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General Joint Surgery Information
Speaking of New and Improved
What are those ads talking about?
At TCJR we get calls daily about:
- Ceramic hips
- Metal hips
- Resurfacing
- Partial knees
- Minimally invasive hips and knees
- Computer-aided surgery
So what does it all mean? The first three items on this list all refer to the type of surface that replaces the worn out cartilage in an arthritic hip. The traditional materials are a metal cup with a plastic liner and a metal ball that fits into the cup. It was discovered that the plastic liner wore out over the course of 10-15 years and that made it necessary to replace the implant in some people. So they replaced the plastic with a ceramic liner, or a metal liner and used either a ceramic ball or a large metal ball. Both of these materials wear better than the old plastic. It is worth noting that there is also improved plastic liners which will last a lot longer than the ones we had just 15 years ago. Hip resurfacing is the ultimate change in bearing surfaces. Instead of a traditional implant, there is only a metal cap that fits over the worn out ball of your natural hip joint.
Each of these technologies is mutually exclusive. Believe it or not, none of them is really new! In some form or another they have been around for as much as 30 years or more. What has happened is that companies have revisited old technology, improved aspects of it and repackaged the whole thing for the changing healthcare market. (See the article on direct-to-consumer marketing.)
The good news is that all three of the new" hip products allow us to consider total hip surgery in younger patients. But each product has its downside, too. Both ceramic and metal hips produce some debris particles that may or may not affect the body. It is too early to tell for sure. Resurfacing has been shown to cause, as one of its biggest complications, hip fractures (2-8% of the time).
The last three items on the list refer to surgical techniques. Partial knees have been around a long time. Even the new" minimally invasive techniques have, for the most part been seen before. Only computer-aided surgery is really a new venture.
Minimally invasive surgery (we prefer the term less-invasive surgery) to the knee is a bit misleading. While partial knees are designed to be done with a very small incision, the total knee implants are pretty big. The incision has to be able to accommodate it and the instruments used to put it in place. So really what you want to examine is the amount of tissue cut during the surgery. Quad sparing" is the term some manufacturers are using. It sounds new, but really has been around for a while. Doing as little damage as you can during the surgery is just good medicine.
Less-invasive hip surgery comes in two versions. One is the posterior" approach and the other is the anterior supine" approach. The results of both approaches are about the same. Anterior supine surgery can allow larger patients to have less invasive surgery. Posterior approaches allow us to use the same implants we have always used. Both approaches have their uses and neither is really better overall.
Finally, we come to the one really NEW technology: Computer-aided surgery. Does it help? It certainly allows doctors to align the knee better than they can do by just eyeing the placement. It may also help in placing the cup in the hip. What does that get you, at the end of the day? Maybe it will prolong the life of the implant by improving wear. Maybe it will be more comfortable because the tendons and ligaments are more balanced. There are no studies that have followed patients long enough to tell us that at this time.
TCJR embraces new technology as it proves capable of solving our patients problems. We currently offer 5 of the 6 things listed above. Resurfacing still has a few too many problems for us to enthusiastically embrace, but several of our doctors are going to being training in 2006 just in case the process improves. So you can count on us to stay abreast of the new and the recycled technologies in total joint surgery. Please call us if you have any further questions at 972-608-8868.
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