Over 65? In agony because of joint pain? Take a look at the advances in joint replacement surgery

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In 2011, the first baby boomers started turning age 65. On average, they are living longer, more active lives than their parents’ generation.

That doesn’t mean they don’t have the same aches and pains and maladies. Arthritis, for instance, is still a significant cause of joint pain and loss of mobility in people 65 and older.

These days, people have treatment options that weren’t available even 10 years ago. The primary goals are always to relieve pain and increase mobility.

The rule of thumb for most people is to try conservative treatments first.

• Weight loss if the person is obese
• Exercise
• Pain medication
• Braces
• Injections to lubricate the joint and reduce inflammation.

When conservative measures no longer work, the next step is usually joint replacement surgery. Two of the most common surgeries performed in the United States are knee and hip replacements. About one million are done in the United States every year. It’s estimated that by 2030, the demand for new knees will increase 673 percent and new hips 174 percent.

In the United States, the first hip replacement was done in 1969, followed by the first knee in 1971. A generation ago, artificial joints weren’t recommended for people under 65 because they only lasted 10 to 15 years. They could be replaced, but it wasn’t an easy procedure.

New joints can now last 20 years or more. Because of improved materials, advances in surgical techniques and more effective pain control, joint replacement surgery is now considered an option for younger people.

Advances in pain control

Managing postoperative pain is considered one of the most important advances. In the past, patients were given heavy-duty narcotics to control their pain. It may have been relieved, but people also usually experienced nausea, drowsiness, and constipation.

Today, surgeons use what they call a multi-modal approach to pain control. They give patients a cocktail of non-narcotic medications that reduce pain and swelling and don’t cause troubling side effects.

The result is that most patients are on their feet soon after surgery and out of the hospital by the following day. Improvements in physical rehabilitation protocols also play a crucial role in a quick, successful recovery.

Minimally invasive techniques

Minimally invasive techniques make a significant difference for some patients. For example, a traditional total hip replacement is done by cutting through major muscles in the buttocks and thigh. It’s less invasive to access the joint through a smaller incision on the front of the hip. Recovery is swifter. Patients don’t need to limit hip motion for several weeks. They can bend their hip and bear weight soon after surgery.

Joint resurfacing

Instead of total joint replacements, some patients may be candidates for resurfacing procedures. They preserve bone in both knees and hips, leaving the door open for total joint replacement later in life, if necessary.

A total hip replacement involves removing the entire head and neck of the thighbone (femur). It relieves pain and increases mobility, but to prevent the joint from loosening, high impact activities are off limits.

With hip resurfacing, the head of the femur is shaved into a rounded shape. It’s covered with a metal cap on a small spike and cemented into the bone. The joint socket is also lined with a metal cap.

The result is a more anatomically correct joint that allows for greater range of motion. Patients can also still do high impact activities. The procedure is not for everyone. It’s most successful in younger active males with strong, high-density bones.

Partial knee resurfacing is not restricted to younger patients. When someone has arthritis of the knee, it may only affect a portion of the joint.

The knee joint has three compartments: the inner, outer and under the kneecap. Partial knee resurfacing replaces only the damaged part. Removing less bone means the knee feels more natural. As with hip resurfacing, if the implant wears out, a full replacement can be done down the road.

Better materials

The materials used in replacement parts have also evolved. In the past 10 years, new plastics and metals have been developed.

A new kind of plastic — a highly cross-linked polyethylene — doesn’t wear down as quickly as older plastics. It also helps prevent a common joint replacement complication called osteolysis. The body may absorb microscopic particles that wear off the surface of artificial joints. The process weakens the bones. The newer plastic should eliminate osteolysis for up to 10 years after surgery and possibly longer.

Highly porous metal is also used. It allows bone to grow into an implant and form a secure, long-lasting bond. Most surgeons prefer using metal and plastic for hip transplants rather than metal on metal, which has a higher rate of revision surgeries. In the future, we can expect more improvements for metal surfaces.

3-D technology and robots

Most artificial joints come in predetermined sizes. Some orthopaedic centers now use advanced 3-D technology to produce custom-made prostheses. Each prosthesis fits an individual’s anatomy.

And don’t be surprised if a robot is lending your surgeon a helping hand replacing that custom-made joint. Computerized 3-D planning plus robotic precision equals greater accuracy. One hundred percent accuracy, claim some surgeons.

The benefits of prehabilitation

In addition to medical and surgical advances, many joint replacement patients now participate in educational and physical therapy programs before they have their surgery.

Len Perenis, a physical therapist with Central Maine Physical Therapy Services, believes that prehab, as it’s called, is critical. “I may be biased,” he says, “ but we’re able to identify impairments that may impact how quickly a patient regains function. We can teach them exercises that, for instance, help stretch the muscles so they are limber and flexible leading up to surgery, potentially helping them recover after surgery.”

Prehab can also help relieve a patient’s anxiety, says Dr. Jeffrey Bush, an orthopaedic surgeon at Central Maine Orthopaedics. “People feel more comfortable coming in for their surgery when they’ve started the process earlier,” he says. “When they’ve been active participants and are doing their exercises. They’ve also met members of the team and seen the unit. The physical results of prehab have been great, but being comfortable with the whole process is also really good, so I’m a believer.”

Making the right choices

Joint replacements get people back on their feet and eliminate their pain. They can give them back their lives. They’re no longer only for older people, but whatever your age, it’s important to work with a joint replacement specialist to decide what’s the best timing and the best replacement for you.

Thank you for reading this blog post about advances in joint replacement surgery. One million hip and knee replacements every year in this country is certainly a lot! Have you had joint replacement surgery? How did it go for you? You may also have some words of wisdom for anyone considering the surgery.