Joint Replacement Center
About Joint Replacement
The human hip and knee joints are marvels of design when working properly. The ball and socket design of the healthy knee can carry and pull great loads of weight and absorb the trauma from jumping and running. The knee joint in particular is amazing in that it features a femur bone balanced on top of the tibia, held in place by a knee cap (patella) and four ligaments — ACL, LCL, MCL and PCL — that act like guy wires o n a tower for stability. Inside the knee joint, soft tissue called meniscus line the surfaces of the joint to provide lubrication during movement.
When the knee and hip joints are healthy, life is good. Running, jumping, lateral movement is all possible without pain. But when age, arthritis or other degenerative bone disease pits out the internal surfaces of these joints, any movement like walking or running can become excruciatingly painful.
Years ago, when hip or knee joints became arthritic from old age, the hip or knee pain sufferer was rendered to a wheelchair, or the joint was fused, and locked into place to prevent the pain that came from movement and friction within the joint.
Hip replacement dates back to experimental procedures where ivory was used to replace the damaged ball joint at the top of the femor. But it wasn’t until 1940 when an American surgeon at Johns Hopkins hospital, Dr. Austin T. Moore, performed the first metallic hip replacement surgery. The next 30 years saw many more advances as surgeons began to perfect a way to replace the ball and socket joint that was damaged from age and arthritis.
Following the successes of hip joint replacement, surgeons began developing artificial knee joints in the 1970s. The early knee joints however had problems in standing up the demands of balancing all the trunk weight of a human body under motion.
Today, thanks to advances in joint replacement, hip and knee replacement has become a common procedure with very good outcomes. For example, one study noted that 97% of patients with hip replacement reported improved outcome from the surgery.
The Joint Replacement Center at South Bend Orthopaedics
 Joint replacement surgery is best done by orthopaedic surgeons who are fellowship-trained in joint reconstruction surgery. This fellowship training represents the highest level of medical training in the United States. South Bend Orthopaedics in South Bend, with additional locations in Mishawaka, Plymouth and La Porte, Indiana has assembled a team of joint replacement surgeons who do a high volume of knee and hip joint replacements.
In addition, the supporting team of therapists and sports medicine specialists help the patient to explore and try other more conservative treatments first, so joint replacement is held as the last resort.
Because the artificial knee and hip joints have a limited lifespan, the longer a person can wait, the better, as the ideal situation is to have the person outlive the lifespan of their artificial joint implant.
To the extent the artificial joint wears out, the person would need to undergo joint revision surgery for a second time, which can be complex, more difficult, and a longer recovery with more risk of complications and a less favorable result.
About Hip Replacement Surgery
Over time, the impact of joint disease, arthritis, or excessive body weight can erode the hip joint.
According to the American Academy of Orthopaedic Surgeons, each year in the United States, about 193,000 hip replacements are performed. With the aging of the baby boom generation, that number is expected to grow as this large segment of the population moves into their 50s and 60s. It is estimated that more than 500,000 knee and hip replacements will be done each year by 2040. Also, the joint implant technology involved is improving, enabling the artificial joint to last longer.
The surgery itself, lasting between two to three hours, is performed on those who experience the chronic and debilitating effects of hip disease. An incision is made in the beauty of the patient. The surgeon then removes the diseased bone and cartilage and fits the prosthesis into the joint. The prosthesis is inserted and the incision is sutured.
Since hip prosthesis rarely lasts longer that 15 to 20 years, and outcomes of revisions are less effective than original replacements, young people are not good candidates for the surgery. In fact, in the United States, 65 percent of hip replacements are given to those over the age of 65. It is also not recommended for the extremely obese, those with a terminal illness, those with nerve disease, those lacking ample skin around the hip.
Types of Hip Prosthesis
Acrylic with Cement Fixation
This is the first type of hip prosthesis developed. Essentially, the prosthesis is secured to the hip with a cement adhesive. Over time (10 to 15 years) the cement will erode and need to be replaced. Usually these implants are used in older, less active adults or in people with weaker bones. The recovery time for this prosthesis is faster than other methods.
Without Cement Fixation
The difference between the cement and uncemented version of the hip prosthesis is the lattice grid that comprises the socket part of the uncemented prosthesis. After the diseased bone and cartilage has been removed, the latticed grid is inserted into the socket. After a while during healing, the remaining hip bone will grow into the grid much like ivy grows into a trellis and suture itself to the prosthesis. The new bone grows into the implant, securing it in place. This is a much more natural cohesion and lasts longer than the traditional prosthesis. Also, it affords much more mobility to the active hip replacement recipient than the cemented type.
Scientists are currently in the process of developing joint replacement methods that will last much longer than the current prototype. While doctors now use a glue to bind the old bone with the new prosthesis, they one day hope to use ceramics as a bone substitute.
