Joint Replacement Improves Quality of Life

Joint replacement surgery is undoubtedly one of the greatest medical advances for improving patients’ quality of life. Over the past 40 years, hip and knee replacements have been performed for millions of Americans, easing pain, improving range of motion, and keeping them active.

Currently, over 400,000 hip and knee replacements are performed in the United States annually. At Penn, orthopaedic surgeons perform more than 2,000 joint replacement procedures a year, treating painful and debilitating joint conditions caused or aggravated by arthritis, trauma, injury and infection.

The number of people seeking relief from joint pain is increasing. Americans are living longer and staying active, and aging baby boomers don’t want to stop participating in sports and other activities because of pain.

“Younger people aren’t ready to slow down and they are not going to let their pain dictate their activities,” said Craig Israelite, MD, orthopaedic surgeon at Penn Presbyterian Medical Center. “It used to be we wouldn’t even consider joint replacement for a patient under the age of 60. But now, with new materials that are more durable and longer lasting, we can help younger patients and get them get back to their life.”

Studies show that the more procedures surgeons perform, the more successful their results, or outcomes. In addition to performing a large number of surgeries, Penn orthopaedic surgeons also perform more complex and complicated joint replacement procedures, as well as many minimally invasive procedures.

“At Penn, we offer advanced, individualized care and we see many patients with complex and complicated problems,” said Gwo-Chin Lee, MD, orthopaedic surgeon.

Along with providing the highest quality patient care, Penn Orthopaedics is involved in educating future orthopaedic surgeons and developing new procedures and joint replacement components.

Building a Better Knee

As leaders and innovators in orthopaedics, Penn physicians are continually working to improve the fit and function of joint replacements. The ultimate goal is to make the replacement feel and act as normal as possible, especially for knees.

Penn ortho surgeons aim to mimic the normal kinematics of the knee. One of the new prosthetics that has been developed replaces both of the patient’s own cruciate ligaments, which makes a significant difference in how the knee feels. It also mimics the normal, asymmetrical anatomy of the knee. The result is a knee that is more stable and feels more natural to the patient.

Patients with arthritis in the knee may also be candidates for partial, or unicompartmental, knee replacement. If an injury results in pain or arthritis on just one side of the knee joint, Penn surgeons are able to use a mini-incision to replace the affected part of the knee joint, with minimal damage to the surrounding muscles and tendons. Patients recover much more quickly from a partial knee replacement and the new prosthetics that are used result in less pain than a traditional knee replacement. Patients can often walk unassisted (without a cane or crutches) within a week after the surgery.

Dr. Lee uses a knee system that includes a rotating platform placed on the tibia (shin bone) that decreases wear on the knee system and allows for some rotation of the knee. He said this helps provide more natural movement of the joint.

One of the latest innovations is the development of customized cutting blocks, designed to improve the accuracy of fitting the knee system. Software analyzes X-ray, MRI and CT images and creates a model of the patient’s knee. Cutting blocks are fabricated from the models and attached to the femur and tibia, allowing the surgeon to precisely fit the knee prosthesis. Called Patient-Matched Custom Knee Replacement, or PMI, the method provides a custom fit and correctly aligns the new joint.

New Hip Materials Offer Durability

For hip replacements, the newest advances are in the types of surfaces being used. The ball and cup implants may be ceramic-on-ceramic, metal-on-metal or metal-on-plastic. Penn surgeons have also seen some success with a new multi-bearing cup for hip replacements. The U.S. Food and Drug Administration (FDA) recently approved use of the cup that can be fitted with a liner of any of the materials. All have unique benefits and all have risks.

“Hip replacements are not one-size-fits-all,” said Dr. Israelite. “All patients are evaluated to determine the best material for their lifestyle and activity level.”

Penn orthopaedic surgeons often perform a minimally invasive hip replacement. The smaller incisions allow the surgeon access to the hip joint while preserving muscle function, enabling patients to return more quickly to their favorite activities.