Total knee and hip replacements are among the most common orthopedic surgeries performed in the United States. Each year, over 7 million of these procedures are performed between these two joints, mostly in the 50 and older age population. As technologies and techniques have improved, and as our population ages, that number is expected to grow.

As a physical therapist, I get questions on a weekly basis from patients considering replacement of one or more of their aging joints. In order to learn more about these surgeries, I spoke to Dr. Joshua Anderson, MD from Bay Street Orthopedics.

Dr. Anderson is an orthopaedic surgeon with fellowship training in total joint replacement surgery. Dr. Anderson’s practice focuses on treating hip and knee osteoarthritis, painful or problematic hip and knee replacements, total joint replacements for post-traumatic arthritis and other complex hip and knee deformities and degenerative conditions. He sees patients in Petoskey, Gaylord, Charlevoix, and Cheboygan.

  1. What does being fellowship trained in total joint replacements mean as an orthopedic surgeon?

I spent an additional year of training performing only knee and hip replacements, as well as complicated revisions of pre-existing hip and knee replacements. I was fortunate enough to train under phenomenal mentors who are some of the best total joint surgeons in the country. My practice focuses solely on hip and knee replacement surgeries. So, in addition to more routine first time total hip and total knee replacements, I have further training in anterior hip replacement surgery, partial knee replacements, joint replacements for posttraumatic conditions and other deformities, and revision (re-do) hip and knee replacement surgery.

This training additionally gave me further insight into the way hip and knee replacements fail. This helps me better understand how to prevent as well as treat these complications. I am able to comprehensively and longitudinally take care of hip and knee patients, whether it is their first time undergoing joint replacement surgery, they have had complications, or are unhappy with a prior joint replacement and need revision surgery.

  1. What are some common questions you hear from patients about hip replacements?

Patients commonly ask about surgical approach, activity restrictions, and postoperative expectations. Ultimately, patients are seeking a way to get rid of their pain because it can be quite debilitating and compromise quality of life. Also, patients want to know if they can return to their prior recreational activities. Fortunately, hip replacement surgery has an excellent track record and is a very durable solution for patients.

Patients also want to know exactly what a hip replacement is. The hip is a ball-and-socket joint. With a full hip replacement, a patient gets a new socket in their acetabulum and new stem in the top of their femur. A liner goes into their new socket and a ball goes on their new stem, so this is the new ball-and-socket joint.

  1. What are some common questions you hear from patients about knee replacements?

Like hip replacement surgery, patients want to be rid of the daily pain and dysfunction they have from their knee and return to their desired activities. Since postoperative rehabilitation is more intensive after a partial or total knee replacement, this is always discussed.

Patients want to know what a total or partial knee replacement is. I explain to them that it is more of a resurfacing surgery. Small amounts of bone are removed from the end of the femur and the top of the tibia to reshape them to receive their new components, i.e. the ‘replacement’. The components and bearing surface are then placed and affixed to these surfaces. It’s much more in-depth and complicated than this, but when you boil it down to what I am doing, that is it.

  1. Generally speaking, how long do hip and knee replacements last?

The short answer is we do not know yet with contemporary implants. Lab testing of hip replacements indicates that new polyethylene liners may last quite a long time. However, clinical follow-up is not that far out yet.

Current data demonstrates contemporary hip implants having a 90-95% change of lasting 25 or more years. Contemporary total knee implants have greater than an 80-90% chance of lasting 20 or more years.

  1. Have any new techniques been developed recently that improve patient outcomes after lower extremity joint replacement?

Fortunately, it is normal for patients to have an excellent outcome after their hip or knee replacement. Anterior total hip replacement surgery, while not necessarily a new technique, has emerged over the past 10 years. There is good evidence that it affords earlier recovery and, in some patients, a lower dislocation rate compared to other approaches.

The involvement of advanced technology, navigation, and robotics is becoming more popular with total joint replacements. This technology allows for more precise surgical planning, preparation of the bone, and placement of implants. However, clinical evidence has yet to demonstrate superiority of this technology compared to more traditional methods.

There is a lot of information on the internet about technology in total joint replacements. I would caution patients on what they read regarding this, as a lot of marketing information exists which may not represent a comprehensive and complete view of that product. The American Association of Hip and Knee Surgeons provides a great resource to patients online to read about hip and knee replacement surgery. The information presented is based solely on peer-reviewed research within the field rather than marketing.

Additional alignment goals for total knee replacements continue to be researched and may afford a more natural feeling knee, easier recovery, and happier patients. Rapid postoperative rehabilitation and management of pain after surgery has improved quite a bit. Most patients are home with their family on the day of surgery! The future of total joint replacement surgery continues to evolve and is certainly exciting.

One of the largest determinants of a good outcome is whether patients participate in a pre-operative physical therapy program. If you’re considering a knee or hip replacement, Call the Total Knee Rehabilitation Institute to set up a pre-operative session to put you in the driver’s seat of your recovery!