New Developments in Local
Special to the Journal by
Deidre Blake, MD
Capabilities in local orthopedic
care continue to expand with the availability of joint revision surgery. If you
have had hip- or knee-replacement surgery and are wondering what is available
to you should your artificial joint wear out, we now have the expertise locally
to address this specific problem.
What causes knee
replacements and hip replacements to fail?
Each patient’s case may be
unique, but artificial joints are constructed from metal and plastic, and the
activities that contributed to the deterioration of your knees or hips in the
first place will also wear out your joint replacements. Repetitive wear over
years is the main factor. High-impact exercises that place excessive stress on
your joints theoretically reduce the life expectancy of your joint
replacements. Another factor in joint replacement and joint revision surgery is
weight. Due to the current obesity epidemic in this county more people are
carrying significant extra weight, which can lead to early wear.
For a variety of reasons, we
are seeing more primary joint replacement surgery on younger patients than was
true of previous generations. While it’s true that knee and hip replacements
can last 15 to 20 years or longer in many people, others will require joint
revision surgery much sooner. This means that if you had your first joint replacement
surgery at 50 or 60 years of age, it’s very possible that you will require
joint revision surgery in your early seventies.
How does joint revision
When a failed primary joint
replacement is removed during revision surgery, the surgeon often discovers
that the patient has significant bone loss. Historically, this has been one of
the biggest challenges of joint revision surgery because there is often
insufficient bone on which to place the new hardware.
We are now using an
innovative type of orthopedic hardware called a metaphyseal sleeve. This is a
new implant that fits inside the tibial bone like an inner sleeve, allowing
bone to grow directly into the sides of the implant, providing strong
structural support. The surgeon first fills in bone defects with cement and
bone grafts when necessary and then places the sleeve, providing a stable
platform for the new hardware to sit on. We are having excellent success with
metaphyseal sleeves in knee-revision surgery.
In hip-revision surgery, we
are using new trabecular metal augments for the acetabulum, which is the socket
in the pelvis that holds the head of the femur and forms the hip joint. This
hardware effectively fills in bone defects and reconstructs the acetabulum with
metal. Like the metaphyseal sleeve, the components of the acetabular implants
are made of a special porous material that encourages the patient’s bones to
grow into it, creating a very sound structural base for the new joint.
Are there other new advances
we should know about?
Innovations in the field of
orthopedic surgery are ongoing. We have new hardware materials using plastic,
ceramic, and metal that last longer and wear more slowly. New gender-specific
total knee replacement hardware is also available as an added option for more
petite females with narrow femurs. In short, we now have several options to
discuss with our patients, which helps us provide highly individualized care.
As an orthopedic surgeon
with fellowship training in primary and revision joint replacement surgery, I
am excited about the ongoing improvements and surgical options. We see patients
ranging in age from their late forties to their late sixties. Some of these
patients have had previous joint replacement surgery and for various reasons
their joint replacements are failing. We can now help this population, as well
as older joint-replacement patients, with joint revision surgery right here in
our own community.
Dr. Deidre Blake is board-certified
orthopedic surgeon who did her fellowship training in joint revision surgery at
Weill Cornell’s Hospital for Special Surgery. She serves on the medical staffs
of Cayuga Medical Center and Schuyler Hospital and can be reached at Orthopedic
Services of CMA at (607) 272-7000.