HIP RESURFACING

Maintaining an active lifestyle can be difficult when hip pain interferes with most daily activities. The most common cause of hip pain is osteoarthritis, also known as “wear-and-tear” arthritis. Osteoarthritis is a degenerative joint disease in which the protective cartilage wears away and exposes the ends of the bones, creating narrow spaces and rough surfaces between the bones of the hip joint.

Hip resurfacing is typically recommended for younger patients with strong bones. Patients under the age of 65, those who actively participate in athletic activities, and those who have good bone quality, benefit the most from hip resurfacing.

Hip resurfacing is a surgical procedure that allows the preservation of as much of the bone of the joint as possible, by reshaping (instead of removing) the head of the femur. The procedure also includes the placement of a new surface in the socket. In comparison, total hip replacement involves the complete removal of the head of the thighbone.

The benefits of hip resurfacing compared to traditional total hip replacement include:

• A more natural fit of the joint components post-op
• Reduced risk of dislocation due to a more natural size implant
• Greater range of motion, stability, strength, and a more natural walking pattern post-op
• Quicker return to an active lifestyle

TOTAL HIP REPLACEMENT

Patients suffering from severe arthritis of the hip, who continue to suffer from increasing pain symptoms even with the use of conservative treatments, or who have a decreasing range of motion and flexibility will often receive the most benefit from total hip replacement surgery.

During total hip replacement surgery, the latest techniques are used to remove the damaged bone and cartilage on both the ball and socket of the hip joint. The damaged areas are then replaced with a metal, ceramic and plastic prosthesis designed to recreate the natural movement of the hip joint.

By using sophisticated surgical techniques, the amount of disruption caused to the surrounding tissue during surgery is minimized, as well as a more natural placement of the prosthesis. Depending on the patient’s needs and condition, the recommended procedure will either be the superior approach or the anterior approach.

The superior approach to total hip replacement decreases pain from hip replacement and allows patients to recover from surgery without any restrictions on activity. During traditional hip replacement surgery, patients may not achieve a full and stable range of motion postoperatively. Using the superior approach, a full range of motion is allowed and encouraged from the very start. Accessing the joint through the front reduces the chance of a hip dislocation to be very unlikely.

The advantages of the superior approach include:

• Decreased length in hospital stay and freedom of movement
• Limited postoperative pain
• Minimal blood loss, eliminating the need for transfusion
• Better ability to perform high quality intraoperative imaging
• Decreased risk of dislocation and more natural-feeling joint placement

With the anterior approach, an incision is made at the front of the hip. This approach is selected if there is a significant flexion contracture or if the patient has an anterior scar from prior surgical procedures or prior femoral artery catheterization. Like the superior approach, the anterior approach provides great stability to the hip, with a lower risk of dislocation after surgery. Intraoperative radiographs are also easier to obtain with the anterior approach, if necessary.

PARTIAL KNEE REPLACEMENT

For patients with active lifestyles, osteoarthritis can be a debilitating diagnosis that wears away at the bones and causes immense pain. A degenerative condition also known as "wear-and-tear arthritis," osteoarthritis worsens over time as it breaks down the joint's protective cartilage. Protective cartilage is integral to musculoskeletal function, as it allows a joint to move through its range of motion without experiencing friction. Without it, bone rubs against bone, making movement extremely painful.

Many patients may be well suited for a minimally invasive approach to knee replacement that preserves healthy bone and can potentially provide a more natural feeling implant and a faster recovery time. When arthritis is confined to a single compartment within the knee, partial knee replacement may be a viable solution. This approach is preferred for patients who still want to pursue an active lifestyle after removal of the arthritic knee tissue.

The type of knee replacement needed – total or partial – will be dependent on several factors such as the extent of the symptoms and degree of cartilage loss. Patients who are candidates for partial knee replacement should be:

• Not significantly overweight
• Have intact knee ligaments
• Experiencing pain in only one area of the knee

For patients with more extensive cartilage loss, a total knee replacement will be the best option for providing necessary relief.

TOTAL KNEE REPLACEMENT

For patients with more extensive cartilage loss, a total knee replacement will be the best option for providing necessary relief. As more of the joint is touched during this surgery approach, recovery tends to be slower (than in comparison to a partial knee replacement) due to the larger amount of healing required. However, following the initial phase of recovery, over 90% of patients report dramatic pain reduction, as well as an improved ability to complete everyday physical activities.

For knee replacement procedures, a minimally invasive approach is used whenever possible. Using an incision at the front of the knee, the damaged bone and cartilage is removed, and the bone surfaces are shaped to accept the artificial joint. The prosthesis is composed of three pieces designed to recreate the natural pain-free movement of the knee joint: the metal femoral component (covers the end of the thigh bone), the metal and plastic tibial component (covers the end of the shin bone), and the plastic patellar component (fitted to the kneecap).

During the procedure, there are several different techniques and technologies that may be used to provide the best possible results for the patient’s needs and to improve the recovery process.

Modern knee surgery offers a less invasive option for the removal of diseased bone and cartilage, requiring less cutting than a traditional operative approach. Potential benefits of contemporary knee surgery include, but are not limited to:

• Reduced cutting and associated bleeding
• Faster recovery times
• "More natural" post-op knee performance and feeling
• Potential increases in prosthetic longevity

Another advanced option is the Cruciate Retaining Knee Implant if the anterior and posterior cruciate ligaments (ACL and PCL) are still healthy and strong, using a cruciate retaining knee implant during a total knee replacement procedure allows for less disruption to the surrounding areas during surgery, a more natural movement after surgery, and allows patients to maintain the full stability of the joint after surgery.

SHOULDER RESURFACING

While performed with less frequency than knee and hip replacement procedures, shoulder resurfacing provides a viable recovery option for patients suffering from pain and disability. There are several surgery options, and the best approach will be determined following assessment of a range of factors. For younger, more active patients, shoulder resurfacing offers a more conservative treatment option, as compared with total joint replacement.

Shoulder resurfacing allows for replacement of only the humeral head’s surface or both the socket (glenoid) and humeral head. The diseased and/or damaged bone will be smoothed and then covered with a stemless, cap-like prosthesis. This procedure is an option should the patient be young, active, and have healthy bone quality.

TOTAL SHOULDER REPLACEMENT

Shoulder replacement surgery is a complex procedure, which requires a significant degree of personalization for each individual patient. The specific surgical approach taken will depend on the exact areas and types of damage, as well as the patient's overarching body structure. Prosthetics are available in a range of sizes and materials and may be cemented or "press fit" into place.