By Dr. Simon Greenbaum, board-certified and fellowship-trained joint replacement surgeon at OAM
Arthritis is one of the most common ailments in the U.S. and can often limit or prohibit a person’s daily activities. The surgical solution for arthritis in the knees or hips is a joint replacement which is generally considered a very successful procedure.
As the medical field is constantly evolving, there are four innovations that I have found to greatly improve outcomes for the appropriate patients:
An Anterior Approach to Hip
During a hip replacement, the surgeon can either make the incision on the front of the leg (anterior approach) or through the back of the hip (posterior approach). Posterior has traditionally been considered the “classic” approach yet anterior has gained traction over the past 15 years or so. Dr. Roy Davidovitch first popularized the approach in New York City, after recognizing the benefits of the minimally invasive anterior total hip replacement, also known as the direct anterior hip replacement. During my fellowship training, I trained with many renowned surgeons including Dr. Davidovitch from whom I learned the direct anterior hip replacement approach.
I have found that the anterior approach is best for the majority of my patients because it is muscle-sparing. As a surgeon, I can move muscles aside temporarily while I complete the operation as opposed to cutting through them, which would be the case if I had gone in posteriorly. In my practice, my patients have experienced faster recoveries, especially in the early stages, when I utilize the anterior approach.
Same-Day Joint Replacements
We can now perform hip and knee replacements in an outpatient setting without requiring an overnight hospital stay. Patients can get their operation done at an ambulatory surgery center such as East Hills Ambulatory Center, or even at a hospital such as St. Francis or Huntington Hospital. Sometimes patients opt to have their replacement at a hospital so they can determine if they want to stay over or go home after the surgery is complete.
The biggest benefit of an outpatient surgery is that patients can sleep in their own bed that very night and do physical therapy at home. Since joint replacements are elective surgeries, there is an advantage to not spending extra time in a hospital if you are not sick. Good candidates are typically younger with fewer health issues and a strong support system at home, although older patients have also been shown to do very well with outpatient surgery. There is also an emotional component to going home the same day – people tend to feel better and recover quicker.
The surgery itself is exactly the same, just done in a slightly different environment. I have found that the anterior approach is an especially good fit for an outpatient surgery due to the quicker initial healing as well as fewer physical restrictions post-op.
Cementless Knee Replacements
Traditionally, surgeons “glue” the implant into the bone with bone cement during a knee replacement surgery. For decades, hip replacements have been performed without cement, and the bone grow into the implant, fixating the hardware on its own. It took a little longer to perfect the technology for knees, but now it’s quite good. This is an excellent option for younger patients and/or overweight patients. It’s helpful to have different techniques available in the operating room so I can really tailor each surgery to each patient. I see the strong benefit of trusting the patient’s own bone to incorporate the implants instead of utilizing bone cement. When the patient’s bone is strong, they are a good candidate for this method. There is the potential for better longevity as you don’t have the layer of cement that can loosen and potentially lead to complications. This surgical style is becoming more and more common, and I would estimate about half of the knees that I replace now are done without cement.
New Options for Physical Therapy
Physical therapy (PT) is a large part of any patient’s recovery especially after a joint replacement. Today, there are many PT options available for patients ranging from in-person to virtual to patient-directed through apps. It’s important to talk to your surgeon about what method is best for you. In my practice, I offer all patients the opportunity to utilize a mobile app which allows them to guide the therapy themselves as well as provide remote therapeutic monitoring so I can follow their progress. Patients can also contact me directly with any questions. It is best to enroll in the app prior to surgery as it also provides some pre-surgical education that can be helpful.
I have found this is an especially attractive option for people who are getting their second side replaced since they already have a good idea of what the therapy entails. It’s also a nice alternative for those who don’t want to go to a rehab facility and can even potentially reduce patient costs.
Each patient is unique and each of their joints are unique. What’s right for one patient may not be best for another, or even for their alternate side. It’s important to speak to your orthopedic surgeon about what is best for your particular case.
About Dr. Simon Greenbaum
Dr. Greenbaum is an orthopedic surgeon at Orthopaedic Associates of Manhasset, specializing in adult hip and knee joint replacement and revision. Please call his office at (516) 627-8717 to schedule an appointment or request an appointment online.