Good Progress Seen in Joint Replacements

Hip and knee replacements are improving.

Better surgical techniques and new materials are speeding patients’ recovery.

Ten years ago, patients seeking total hip and knee replacement faced lengthy hospital stays, painful recoveries, and the possibility that the joint would wear out in 10 to 15 years.

Improvements in surgical technique, better pain management at the time of surgery, and new technology enable faster recoveries with less pain and the promise that the new joint will last, says Dr. Eric Jepson, a total joint specialist with Colorado Springs Orthopaedic Group.

“We are able to mobilize patients earlier than we did even five years ago. The plastics, metals, and ceramics we are using make the biggest difference in long-term outcomes,” Dr. Jepson says.

Better surgical techniques

A decade ago, a standard hip replacement required an 8- to 10-inch incision and detachment of many muscles so the surgeon could see the joint. Now incisions are much smaller and new techniques allow for less moving around of muscles. “Being gentle on the muscles is really the key to recovery and good outcomes,” Dr. Jepson says. “The more muscle sparing a surgeon can be, the quicker the recovery for the patient.”

Similarly, successful knee replacement depends upon minimizing damage to the quadriceps tendon. With smaller incisions and much less tissue trauma than knee surgeries done 10 years ago, patients recover more quickly.

Hip and knee replacement patients commonly spend only two or three days in the hospital, minimizing the risk of infection. They often can return to normal activities four to six weeks after surgery.

Pain management also helps speed recovery. “We are now trying to aggressively attack pain,” Dr. Jepson says. “That allows patients to get up and get moving.”

Better materials

The materials used in total joint replacements “truly are light years ahead of what was used 10 years ago,” Dr. Jepson says. “Based on lab testing, modern implants take an extraordinary amount of time to wear out and offer the hope of greater longevity. For 60-year-olds, we have options for hip replacements that we think will last 30 plus years.” A metal ball on a plastic socket is traditionally used for hip replacements, but newer plastics have a longer life span. For younger patients, a metal ball on a metal socket has improved wear characteristics.

“Another combination used is a ceramic ball on a ceramic cup, which is at least comparable to metal on metal and may last even longer,” he says. “The chance of needing more surgery because a hip wore out is very low because of these advances in materials.”