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. • 18 TITANIUMTODAY
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