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Total
Joint Replacement of Hip & Knees
Stephen
Bessinger, M.D., F.A.C.S. & Ashok Sonni, M.D., F.A.C.S.
A
painful hip or knee is frequently the problem that will keep an adult
from being normally active and able to enjoy recreational activities.
This pain often is caused by some form of arthritis or degenerative
changes in the joint. These progressive changes for many individuals
may not become serious enough to need attention. However, in some, this
problem is the source of much discomfort and associated physical limitations.
Conservative measures will often provide adequate relief for older adults
with joint problems. The treatment alternatives, depending upon individual
circumstances, may include modification of activities, weight loss,
anti-inflammatory medications, joint injection with cortisone, a brace,
physical therapy or use the use of an external support like a cane.
Surgery is best reserved for when one is no longer managing well with
conservative treatment. If, in spite of these non-surgical treatment
efforts there is persistent disabling discomfort, limiting one from
normal adult activities or possibly even waking the individual from
sleep, surgery is a reasonable consideration. Most commonly today in
an adult population where arthritis has caused a hip or knee joint to
be worn out, surgical reconstruction would require a replacement of
these worn surfaces.
A total joint replacement is the surgical removal of joint surfaces
and implanting new joint surfaces and implanting new joint surfaces
that are made of various metal alloy and high density plastic components.
There are many types of implants and various factors may determine what
specific component or type of fixation securing the implant to the bone
is most appropriate for each individual. For the past thirty years methylmethacrylate
has been used as a cement to provide immediate and long lasting fixation
of hip and knee total joint replacements. This cement is not a glue,
but more like grout and overtime can fail. This can be a cause of recurrent
pain and failure of a previous joint reconstruction.
Although cemented technique is still the standard for comparison, other
forms of biologic fixation are popular for younger more active patients
and those with good quality bone. This alternative to cement involves
precise surgical technique where the implant components have a surface
into which the bone may grow or adhere. Continuing advances in biomaterials
have led to the use of stronger and lighter alloys like titanium and
also newer ceramic components to be used as a joint surface.
Adult reconstructive surgery or total joint replacement has become increasingly
common as our population of older adults has grown larger and people
are otherwise healthy and active. This type of surgery has the dramatic
effect of eliminating the pain from an arthritic joint, improving the
motion of the joint and restoring an individual's ability to handle
prolonged standing and walking activities. Along with improved function
and the relief of pain comes an ability to again enjoy life.
Although total joint replacement is "major surgery" and has
definite risks along with potential complications, for the vast majority,
the benefits far outweigh the risks. On the average, over ninety percent
of those patients having had a total joint replacement of the hip or
knee ten years ago still have the same joint and continue to enjoy what
may be considered a good or excellent result.
Stephen Bessinger, M.D., F.A.C.S. & Ashok Sonni, M.D., F.A.C.S.
are Board Certified by the American Academy of Orthopaedic Surgeons
and specialized in the surgical treatment of arthritic joints and sports
related injuries.
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