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. To learn more about these surgeries, I spoke to Dr. Joshua Anderson from Bay Street Orthopedics.
Dr. Anderson is an orthopedic 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, as well as general orthopedic surgery. He sees patients in Petoskey, Gaylord, Charlevoix, and Cheboygan.
What does 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. So, in addition to more routine first time total hip and total knee replacements, I have further training in anterior hip replacements, partial knee replacements, joint replacements for posttraumatic conditions and other deformities, and revision hip and knee replacement surgery. This training additionally gave me further insight into the way hip and knee replacements fail and helped me better understand how to prevent, as well as treat these complications. I am able to longitudinally take care of hip and knee patients, whether it is their first joint replacement, they have had complications, or are unhappy with a prior joint replacement and need revision surgery.
What are some common questions you hear from patients about hip replacements?
- Patients commonly ask about surgical approach, activity restrictions, and postoperative expectations. Most commonly, patients are simply seeking a way to get rid of their hip pain. This can be quite debilitating and lead to a poor 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.
What are some common questions you hear from patients about knee replacements?
- Similar to 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 physical therapy is more intensive after a partial or total knee replacement, this is always discussed.
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 indicate that new polyethylene may last quite a long time. However, clinical follow-up is not that far out yet. As long as a patient gets out of the first couple of years after a hip replacement without complications, the chance that they are able to keep their implants and not require a revision surgery at 20-25 years is greater than 90%. Total knee replacements are somewhat less durable, regardless of whether or not it’s a cementless or cemented total knee. At 20 years, if there are no postoperative complications, survivorship is greater than 80-85%.
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, regardless of technique. Anterior total hip replacement surgery, while not necessarily a new technique, has emerged over the past 10 years or so. There is good evidence that it affords earlier recovery and 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. Clinical evidence has yet to definitively demonstrate superiority of this technology compared to more traditional methods. Additional alignment goals for total knee replacements continue to be researched and may afford a more natural feeling knee and happier patients. Rapid postoperative physical therapy and management of pain after surgery has improved quite a bit. Most patients are home with their family 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 your physical therapist to set up a pre-operative session to put you in the driver’s seat of your recovery!