I spent the first 16 years of my career handing instruments to surgeons in a busy suburban operating room. I left the OR in 2006 and at that time there were not any surgeons using the minimally invasive technology to replace knees and hips, yet it was still one of the most common orthopedic surgeries we performed. Measurements of the implants were made by visual examination of the x-rays using sized templates and intra-operative methods of ensuring the closest fit. The bone cement filled in the small gaps to make it an airtight fit. Since then, the world of orthopedics has concluded that if a total joint replacement fails it is usually the breakdown of the bone cement. This can cause an implant to become loose and moveable which can be responsible for everything from intense pain to an infected abscess requiring the implants to be removed. Cement is not always used and implants have a coating that promotes bone growth to hold onto the implant. Eliminating the need for bone cement has been shown to lengthen the life of the implants.
Total joint replacement technology has changed drastically in the way the implants are sized and it is very common for your surgeon to order a CAT scan preoperatively to create a 3D model of your damaged joint. The robotic equipment used by the surgeon has software that translates that 3D model into a surgical plan that preserves healthy tissue and enables the closest fit to your natural joint. Some very skilled surgeons are combining several of the latest techniques for the best patient outcomes. The minimally invasive technique for a knee replacement can also allow for muscle sparing procedures and eliminate the need for a tourniquet. Historically a surgical tourniquet is applied to the upper thigh in the OR before the patient is prepped and draped. It prevents blood flow into the lower leg while the surgeon is operating but is a major cause of post operative pain and blood clots. Each patient is unique but if your surgeon is skilled in the procedure without a tourniquet you will be giving yourself the best chance of a smooth recovery.
There are 2 different surgical approaches for a total hip replacement. Both can utilize robotic, minimally invasive technology and both have pros and cons. The most popular is the anterior approach where they enter the hip joint from the front of the body. There is no need to cut and repair muscles which reduces post operative pain and recovery time. The anterior approach has very few restrictions for movement, even in the first few post op days! The anterior approach is technically more difficult for the surgeon and requires specialized training and equipment. A posterior technique does give better visualization of the hip joint and is easier for the surgeon, but outcomes tend to have a longer recovery period and higher risk for dislocation.
As always, there are risks to total joint replacement surgery but with the right surgeon and appropriate procedure for you, the risk is worth the outcome. Patients can return to a healthy, active lifestyle with little or no pain for many years after surgery.
