| Posted June 5, 2014 | By Brian Perkinson, M.D. | Categorized under Men's Health, Women's Health |

Along with the aging Baby Boomer generation, advancements in total and partial joint replacement technology are leading to more joint replacement surgeries than ever before.

Not only do you have a large aging population that wants to improve their mobility and gain back some quality of life, you also have a slightly younger demographic that isn't waiting until they have become too deconditioned to take advantage of these surgeries to maintain an active lifestyle.

New techniques

The most popular joint replacements right now are the anterior total hip and total knee arthroplasty with the potential for a partial knee arthroplasty. Arthroplasty is when we replace an arthritic joint with an artificial joint that is usually composed of metal, plastic or ceramic.

The anterior (or front) hip replacement is gaining popularity because it enables faster functional recovery from surgery. We use the word ‘approach' to talk about how we make an incision and traditionally, the most popular approach was a posterior one, or making the incision on the back of the hip. This approach, although extremely successful, does require a little bit more muscle release and has a slightly higher risk of dislocation after surgery.

The anterior approach allows us to cut less muscle, thereby allowing for a little earlier independence as well as a decreased risk for dislocation. What that means for the patient is we can allow them to return to normal activity slightly faster without putting precautions on activity. Oftentimes after hip replacement surgery you can't do everyday things like putting on shoes or crossing your legs for some time. With the anterior approach we don't give you those restrictions because the risks are different, so you can recover faster and better.

Totally partial

The partial knee replacement is probably the most niche thing I do. The advancement of the technology for a partial knee replacement has been tremendous over the last 15 to 20 years. I'd say 25 percent of the patients who are candidates for a full knee replacement could be candidates for a partial one. 

The benefits of partial vs. total are again, that all-important quicker return to functional activity. Further benefits include shorter hospitalization, less blood loss, and it allows a patient to retain 2/3 of their native knee. Once the patient has recovered from surgery, a partial knee replacement provides increased range of motion and it just feels less mechanical.

Less pain, more gain

I think the biggest misconception about replacement surgery is that the patients are going to suffer excruciating pain during a long rehab course. I no longer feel that the majority of my patients agree with that perception.

My referrals from former patients come to me expecting good pain management and quick recovery. The days of having a week to recover in a hospital bed are gone. That is no longer the standard of care. The new standard is that within two days of your surgery we send you home and you begin outpatient physical therapy. Many of my partial knee replacements and anterior hip replacements go home after just a one-night stay in the hospital.

We know what the impediments to discharge are and most of the issues stem from side effects of drugs, blood loss, and probably the biggest one is fear. What drives fear is the feeling of dependence. So because of that, mobilization is the number one key to success. Regional anesthesia, blood management and non-narcotic-based pain regimens are big pieces of the accelerated recovery puzzle. It all works in unison.

Mobilization

Quite possibly the biggest piece of that puzzle, though, is pre-educating the patient as to why everything is happening the way it is. The patients need to know that on the day of their surgery, someone from physical therapy is going to come get them and walk them around. Getting patients up and walking on their new joint, the day of surgery quickly begins to dissipate their fear, and allow them to realize they will maintain independence. They can put weight on it right away and it will be OK.

Side effect reduction

Narcotics, which are typically used for pain management, can have a number of side effects such as nausea, vomiting, confusion and constipation. They also have a tolerance associated with them, which means the more you use them, the more you require to get the same result. If we utilize multiple different types of medications to control pain in the human body via different pathways, then we can decrease the side effects and help the patients return to normal activities faster. Therefore, we utilize advanced pain management strategies that drastically reduce the need for narcotic medication.

Back to life

Thanks to these new standards of care, routinely 10 to 14 days after hip or knee replacement surgery, patients walk into my office unassisted. By this time the patient's previously painful limp has usually normalized into a normal walking pattern.