When a bone breaks in the body, the bone cells will form together to rejoin the broken bone. In the same way, bone cells can join with coral or ceramics forming one, continuous bone. While the glue or cement that doctors use will eventually deteriorate, ceramics will last much longer as they have better chances of being accepted by the cells. While recovery may take longer initially, the effects of surgery will last much longer than current replacement methods.
Hybrid Fixation
The hybrid fixation is where one part of the hip prosthesis (generally the stem) is cemented together while the other part of the hip (generally the socket) is inserted without cement.
Scientists are now working on using ceramics and coral to be used as joint replacements in the future. Hospital stay after surgery usually lasts for five days. After the hospital stay, the patient will probably require the aid of a walker for a few days before putting full weight on the leg.
The future of joint replacement surgery
Scientists are currently in the process of developing joint replacement methods that will last much longer than the current prototype. While doctors now use a glue to bind the old bone with the new prosthesis, they one day hope to use ceramics as a bone substitute.
When a bone breaks in the body, the bone cells will form together to rejoin the broken bone. In the same way, bone cells can join with coral or ceramics forming one, continuous bone. While the glue or cement that doctors use will eventually deteriorate, ceramics will last much longer as they have better chances of being accepted by the cells. While recovery may take longer initially, the effects of surgery will last much longer than current replacement methods.
About Knee Replacement
Quality of life is never to be underestimated and when a knee problem is so debilitating that it is impossible to enjoy hobbies that are important to you like gardening or playing with your children or grandchildren, than it is crucial to seek medical help.
Fortunately, before even considering knee replacement surgery as an option, generally physicians will try to find other ways of assuaging the pain. For instance, physical therapy, analgesics and walking aids might be the answer to many knee problems including those stemming from arthritis.
However, it is also nice to know that when other treatments prove to be futile, knee replacement surgery is an option. So prevalent is this surgery, in fact, that over 250,000 knee surgeries are performed each year in the United States alone. It is estimated that in 2040, more than 500,000 knee and hip replacement surgeries will be performed due to the influx in aging Baby Boomers. Knee replacement will help renew the ability to participate in several fun, day to day activities such as gardening, going on walks, golfing, and overall mobility. It is important to try other options before knee replacement surgery, however, since they only last for 15 to 20 years and are not easily replaced. For this reason, physicians are very selective about the types of candidates for the surgery.
So, who is a candidate?
Knee replacement is a procedure generally reserved for those who are over 60 years of age who are in relatively good health, aside obviously, from their knee pain. In fact, 72 percent of knee replacements are done on those over the age of 65. Generally, this means, they maintain a healthy weight, they do not suffer from cardiovascular problems, and they are not suffering from a terminal illness.
Active knee replacement candidates will find it comforting to know that they will be able to resume some athletics following surgery such as golf, swimming, and walking. Some knee replacement recipients have even continued to play tennis and snow ski. Unfortunately, a knee prosthesis is not quite as effective as a healthy, natural knee, however it will be a great improvement over the preoperative pain and discomfort.
Who is not a candidate?
To receive knee replacement surgery, you must be a good candidate. If not, surgery could prove counterproductive. For some, knee replacement surgery is not in their best interest. Those who are too young, with the exception of those who suffer from severe rheumatoid arthritis, should consider other types of treatment for knee pain since after 15 or 20 years, the prosthesis will need to be replaced. Unfortunately, the bone will need to be cut short to make room for a new prosthesis and function and mobility is likely to be damaged during the second operation. Those who are overweight are not good candidates as the prosthesis (just as the natural knee) is designed to carry a weight in proportion to the person’s body. Too much weight on the prosthesis can cause it to be damaged and subsequent knee surgeries will be necessary. Those with cardiovascular problems and with terminal illnesses are also not good candidates as the surgery may be too much for the body to handle. Also those with poor skin coverage over the knee are not good candidates as surgery could impair movement of the knee.
What knee replacement surgery is like?
During knee replacement surgery, you will be under general anesthesia meaning you will be asleep and without pain during the entire procedure, which usually lasts a few hours. The knee is opened up and the kneecap is moved out of the way. Doctors then, shave off the bottom of the femur and the top of the tibia and fibula bones. The prosthesis is then glued to the bones with special, surgical cement. The knee is then sutured back together and drainage tubes are used to prevent clogging.
Usually, a hospital stay for knee replacement surgery lasts between four and five days. During your time at the hospital, your leg will be attached to a device called Continual Passive Movement (CPM), which will move your knee to prevent stiffness. After the hospital stay, the patient will probably require the aid of a walker for a few days before putting full weight on the leg. Overall, full recovery can take anywhere from two months to one year although dramatic improvements should be seen sooner than that.
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