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Robotic Hip/Knee Replacement: Is It Right For You?
Robots are the future…at least that’s what we hear!
For the past few years, robotic assistance in orthopedic surgery has become increasingly popular. National advertisement campaigns showing patients after robotic-assisted joint replacements recovering more quickly and gaining better function are filling internet searches for total hip and knee replacements. The real question is, does it matter? Does robotic assistance in hip and knee replacement really make a difference? Should you as a patient or family member seek out surgeons using this technology?
Read MoreGoing to the Dentist after Joint Replacement
The concern with dental work after joint replacement is a possibility of inducing infection. Bacteria from your mouth can enter your blood stream and settle onto your implant. Approximately 6-13% of total joint infections involve bacteria primarily found in your mouth. The highest rate of infection is within the first 2 years after surgery. While this does not directly mean that bacteria from the mouth cause joint infections, the association is strong and concerning if you happen to be unlucky!
In 2003, the American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS) first published guidelines regarding antibiotic use for dental procedures following hip and knee replacement. These recommendations have been addressed twice by this joint panel since that time, with the latest publication in 2012 suggesting that the data is not strongly for or against antibiotics before dental work. Ultimately, the [social_warfare buttons=”Facebook, Linkedin”][social_warfare]decision to use antibiotics for dental procedures should be made with consideration of each patient’s health and surgery.
Is Outpatient Joint Replacement Right for You?
Why Should You Consider Outpatient Hip or Knee Replacement?
Joint Replacement is a relatively major surgery. Typically, patients spend 1-3 days in the hospital following the procedure to work with physical therapy and monitor for issues with pain. The hospital setting has been very successful, so why change something that works?
Patient Experience
The hospital is a busy, and sometimes, chaotic environment, and the many moving parts are not always directed towards your direct care. In the ambulatory setting, there is considerably more surgeon control over the care episode. The teams are smaller and highly specialized, translating to an efficient and more personalized experience. Most centers that perform outpatient total joint procedures are highly specialized for orthopedic care. The Boston Out Patient Surgical Suites performs only orthopedic procedures, and as a result, everyone on the team has extensive experience and interest in your case.
For you, outpatient joint replacement will likely be a less stressful surgical experience….and this means a quicker recovery.
Can You Be Allergic to Your Hip or Knee?
What is Metal Sensitivity?
Metal sensitivity(or metal hypersensitivity) is an allergic reaction triggered by the body’s immune system. Unlike the clear and immediate reaction one might experience to pollen and dust, allergies to metal present in a more delayed fashion. Basically, your body develops a negative memory regarding a specific antigen (i.e. metal) and overreacts when that metal shows up again. It’s not usually an immediate response like a bee sting, but rather, it can take several days or more before the signs begin to appear.
Metal Content in Total Joint Implants
When a patient has a reported allergy to an orthopedic implant, it is usually a reaction to nickel, cobalt, or chromium. The incidence of sensitivity to nickel (usually seen as a skin reaction to cheap jewelry) is 10-15%, but to date, there is not a consensus between this type of reaction and issues with orthopedic implants containing nickel.
How Long Will My Hip Replacement Last?
A common question we as surgeons, and you as the consumer, are faced with is: “How long will my hip replacement last?” It’s easy to rattle off a number, but the reality is not so cut-and-dry.
According to CDC data, in 2010 alone >310,000 hip replacements were performed in patients age 45 and older. Recent projections expect that number may reach almost 600,000 by 2030. We are seeing a significant increase in hip replacements for younger patients. From 2000-2010, the population with the largest volume increase was age 45-54. Additionally, by 2010, hip replacements in patients age 55-64 accounted for a higher percentage than those >75.
SOURCE: CDC/NCHS, National Hospital Discharge Survey, 2000 and 2010.
Does Approach Matter for Hip Replacement?
In the past few years, there has been a debate among physicians and patients regarding the “optimal” approach for hip replacement. If fact, considerable marketing has been deployed to attract patients to a surgical approach, citing rapid recovery, minimal or no pain, muscle-sparing exposure, and return to unrestricted activity. The frank reality is that these outcomes are possible with almost any of the common approaches today. The American Academy of Hip and Knee Surgeons (AAHKS), which is the largest collection of fellowship-trained specialists in total joint replacement, has concluded that “the best approach is the one your doctor is most comfortable with to allow safe and precise implantation of your hip replacement components.” As a patient, you should choose the surgeon and trust on their decision regarding the approach.
Surgical Hip Approaches https://musculoskeletalkey.com/the-hip-5/
I personally prefer the direct anterior approach for most of my primary hip replacement procedures. In certain circumstances, I will also utilize a direct lateral or posterior approach, but I plan for each and every case on an individual basis based on specific patient characteristics. There are benefits and disadvantages to every approach, and despite what marketing campaigns have proposed, no approach is infallible.
Opioids…A Growing Epidemic
Last week, Tiger Woods was pulled over for driving under the influence…of opioid medications. He is not an IV drug user and he was not drunk behind the wheel. Instead, his judgement was clouded, at least in part, by very strong pain medications. His picture was plastered over every major news outlet, and for better or worse, he is becoming today’s face for an epidemic.
A 2016 Washington Post/Kaiser Family Foundation survey found that 1 in 3 patients who took opioids for at least two months reported feeling addicted or dependent on the drugs. In addition, patients taking opioids prior to surgery have greater post-surgical pain, and face a higher risk of pneumonia, over-sedation and even death. It is not uncommon to have post-surgical patients report they felt symptoms of “withdrawal” after they stopped taking their pain medications only a few weeks following surgery.