100% Positive Material Identification

Understanding Implants in Knee and Hip Replacement (continued)
campaigns may seek to persuade
consumers that “newer is better”, Dr.
Windsor cautions that it’s important
to bear in mind that it will take time
to determine whether modifications to
previous implant systems actually fulfill
their promise and whether they offer any
advantage over existing systems.
One new technology that may
enhance the precision of knee implant
placement has also received some
coverage in the lay media. Many
orthopedic surgeons now use custom
cutting blocks - models based on the
patient’s specific anatomy - to refine
precision and accuracy during surgery.
The cutting block is created based on
information obtained with pre-operative
MRI. The goal of this technology is to
allow the surgeon to more precisely plan
where surgical cuts in the bone will be
made and to preserve as much of the
patient’s anatomy as possible. Further
long term follow up will be necessary
to determine if there is benefit in using
custom cutting blocks.
Hip and Knee Implants
With a history of excellent surgical
technique and outcomes, the focus of
new development in this area is on the
use of enabling technology to improve
preparation and component positioning
in hip and knee replacement surgery.
These tools include navigation devices
that provide three-dimensional spatial
orientation and robotics which can also
provide tactile feedback during surgery.
“The role of these emerging technologies
is still evolving,” Dr. Padgett notes.
Choosing a Surgeon
As with any orthopedic surgery,
people contemplating knee or hip
replacement are advised to seek out a
surgeon whom they trust, who does a
high volume of these procedures - and
an institution with a reputation for
excellence in the field. Surgeons who
focus on a given surgery or technique are
most likely to have predictably successful
outcomes. Single specialty centers
of excellence, such as HSS, also have
outstanding anesthesiologists, nurses and
rehabilitation therapists who collaborate
to achieve the best possible outcomes of
care.
At specialized institutions like HSS,
surgeons may also serve as consultants
in the development of implants. These
surgeons are particularly practiced in
the use of implants they have helped
to develop. (All orthopedists at the
Hospital for Special Surgery disclose such
professional affiliations, information
which can be found on the physician’s
individual profile on hss.edu.)
When to Schedule Surgery
Timing of surgery is another
important consideration in predicting
successful outcomes. “Generally I advise
patients that it’s reasonable to consider
surgery when the disability and pain in
the knee or hip is affecting your quality
of life and you’ve tried all other means
available to alleviate your symptoms,”
says Dr. Windsor.
Prospective patients should also take
into account the importance of having
surgery while they are otherwise in good
health. In the past, some middle-aged
patients have elected to wait for a joint
replacement, because of their concern
about the longevity of the new joint;
that is, that a second joint replacement
surgery might eventually be required.
However, not only does the data indicate
that knee and hip replacements are
lasting as long as twenty-five or even
thirty years, but delaying surgery may
result in the surrounding muscles
becoming de-conditioned owing to
reduced function. In turn, this may make
recovery from surgery more difficult.
Older individuals, including those
in their 80s and 90s may also want to
consider the benefits of scheduling
surgery sooner versus “living with”
disability. While the ability to tolerate
surgery and recovery, as well as the
existence of co-existing medical
conditions must be taken into account,
recent data shows that joint replacement
that helps to preserve function can
have an overall positive effect on the
health of older patients. Those who are
able to be more active have a reduced
risk - when compared to their more
sedentary counterparts - of various
medical conditions including pulmonary
embolism, deep vein thrombosis and
pneumonia.
“Knee and hip replacement surgery
improves the quality of life of thousands
of patients each year,” Dr. Windsor notes.
“However, both advertising claims and
misinformation on the Internet can lead
to confusion about which implant works
best or even an exaggerated sense of risk
associated with the surgery. In many
cases, a discussion with your surgeon
can clarify implant options and establish
realistic expectations about hip and knee
replacement surgery.”
“As with any surgery there is always
some risk involved. There have been a few
knee and hip implant systems that have
not worked well,” Dr. Windsor says, “and
isolated recalls of specific models have
occurred. But people should be aware of
the shared commitment on the part of
industry, hospitals, and surgeons to the
welfare of the patient and to addressing
any problems with implants that do
occur.”
One method to monitor performance
of hip and knee implants is through a
patient registry. The orthopedic surgeons
at HSS are dedicated to following the
long-term patient centered outcomes of
joint replacement surgery in our Total
Joint Prospective Clinical Outcomes
Research Registry. Using this registry,
long term implant performance may be
followed and hopefully surgeons can
identify as early as possible any poor
performing implants.
If you would like more information
about knee and hip replacement at HSS,
please visit the Physician Referral Service
or call 1.877.606.1555. •
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