaker bones are more likely to receive the additional stabilizers. As with any surgery, complications may arise with joint replacement, and an evaluation of risk versus return is a prudent course of action.
While the knee is the most commonly replaced joint, the hip, shoulder, elbow, and even finger joints may be candidates for replacement surgery. Patients may decide to visit an orthopedic surgeon following consultation with their primary care physician or after talking with others who have experienced joint replacement. After a thorough evaluation, an informed decision may be made with confidence.
“It is good to look at the internet and to read about things,” reasoned Dr. Redish, “but people should realize that a lot of what they are seeing are advertisements for different companies and things. I think the best way to make a decision as to who to see is to talk to people who have had work done.”
Dr. Redish came to Chattanooga in 1980, completed his residency at Erlanger Hospital, and previously practiced with Dr. Paul Thompson, a well-known local orthopedic surgeon. He has advocated the partial knee resurfacing procedure and has performed nearly 800 of these during the last seven years.
“The partial knee resurfacing is one newsworthy item to talk about,” he commented. “A total knee replacement involves the entire knee surface. Ligaments are removed, muscle has to be cut, and there is a long recovery period for a total knee replacement. A partial knee resurfacing is done to just the portion that is worn out in the knee, and it can be done through a small incision with an overnight hospital stay and no physical therapy. People are usually back to doing what they used to do in two weeks as opposed to three to six months. They are often walking without a cane or walker within a week.”
“Partial knee replacement or full knee replacement really depends on the patient and their needs, says Mike Tew, President of University Orthopedics and Program Director for the University of Tennessee College of Medicine Orthopedic Residency. “We do a lot of unicompartmental knee replacements (replace part of the knee), patellofemoral arthoplasty (replace part between knee cap and femur) and full knee replacements.”
“What are really newsworthy are MIS and Computer Navigation. Whether for the knee or the hip, people are interested in MIS or minimal incision surgery. Computer Navigation for total knee and total hip replacement is what is at the forefront of new technology.”
MIS (or Minimal Incision Surgery) involves a much smaller incision, less cutting of the muscle and tendon, less pain and quicker recovery time. It is used most often for full and partial knee replacements and is evolving for hip replacements.
“Computer Navigation for total knee and hip replacement is cutting edge,” adds Dr. Tew. “LED sensors are used to completely identify the position of bones and improve the accuracy of surgery. Greater accuracy in surgery results in a more accurate alignment between the patient and the prosthesis, which subsequently improves the life of the artificial knee or hip.”
Since a continuing increase in the number of joint replacement procedures is a foregone conclusion, the role of rehabilitation will remain prominent in the future as well. Memorial Hospital’s Center for Rehabilitation provides comprehensive services for those who have undergone joint replacement surgery.
“As it relates to the joint program, we provide inpatient acute care, so we are the first therapists the patient sees coming out of surgery,” remarked Lisa Harrison, Director of Rehabilitation and Sleep Services at Memorial. “We have both physical and occupational therapists that take care of our joint patients. The physical therapist’s job is to get people up and walking again and to teach an exercise program -- if the joint is a knee, getting it to bend again, and if it is a hip, getting the patient walking. Occupational therapists work a lot in getting people back to the activities of daily living, like getting clothes on and off and going to the bathroom. It is standard procedure for a patient to see both types of therapists while they are here.”
On the inpatient side, Harrison notes that about 50 percent of the center’s caseload is related to joint replacement patients. The average length of stay is 2.9 days, including severe cases, which require stabilization prior to surgery due to trauma. The usual stay is two days.
“The other side of the rehabilitation program is outpatient,” Harrison continued. “These are folks that have gone home from the hospital and then come back in for therapy to get them going back to work and active again. Altogether, we probably see a couple of hundred outpatients who have had joint replacement during a year and probably close to 1,500 joint replacements on the inpatient side.”
Considering the advances in joint replacement surgery, which have been realized in recent years, the prospects for active, pain-free living are good for many who might otherwise continue to suffer. Undoubtedly, a growing number of people will choose to take advantage of these procedures to maintain or return to active lifestyles.