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Joint replacement is changing fast

Recovery times are getting faster. And more change is coming



Joint replacement surgery is becoming more common among Americans. In fact, more than 7 million Americans are living with an artificial knee (4.7 million) or hip (2.5 million). And a growing number of people undergoing these procedures are younger than 65. With an aging population, experts believe demand for joint replacement will only continue to grow.

In light of this anticipated demand, Charlotte Orthopedic Hospital is expanding. On October 15, the newly expanded hospital will open its doors to the public. It will offer 32 patient rooms, 7 operating rooms, 11 post-anesthesia care bays, 14 pre- and post-operative rooms, a pre-surgical wellness unit and a rehabilitation gym.

Orthopedics has changed greatly over the last decade and continues to evolve. We spoke to Dr. David Homesley, an orthopedist at Novant Health Barron, Homesley and Valentine Orthopedic Specialists about the changes and what is on the horizon. 

What is different about orthopedic surgery today compared to 10 years ago?

We have improved how quickly we can return patients to their normal activity more safely and make the recovery less painful.  We balance the faster recovery with making sure patients do not return to their activities too quickly.  Often patients feel so great that they are ready to push their post-operative rehabilitation faster than their body can heal.

What are common misconceptions about orthopedics?

I don’t think most people realize how many subspecialties there are in orthopedics. Over the last 10 years, technology has boomed, and orthopedic fellowships post residency have increased which allow general orthopedists to focus on specific areas such as hand, spine, total joint, and so on. It’s hard for orthopedists to stay on top of everything and the evolving technology in each subspecialty. Patients should research for orthopedists that sub-specialize in the field where they are seeking assistance.

Numerous studies have shown the knee and hip replacement have sky rocketed in recent years. Why is that?

It’s largely due to the large aging baby boomer demographic. They tend to have a more active lifestyle, but even with chronic use problems, surgery is not always necessary. Your orthopedist will suggest other conservative therapies first.

Why are more patients getting joint replacements? Is it due to more active seniors, overuse injuries, rising obesity rates or a combination?

It’s probably a combination of factors. Orthopedic surgeons are actually performing fewer elective surgeries on certain patients because patients and surgeons understand the risks and concerns of complications. We want the patient to have the opportunity to have the best result and research has shown us the underlying conditions that contribute to poor outcomes: such as smoking, obesity, chronic narcotic use before surgery. Before recommending surgery for knee or hip replacement, we will assess patients to see whether they are candidates for surgery because we want to minimize the potential complications that can happen from surgery. We want patients to be medically optimized before we perform elective surgeries.

How long do current replacements last?

With our current technology, we think that the implants could last 20 to 30 years. They do not last forever so there’s a risk that someone might need another implant surgery if it’s performed at a younger age. That’s why we focus on other alternatives and surgery really is a last resort when we have exhausted other options. The idea is not to make you a marathoner again but to restore your quality of life.

Are surgeries less invasive than in the past?

I don’t really like the expression “less invasive.” Surgical technology has assisted with smaller incisions and shorter hospital stays, but a successful outcome really has to do with the patient’s mentality, how we handle the tissue and the management of pain. Today, there is less blood loss, lower infection rates and less pain associated with surgery.    

 Are recoveries quicker? 

Yes, they are. In the last few years, we’ve become more aggressive about getting patients mobile and have them walking hours after the procedure. This helps with blood flow, as it decreases the risk of developing a blood clot and can better control pain. 

What are the advantages of having a dedicated surgical team such as the ones at Charlotte Orthopedic Hospital perform the procedure?

Having a dedicated team in the operating room helps with work flow and makes the surgery more efficient so a patient isn’t under anesthesia for as long. By having a dedicated team of orthopedically trained nurses and physical therapists on the floor, you have individuals who are very familiar with procedures which can help in the healing process and spot concerns more quickly.

 Going forward, where do you expect to see the greatest change?

We’ll probably see the greatest change in patient outcomes and safer surgeries. We’ll probably continue more technology changes and we’ll be better able to evaluate the performance of robot-assisted surgeries as it is still being assessed.

 




Published: 9/19/2017