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Musculoskeletal Care of the Mature Patient

 What’s the best hip or knee prosthesis? More importantly, do you really need surgery? What about the type or length of that surgical incision? Is a 23-hour hospital stay for a joint replacement the best option?

While I have been personally involved in data collection and clinical studies for over 35 years, it wasn’t until April of 2009, that a sincere global initiative was introduced within the American joint replacement community to create a United States total joint registry.

Scientific outcomes, patient satisfaction, and prosthetic performance studies leading to publications after total hip and total knee replacement continually provides me with information concerning what works and what doesn’t work. The problem is an inherent potential bias in the reporting process. That bias is eliminated with a joint replacement registry. Recently, other criteria for prosthetic performance have been established by way of Product Recall announcements from the several orthopedic manufacturers. The latter is a retrospective announcement when a prosthesis fails to perform after FDA approval and the company is sent a warning letter by the government agency. Until 2008, orthopedic companies have been preempted from legal redress for product liability but that protection has taken away by the Congress.

The reasons for considering hip or replacement surgery are to relieve pain, restore motion, correct deformity, and improve the quality of life. Whether at age 45 or 85, published studies have documented patients with arthritis of the hip and knee, who have undergone joint replacement surgery, in over 95% of those studied recorded a very high degree of immediate as well as long term satisfaction with the results of surgery.    Published long term satisfaction rates have allegedly remained not too different; but recent product recalls and s sudden spike in the occurrence of revision surgery maybe reason for re-evaluation of our thinking.

Is this tendency toward increased revision numbers the result of less bone resection and minimally invasive surgery with the promise of rapid recovery. Shorter hospitalization and less pain? Is the increase in revision surgery because of our introduction of new technologies that aren’t living up to the manufacturers’ promise? From the patient’s standpoint, be discerning about where you get your decision making input.

A second opinion is worth the time and effort before deciding on the need for surgery, the surgeon and the type of implant.

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