December 2007 Archives

Background Information
What is it about the craze for "minimally" invasive total joint replacement surgery? Some of the other terms you may have heard are "mini incision" or "two incision" total hip replacement or quad sparing total knee replacement.  The term "minimally" invasive (MIS) is misleading, as it would be more accurate to describe all of the current approaches as "less" invasive.  Surgeons are using smaller incisions and less invasive techniques, but even with these improvements, the techniques are not "minimally invasive".  For example, a true MIS procedure is arthroscopic surgery, and we are not there yet with total joint replacement surgery. 
It also is important to remember that the surgery itself is just one component of a successful total joint replacement surgery experience.    Renaissance Orthopedics and the Orthopedic Program at Magee Hospital feel that the patient and family centered care  (PFCC) approach is what makes our program special.  PFCC involves pre-op education and preparation for both the patient and family, special anesthesia and post-op pain management protocols, and rapid rehabilitation.  The goal is to return you to your active pain-free lifestyle as quickly as possible.

The PFCC approach encourages you and your "coach" to become part of a dedicated team whose goal is to ensure you achieve the best possible results.  By working together, we can have you walking the day of surgery, driving when you're on a cane, and back on the golf course!  So we found that we need a complete, efficient, and organized approach in addition to these new techniques to speed your recovery and get you back to your active lifestyle as soon as possible!

SO WHAT IS FACT FROM FICTION?

POTENTIAL BENEFITS:

• The smaller incision and less muscle work may allow for faster rehab and recovery

• Usually less bleeding

• Shorter hospital stays
  

• Quicker recovery
  

WHAT ARE THE POTENTIAL PROBLEMS?

• Smaller incisions also means that the bones are harder to visualize, which can result in placing the implants in a less than optimal position, and also increase the risk of fracture and nerve injury.

• Make sure you see a surgeon who is well trained in the less invasive techniques to ensure the best possible outcome.
  

• The potential adverse effects are the same as for the traditional hip or knee replacement.  These include, but are not limited to:

• Infection

• Bleeding
• Blood clots
  
• Pneumonia

• Nerve injury or blood vessel injury
  

• Fractures and stiffness

WHAT ARE THE MOST IMPORTANT PARTS OF A SUCCESSFUL TOTAL JOINT REPLACEMENT?

• Renaissance Orthopaedics and the Orthopaedic Program at Magee Hospital have a special approach to total joint replacement surgery to make this experience as pleasant and anxiety free as possible.  We call our approach: The Patient and Family Centered Care Approach (PFCC).

• Patients chose to have TOTAL JOINT REPLACEMENT SURGERY in order to regain a higher quality of life, but remember EVEN THE LESS INVASIVE TECHNIQUES are only one part of a much larger process.
• The Patient and Family Centered Care Approach is designed to make the process as easy and pain free as possible for patients and their families.
• We promote a positive experience and a successful outcome with our "Complete" approach!!

Background Information
As you may have seen on the news or in magazines, orthopaedic implant companies have been marketing a hip resurfacing procedure, which involves removing the arthritis from your hip and putting a cap on the "ball" (femoral head) part of your hip.  A total hip replacement involves removing the femoral head and replacing it with a large metal head and a stem that goes down into your thigh bone.  Although resurfacing has been marketed as a new procedure, it has actually been around for over 30 years.

SO WHAT IS FACT FROM FICTION?

POTENTIAL BENEFITS:

• The surface replacement theoretically removes less bone than a hip replacement, but only on the ball part of the joint

• The cup part (acetabulum) is the same as used for a total hip replacement

• May have a lower rate of dislocation compared to some types of total hip replacements secondary to the larger head, but the new total hip replacement systems also have the larger heads

• Revisions of the femoral component only (ball part) may be easier than the revisions of some types of hip replacements, but there are no differences on the cup side

• Metal on metal articulation, which may decrease wear, although the metal on metal articulation is now available in a total hip replacement

• Best candidates are patients under 50 years old with good bone stock and no cup deformations

Total Hip Replacement                                                                                        Hip Resurfacing
X-ray of a hip replacement and a hip resurfacing. Hip replacements now use the larger heads that are similar in size to the hip resurfacing.

WHAT ARE THE POTENTIAL PROBLEMS?

• The contraindications to having a hip resurfacing:

• Severe bone loss and bone cysts

• Small or bone deficient hip socket
• Age greater than 65
• Obesity
• There are very few studies about the long-term efficacy and safety of hip resurfacing and the long-term outcomes of subsequent revision surgeries
• Problems include femoral neck fracture, which is related to the surgical technique and the type of patient. There is no risk of femoral neck fracture with a total hip replacement, which removes this bone.

Normal Hip Resurfacing                                                                               Hip Resurfacing with Fracture

Background Information
As you may have seen on the news or in magazines, orthopaedic implant companies have been marketing unicompartmental knee replacements, or what they are calling "minimally invasive" knee replacements.  The unicompartmental replacement basically removes the one area of your knee that has the damaged cartilage and bone, theoretically permitting a smaller incision and faster recovery, compared to a total knee replacement.  BUT YOUR ARTHRITIS MUST BE LIMITED TO ONLY ONE SMALL PART OF YOUR KNEE for this approach to be successful!

One estimate is that only 5% of patients with knee arthritis may even be a candidate for a "uni".  For example, if you have arthritis that has spread to the knee cap, then you are not even a candidate for the "uni."  If you would have the "uni" you could still be left with pain from your knee cap arthritis and therefore would be best treated with a total knee replacement.  Remember, even a "total" knee replacement is really just a resurfacing procedure.  The areas damaged with arthritis are "resurfaced" and the missing cartilage is replaced with the artificial cartilage, leaving your healthy bone intact.

Uni Replacement                          Total Replacement