Joint replacement – where we are and where we’re headed
As with many other aspects of medicine and healthcare, advances and changes in technology, technique and yes, even reimbursement from insurance companies, have been instrumental in the evolution of what we now see and experience.
Hysterectomies done as outpatients, cardiac bypass patients going home in a fraction of the time compared to 30 years ago – things that were considered impossible, or at least unlikely, are now becoming more and more commonplace.
Such is the case for orthopedic procedures, particularly knee and hip replacement procedures.
I can remember “back in the day” when a knee or hip replacement was considered a monumental experience (believe me, it still is). Patients would be admitted to the hospital at the very least, the day before surgery and remain in the hospital for several days afterwards.
Weeks and weeks of therapy; non-weight bearing for weeks, on a walker for what seemed an eternity and the interesting thing was – our motion expectation was to work hard to obtain 90-degrees of flexion (bend) to be able to sit in a chair and on the commode. Really, that’s all? Ninety degrees? Hey, you have to be able to sit on the “throne,” right?
My, how times have changed.
Technology has advanced beyond our expectations-implants touted to last 20 – even 30 years. They’ve even become a bit more “gender specific” with implants on the market geared more toward the women. While it’s been around for many years, one of the most interesting developments, and one that is getting more attention as of late, is the “partial knee replacement.”
Partial knee replacement, also known technically as a “uni-condylar knee replacement (let’s stick with “partial knee replacement”, it’s easier) is a procedure where only one side of the knee joint is re-surfaced instead of the entire joint. Used to treat specific, localized arthritis, the procedure is not new, but technology has changed over the years; better parts, longer-lasting, and each brand has something unique about it.
Performed largely in the under-65 age group, this procedure is, quite literally, “half” of what is done in a conventional knee replacement procedure. Only one “knuckle” of the thigh bone is re-surfaced and the tibial (shin bone) surface on the same side is also re-surfaced. Surgery time is typically shorter, as is the recovery. Many people have this procedure performed and are walking around within a couple hours of the surgery.
That said, one of the most interesting aspects of partial knee replacements is that they, too, are now being done as outpatient procedure. For example, let’s say you have your outpatient partial knee replacement done at 7 am. Odds are you’ll be home by noon or 1 pm. As with any surgical procedure of this nature, some patients may not qualify for the procedure, let alone being done as an outpatient, because of medical history, age, type and severity of the arthritis.
Several things have contributed to the development of “outpatient joint replacement,” some of which are technical, financial, marketing, more efficient use of time and resources in an outpatient surgery center, and public awareness/demand. Additionally, anesthesia delivery and post-operative pain control have become so tailor-made for these procedures that it is much easier and more comfortable than ever before to have this procedure done, even as an outpatient.
At this point in time, there are as many opponents to this new style of surgery as there are proponents – each with their own valid rationale. Suffice it to say that, for now, it seems to be the future of many knee joint replacements. Remember, we never dreamed heart bypass surgery patients would go home in just a few days, or that many of those procedures are now performed with the “minimally invasive” approach.
So, is hospitalization for joint replacements over-kill? Is it really safer, easier and better as an outpatient? Just remember, the same questions were once asked about hysterectomies, major ligament reconstruction procedures in the knee, cataract surgery as well as many others.
Personally, I believe that these recent changes in how surgery is performed – outpatient, micro-surgery, minimally-invasive techniques, better, longer-lasting parts are all elements which will continue to add up to better, easier, safer surgical procedures for us as patients moving forward into the future, and that, my friends, I am completely in favor of.