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Joint Replacement

Indications

Joint replacement is an excellent solution for advanced joint disease with severe symptoms. Joint replacement offers an effective long term solution to chronic pain, joint stiffness, muscle weakness, and reduced overall function. However, most people should be consider joint replacement after failure of less invasive, conservative treatments. Common non-operative strategies include: behavior and nutrition modification, pain medication, activity modification, physical therapy, steroid injections, hyaluronic acid injections, and stem cell therapy.

Dr. Bader is fellowship trained in joint replacement with special focus on Anterior Hip Replacement and Ankle Replacement. 

Types of procedures:

Anterior Hip Replacement:

 

Anterior Hip replacement involves removal of the arthritic components of the hip joint. During surgery, part of the thigh bone (femoral  head) is excised and the cartilage surface of the pelvis (acetabulum) is shaved down. The removed components are than replaced with a metal acetabular shell, a plastic acetabular liner, a metal  or ceramic femoral head, and a metal femoral stem.  Some of the advantages of anterior hip replacement compared to other surgical hip replacement techniques are reduced risk of hip dislocation, precision placement of implanted components, and accurate leg length assessment.

Satisfaction:

In general, joint replacement surgery is very successful. Patients undergoing total hip replacement consistently report decreased pain, increased strength, and improved overall  function.

Recent data out of France reports overall patient satisfaction of 90% for hip replacement1.

Survivorship:

While joint replacements are incredibly durable they wear with time and unforeseen complications can occur that require a revision type surgery. Various rates of survivorship have been reported for joint replacement:

Hip Replacement- On average, at 15 years from surgery,  8 out of 10 individuals who underwent a hip replacement had not undergone a second surgery to address any complication2.

Knee Replacement:

 

Knee replacement involves removal of the arthritic components of the knee joint. During surgery, the distal aspect the thigh bone (femur), the proximal aspect of the leg bone (tibia), and the undersurface the knee cap(patella) are removed. The removed components are than replaced with metal end caps on both the femur and tibia that are separated by a plastic spacer. The undersurface of the patella is replaced with a plastic button.

Satisfaction:

In general, joint replacement surgery is very successful. Patients undergoing total hip replacement consistently report decreased pain, increased strength, and improved overall  function.

Recent data out of France reports overall patient satisfaction of 85% for knee replacement1.

Survivorship:

While joint replacements are incredibly durable they wear with time and unforeseen complications can occur that require a revision type surgery. Various rates of survivorship have been reported for joint replacement:

Knee Replacement- On average, at 12 years from surgery,  93 out of 100 individuals who underwent a knee replacement had not undergone a second surgery to address any complication3.

Ankle Replacement:

 

Ankle replacement involves removal of the arthritic components of the ankle joint. During surgery, the distal aspect the leg bone (tibia) and the proximal aspect of the ankle bone (talus)are removed. The removed components are than replaced with metal end caps on both the tibia and talus that are separated by a plastic spacer.

Satisfaction:

In general, joint replacement surgery is very successful. Patients undergoing total hip replacement consistently report decreased pain, increased strength, and improved overall  function.

Recent data out of France reports overall patient satisfaction of 76% for ankle replacement1.

Survivorship:

While joint replacements are incredibly durable they wear with time and unforeseen complications can occur that require a revision type surgery. Various rates of survivorship have been reported for joint replacement:

Ankle Replacement- On average, at 10 years from surgery,  8 out of 10 individuals who underwent an ankle replacement had not undergone a second surgery to address any complication4.

 

Reference:

  1. Dalat&Viehweger 16th European Federation of National Associations of Orthopaedics and Traumatology (EFORT) Congress
  2. Mäkelä KT1Eskelinen APulkkinen PPaavolainen PRemes V. Total hip arthroplasty for primary osteoarthritis in patients fifty-five years of age or older. An analysis of the Finnish arthroplasty registry. J Bone Joint Surg Am. 2008 Oct;90(10):2160-70. doi: 10.2106/JBJS.G.00870
  3. Vertullo CJ1Lewis PLGraves SKelly LLorimer MMyers P Twelve-Year Outcomes of an Oxinium Total Knee Replacement Compared with the Same Cobalt-Chromium Design: An Analysis of 17,577 Prostheses from the Australian Orthopaedic Association National Joint Replacement Registry. J Bone Joint Surg Am. 2017 Feb 15;99(4):275-283. doi: 10.2106/JBJS.16.00092.
  4. Bartel AF1Roukis TS2. Total Ankle Replacement Survival Rates Based on Kaplan-Meier Survival Analysis of National Joint Registry Data. Clin Podiatr Med Surg. 2015 Oct;32(4):483-94. doi: 10.1016/j.cpm.2015.06.012. Epub 2015

 Lucas J. Bader MD

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