Healthy Living magazine recently assembled three Eisenhower Medical Center experts to discuss the latest developments in joint replacements and what the future holds for this expanding field of medicine. The participants were Board Certified Orthopedic Surgeons Robert Murphy, MD, Adrian Graff-Radford, MD, and John Velyvis, MD. Dr. Murphy moderated the discussion.
Now, we’re seeing after 30 years of use that the results are quite dramatic — the patients are doing well, and the joint replacements are lasting longer than expected. We believe the new replacements we’re using now will last even longer. So we are confident we can help people with arthritic joints at a younger age, and trust that their joint replacements will last and work well for them.
DR. GRAFF-RADFORD: Confidence in the technology has improved substantially. Most implants today are going to last 20 to 25 years or longer, assuming ideal conditions for placement and healing. Younger patients might have to have an additional replacement later in life, but patients in their mid-50s and older are probably not going to need a second replacement.
[PHOTO dir="assets/news/adriangraff-radfordmd.jpg" align="left" caption="Adrian Graff-radford, MD" width="250"]DR. VELYVIS: Each of the surfaces currently used in joint replacement surgery has its own advantages and disadvantages. Certain patients have specific requirements for things that they want to do based on age and their activities, and we can adjust our materials to each patient on a case-by-case basis. It’s based on the individual, and an experienced surgeon can make a recommendation on what would be best for each patient.
DR. GRAFF-RADFORD: When it comes to having a replacement redone, as younger patients may require later in life, we have a concept now called “modularity.” The bearing surfaces can be removed, rather than removing the entire component.
DR. VELYVIS: Computers can also help us check exactly what we’ve done during surgery, which allows us to be more accurate every time. They give us a lot more information, beyond just what we can see. Currently, robotic technology can assist the surgeon with precision, but we are a long way from robotics being widely utilized. I am currently performing both computer and robotic assisted joint replacements.
DR. MURPHY: I believe the greatest advancements in joint replacement surgery over the past five years have not been in technology, but in the management of the patient’s post-operative pain. These advances have dramatically reduced the fear of surgery and the stress on the patient’s body. What are some of the pain management techniques that we’re using at Eisenhower?
DR. VELYVIS: There is no question that many patients are still fearful of having surgery. One of the advances is the use of spinal anesthesia instead of a general anesthesia, whereby the patient breathes on his own throughout surgery, rather than by a breathing machine, which reduces throat soreness for the patient. The benefit of this is that the pain reliefs lasts for 24 to 36 hours after the surgery, so the patient wakes up feeling comfortable.
Another important advance is “preemptive analgesia.” We try to block the pain receptors in the peripheral nerves and brain before we even make an incision, preventing the brain from receiving stimuli that will cause discomfort, helping decrease post-operative pain, and even reduce the pain medications the patients will need while they’re in the hospital recovering from surgery.
DR. MURPHY: We can manage most of our patients’ post-operative pain with oral medications, which allows them to get up and move quickly. We usually get patients up the same day as their surgery, and we can do that because of the pain management advances we’re talking about. How long is the typical hospital stay for joint replacement surgery?
We are seeing better pain medications that target the appropriate receptors, reducing side effects. Advances in physical therapy mean we’re getting better at helping people restore their joints and stay mobile. The BioniCare® knee brace, for example, helps the patient’s muscles using pulses of electrical stimulation and keeps the joint aligned properly, which may delay the requirement for surgery because the patient’s pain is minimized.
We are also starting to see great success with partial knee replacements. I think in the next five to ten years, we’ll have smaller metal caps that we can place on cartilage lesions. We’re probably going to see a bi-compartmental knee replacement as an alternative to a total knee replacement, which helps give the patient a more normal feeling knee, a smaller surgery, a quicker recovery and fewer restrictions on physical activity.