Total Knee and Hip Joint Replacement are two of the most efficient and reliable therapies modern medicine has to offer. Studies have revealed high patient satisfaction and consistent improvement in pain and function over the first and second decades after surgery. Some 500,000 hip and knee replacements are done yearly in the United States, a number that is expected to double in the next twenty years. Despite this success, many delay having the surgery longer than necessary for fear of a prolonged and painful recovery. A combination of increased emphasis on patient outcomes and a more knowledgeable and demanding consumer has led to the development of Minimally Invasive surgeries and advances in knee and hip joint replacement in Savannah, GA.
Minimally Invasive Surgery
Minimally Invasive Surgery (MIS) is more of a mindset than a particular procedure. The concept is to optimize the patient’s surgery and recovery through preoperative education, pre-emptive analgesia, regional anesthetic techniques, reduced tissue trauma surgical techniques, and a coordinated rehabilitation program. The goal is to minimize short-term pain and disability while preserving the long-term success of traditional joint replacements.
An educated patient can participate in the recovery process more fully, unhindered by unwarranted apprehension. Pain is a complex process, which can be affected by many things. Giving pain medication before the surgical procedure reduces the level of pain and amount of medication needed afterwards. In regional anesthetic techniques, numbing medications are injected to temporarily interrupt the transmission of pain signals to the brain, thus reducing the level of pain endured in the first 24 hours after the procedure. Careful handling of the soft tissues and avoiding splitting or detaching major tendons and muscles can reduce swelling, inflammation, and weakness after surgery.
The Knee
Traditional Knee Replacement involves a 12-18 inch incision, splitting the Quadriceps tendon and patella eversion (flipping the kneecap over 270 degrees). Diseased cartilage and bone are then removed and replaced with metal and plastic. The longer incision and broader exposure of the knee facilitates accurate placement of the implants but also increases pain after surgery. The subvastus technique was promoted to improve tracking of the kneecap by going under the muscle rather than through the tendon. It seems to be less painful and provides a faster return of muscle function.
Patellar subluxation (sliding rather than flipping the kneecap) was originally described in revision surgery to avoid injuring the patellar tendon in a scarred knee. It avoids twisting and stretching the patellar tendon and appears to be less painful. The length of the incision can be tailored to the size and stiffness of the leg reducing it to 5-8 inches for most patients. A major concern about MIS has been that the accuracy would suffer. An improperly aligned or balanced knee may wear out prematurely or not bend properly. Improved surgical instruments and a computer guidance system can negate this concern. Studies have shown Computer Assisted Surgery (CAS) to be more accurate than standard mechanical techniques. By combining the MIS philosophy with the CAS technology, patients experience less pain and a faster recovery without compromising accuracy.
The Hip
Total Hip Replacement has involved more variations in opening the joint. One can approach the hip from the back (Posterior), side (Lateral), or front (Anterior). The lateral approach was initially used, but declined in popularity due to higher blood loss and more prolonged limp. The posterior approach became the most commonly used despite a higher risk of dislocation and the need for strict range of motion precautions. The anterior approach avoided the limp and dislocations, but seemed more difficult and failed to gain widespread appeal.
Smaller incision variations on each of the approaches have been developed with varying degrees of success. Research on the Mini-posterior and Mini-lateral techniques has suggested minimal gains in recovery and higher rates of instability and component malposition. The French have used a traction table for hip replacements with the anterior approach for many years. Until recently, these tables were not widely available in the U.S. While not required to perform the surgery from the front, the traction table makes the surgery easier on the surgeon and allows the use of X-ray imaging to increase the accuracy of component positioning.
Conclusion
There are many reasons to have hip and knee pain. Some benefit from surgery. Some respond to non-operative measures. Advances in technique and technology have decreased the pain and disability after surgery while maintaining or improving the functional outcomes. Patients no longer need to suffer unnecessary pain or give up important activities because of arthritis. A consultation with an orthopedic surgeon can answer questions and provide options for treatment. Additional resources include the official website of the American Academy of Orthopaedic Surgeons (www.AAOS.org) and industry sponsored links such as (www.allaboutjointreplacement. com).
