Published on November 12, 2012

Replace, Renew, Revive

Health Source Magazine November 2012

Laneta Crighton

Gavan Duffy, M.D.Why more men (and women) are opting for joint replacement

Each year, an increasing number of Americans undergo joint replacement procedures trading painful, injured joints for brand new ones

The most common reason for having joint replacement is arthritis,” says Gavan Duffy, M.D., an orthopedic surgeon at Heekin Orthopedic Specialists. “Arthritis of the hip and knee is extremely common. It’s one of the fastest growing disease problems.” He estimates there are currently about 500,000 knee replacements done in the US each year with a similar number of hip replacements also performed. Over the next 20 years, Dr. Duffy says the numbers are expected to climb to 5 million knee replacements and 1 million hip replacements per year.

The link between obesity and osteoarthritis has been well established, and the sharp increase predicted for knee replacement can be attributed in part to the expanding waistlines of Americans.
Dr. Duffy points to the aging population as another cause for the increasing number of joint replacements.

Is Joint Replacement Right For Me?

Joint replacement is the final resort for those whose joints have been damaged by arthritis, traumatic injury or disease. Joints that are painful, difficult to move and no longer respond to other treatment, may require replacement.“There has to be a relatively significant level of dysfunction to warrant joint replacement,” explains orthopedic surgeon, James Grimes, M.D., chief of the Department of Orthopaedics at Flagler Hospital in St. Augustine.

Before moving to surgery, those suffering with joint pain are typically advised to try over-the-counter medications such as ibuprofen. According to Dr. Grimes, the literature mostly suggests some patients may also benefit from glucosamine.If non-prescription medications are not helpful, cortisone injections or injections to stimulate hyaline cartilage growth are usually the next step.

Even in cases where surgery is needed, it doesn’t necessarily mean joint replacement is the answer. “Surgical procedures can be done to realign a malformed joint, or we might do arthroscopy to repair a torn meniscus,” says Dr. Grimes.

When joint replacement is indicated, the damaged joint is removed and replaced with an artificial one. The artificial joints of today are designed to function just like a normal joint. “There used to be very severe limitations with artificial joints. Studies now show high activity levels are actually good,” says Dr. Grimes.

Afterwards, many patients achieve a higher level of function than they experienced before joint replacement surgery and are free to enjoy activities like jogging and hiking.

Mileage Count

Information from the American Academy of Orthopaedic Surgeons indibCates joint replacements typically last a decade or longer, but the longevity of a replacement may depend on a number of factors.

While it’s common for patients to ask how long a joint replacement will last, Dr. Duffy suggests a more appropriate question may be how many miles will it last. “For the majority, a joint replacement will last forever,” he says. “But if you consider the miles per year, we typically do less and less each decade.At 70, you’re probably not as busy as someone who is 30.”

For this reason, younger, more active patients have a higher revision rate than older ones. But all patients require careful follow-up. “The most important thing patients can do is to come in for a regular annual check-up by the surgeon who performed the joint replacement,” says Dr. Duffy. If a problem is detected early on, it may be possible to do a minor repair, such as replacing the plastic lining of the artificial joint, rather than wait until a complicated revision is needed.

Now and Then

Although joint replacement procedures have been performed with great success for a number of years, there have been many advances. “Technology is always changing,” says Dr. Duffy. “It’s similar to new cars. Ten years ago, you could get a pretty good car, but you had to use a map because we didn’t have GPS.”

There have been improvements in the materials and design of the implants, and the surgery is now less invasive.Most joint replacement procedures today take less than an hour to perform, and have faster recovery times“Recently, we’ve really worked on pain management and getting the patient up and moving,” Dr. Duffy says.

Computers are also being used in joint replacement procedures, allowing the surgeon to navigate the optimal position of the replacement joint.Proper alignment reduces the risk of dislocation and helps extend the life of the replacement joint.

Surgical techniques have evolved as well, including the direct anterior approach Dr. Grimes now utilizes in approximately 80 percent of the hip replacement surgeries he performs. The new approach, which he says is used by only 5 percent of surgeons in the nation, allows him to split the muscles rather than detach them to gain access to the joint, leading to less pain postoperatively.

What You Should Know

Patients who prepare for joint replacement surgery by doing a variety of exercises fare better than those who don’t. “The better shape you are, going in, the faster and easier your recovery is going to be,” says Dr. Grimes.

Exercise is also an important part of recovery. “We have patients standing the first day after surgery across the board,” says Dr. Grimes. Patients stay an average of three days in the hospital where they walk with assistance. By discharge, they are using a walker, and two to three weeks after the surgery, they are carrying a cane. At five to six weeks the joint is stable, but the muscles still need to be strengthened, says Dr. Grimes.

“Success of the joint replacement surgery is determined not only by the patients themselves, but also by the skill of the surgeon,” says Dr. Duffy.The training and experience of the surgeon are important factors for patients to consider. “The complication rate goes down with the number of joint replacement procedures a surgeon performs.”

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