Understanding Joint Replacement Options for Hips & Knees

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Dr. Kevin Plancher with Plancher Orthopaedics & Sports Medicine with tips on patients’ choices for most common artificial joints.

Dr. Kevin Plancher

Hip and knee replacement procedures are among the most commonly performed surgeries in the nation.

As the U.S. population ages – but still desires to stay active – more people than ever are finding that getting a new hip or knee is a ticket to aging with vigor. Despite their enthusiasm, however, many don’t understand their joint replacement options, according to orthopaedic surgeon Kevin D. Plancher, MD, founder of Plancher Orthopaedics & Sports Medicine.

Hip and knee replacement procedures are among the most commonly performed surgeries in the nation, with American Academy of Orthopaedic Surgeons figures showing about 1 million such operations are performed each year. An estimated 7.2 million Americans are living with artificial hip or knee joints, and the prevalence increases with age. Most undergo joint replacement to swap out hips or knees painfully damaged by osteoarthritis or trauma in order to return to pain-free living, Dr. Plancher notes.

“We’re fortunate to have so many joint replacement options to maintain our activity levels and continue doing all our favorite things,” he says. “But determining the best choice for hip or knee replacement surgery requires understanding what’s available and how it may best work with our needs.”

Knee joint options
With an estimated 4.7 million Americans living with total knee replacement – also called total knee arthroplasty, or TKA – it’s likely we all know someone who’s undergone this extremely common surgery, Dr. Plancher says. But partial knee replacements are also done, depending on a patient’s individual circumstances.

Dr. Plancher offers a breakdown of total vs. partial knee replacement:

Total knee replacement removes the surface of bones surrounding the knee that have been damaged by osteoarthritis or other causes and inserts an artificial implant selected to fit each patient’s own anatomy. First performed in 1968, TKA surgery has advanced over intervening decades to use knee implants that virtually duplicate how the human knee normally moves. “It’s become one of the safest and most effective of all orthopaedic surgeries,” Dr. Plancher says.

Partial knee replacement, known medically as a uni-compartmental knee replacement, is far less common than TKA but has been performed since 1994 by Dr. Plancher. As the name implies, this procedure replaces only part of the knee in order to preserve as much original healthy bone and soft tissue as possible. Patients undergoing partial knee replacement typically suffer from osteoarthritis in only one of the three knee compartments, so the surgery replaces the portion with diseased bone. Because only one part of the knee is involved, recovery is typically faster.

Minimally invasive surgical techniques can be used for either total or partial knee replacement. This means the implant is inserted through a shorter incision that’s typically 4 to 6 inches long, instead of 8 to 10 inches. “Minimally invasive techniques are used whenever possible, depending on the patient’s case, but also allows for less tissue disturbance,” Dr. Plancher says.

Hip joint options
About 2.5 million people in the United States are living with artificial hip joints, a procedure expected to become even more popular as Baby Boomers age, says Dr. Plancher, who lectures globally on issues related to orthopaedic procedures and sports injury management.

Various options in hip replacement surgery center around the technique used to insert the artificial joint. They include:

Traditional hip replacement surgery involves a single, long incision of 10 to 12 inches to view and access the joint from the side or back of the hip. Muscles are split or detached from the joint, allowing surgeons to remove the damaged head of the femur (thigh bone) and replace it with a metal stem inserted into the femur’s hollow center. A metal or ceramic ball is placed on the upper part of that stem, which fits into a replacement metal hip socket.

Anterior hip replacement approaches the hip from the front of the body instead of the side or back. It can involve using a specialized operating table to correctly position the patient during surgery, but the anterior approach can result in less tissue trauma by avoiding cutting the muscles surrounding the hip.

Minimally invasive techniques enable less cutting of the tissue surrounding the hip by using specially designed surgical instruments to prepare the femur and socket and properly insert the implants. Minimally invasive hip replacement surgery can involve one or two smaller incisions, Dr. Plancher says.

“As with all surgeries, clear communication is needed between patient and doctor to figure out the best option for your joint replacement procedure,” he says. “We always aim to offer the right procedure to the right patient at the right time but always try conservative treatment if therapy can help resolve any or some of your symptoms.”

Kevin D. Plancher, MD, is a board-certified orthopaedic surgeon and the founder of Plancher Orthopaedics & Sports Medicine.

Plancher Orthopaedics & Sports Medicine is a comprehensive orthopaedics and sports medicine practice with offices in New York City and Greenwich, CT. http://www.plancherortho.com

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