If ceramic hips sound too breakable, McCarthy emphasizes that the newer versions are highly resilient. “There was a 1 in 5,000 breakage rate originally; today it’s 1 in 49,000. I had an avid horse rider, who fell from her mount five months after her ceramic-ceramic replacement. She broke her pelvis, but not the artificial components!” he says.
News About Knees
Craig H. Bennett, M.D., chief of sports medicine at University of Maryland, says thanks to new materials, “We anticipate getting at least 20 years viability out of an artificial knee.”
Bennett notes that, as with hip replacements, there are knee surgeries that use smaller and less invasive incisions. “We try and preserve as much as possible of the extensor muscle group, the one that straightens your knee. It provides earlier bending and straightening with less pain, thus enhancing rehab,” he says. McCarthy adds, “Patients can get much greater flexion (flexibility).” A wider possible bend is great for people who like to garden.
“One of the biggest advances in knee replacements is replacing only the part of the knee that’s been damaged, instead of always doing a total knee replacement,” says Bennett. “That leads to much less blood loss, especially for people on blood thinners. Sometimes with a total knee replacement we have to replace lost blood. I’ve never had it happen with a partial knee surgery, though I do have patients stop their drug a week before.”
Beyond the Devices
Bennett says partial knee replacements are still mostly done on people under 60, but adds, “We look more at a patient’s biologic—how healthy they are overall—rather than their chronologic age.” Someone may be 65, for example, and not have the upper body strength to handle the walker or cane they’ll need while recovering.
Interestingly, he also checks his patients’ teeth. “I look at whether they’re loose or in poor shape. If so, they need to be fixed; otherwise such problems can lead to bacteria entering their blood.”
McCarthy says, “Medicare often doesn’t reimburse the hospital for newer and more expensive technology, such as metalmetal or ceramic-ceramic bearings.” So while those 65-plus can potentially benefit from these advances, they may not be encouraged to use them. The only real solutions: talk carefully to both your surgeon and the hospital, and start lobbying Congress.
Optimizing Surgery Results
Both McCarthy and Bennett agree with William Russell, M.D., medical director of Oak Crest, a community in Parkville, Md., built and managed by Erickson, that a total team approach is critical to optimizing the efficacy of replacement joints. “Every patient should include their primary doctor, especially if he/she is a geriatrician who is trained to deal with the whole patient,” says Russell. “I can’t tell you how many times I’ve seen someone get a joint replacement, then doesn’t have the energy to participate in rehab adequately. They end up worse than when they started.”
McCarthy adds, “Direct communication is critical: between the surgeon and the patient’s primary doctor; between the specialists, the primary, and the surgeon; and between surgeon and the patient.” He adds that for such communication, “a system like Centricity (see page 1) is great.”
Speaking of rehab, it’s critical the patient commit to it because—as Russell notes—“You only have a relatively small window of post-op opportunity to optimize results.” McCarthy encourages patients to exercise before surgery, so as to strengthen muscles. Russell notes that residents at communities built and managed by Erickson often have a team approach available, thanks to on-site rehab facilities.
Finally, all three doctors emphasize patients should maintain realistic expectations. “I always remind them it’s not a ‘new’ joint, it’s an artificial joint,” Russell says.
McCarthy adds, “There are spectacular developments, giving much greater quality of life than was previously possible. But it’s somewhat presumptive to think any device—be it an artificial joint or a heart valve—can be better than what nature gave you.”