Joint Replacement Now Viable For Younger Patients
Advanced surgical materials and techniques offer relief for patients in their 50s, says RGHS Chief
When he was in medical school, recalls Edward Tanner, MD, hip or knee replacement surgery was recommended only for seniors 75 and above. “If you got seven to 10 years on a replacement joint, you were doing great,” he says, “so the procedure tended to be saved for people who were older. No one wanted to go through the operation twice.”
Times have changed, says Dr. Tanner, chief of Orthopaedics at Rochester General Health System. Replacement joints now last 30 years or more, potentially providing a lifetime of relief for men and women in their early 50s. And surgical refinements have shortened OR and recovery times, allowing younger patients to return more quickly to their active lives.
The most profound improvements have occurred in joint fabrication and fixation, Dr. Tanner says. Hip joints, once cemented in place, today rely on porous ingrowth components for a more long-lasting grip to bone. Replacement knees are still typically fixated with cement, but the knee joint material – a more durable form of polyethylene than that used in the procedure’s early days – lasts much longer than previous generations of replacement joints.
OR and post-op procedures are constantly improving, too, particularly in the area of pain management. A lidocaine spinal block during the operation can eliminate the need for general anesthesia and its possible side effects. Coupled with an ultrasound-assisted femoral nerve block that can provide pain relief for 18 to 24 hours after the surgery, a knee replacement patient “can wake up, gain control of his muscles and start walking again, without pain, for up to a day,” Dr. Tanner says.
Although computer-assisted or robotic platforms are not yet the standard for joint-replacement procedures, a refined manual technique now uses smaller incisions that provide sufficient visual alignment of the new joint without the more invasive wide-open techniques that were once the norm.
Surgical standardization is another significant advantage, Dr. Tanner says – particularly at RGHS, where OR standardization has been rigorously honed by a highly experienced team. “We do things very systematically – the assistants know where to hold the retractors, the scrub nurses know which instruments to hand up next, the circulator knows what to bring in at each point of the operation, and so on.” This high-efficiency environment helps reduce OR time and minimizes the patient’s risk of complications, infections, and other variables – while still ensuring optimal results.
The RGHS Orthopaedics program is nationally regarded for excellence, having earned the Gold Seal of Approval from The Joint Commission for total hip and knee replacements in 2012. That certification recognizes RGH’s dedication to continuous compliance with the state-of-the-art standards.
Learn more about the RGHS Orthopaedics program at www.rochestergeneral.com/ortho.