J Bone Joint Surg Am
2020 Mar 18;102(6):468-476.
294 Knee Replacements in a Study Group of 3,417 were deemed “likely” Inappropriate
According to the Journal of Bone and Joint Surgery, it is clinically relevant to ensure that the patient is actually ready for joint replacement surgery to maximize benefits. “Undergoing total knee replacement too early may result in little or no benefit while exposing the patient to the risks of a major operation.” The study further states that waiting too long for a replacement can also have long-lasting problems.
What other options are there when it isn’t time for joint replacement surgery? Platelet Rich Plasma, Bone Marrow Concentration, and Micro-Fractured Adipose Tissue (fat) are available to mitigate pain, regenerate tissues, and reduce inflammation in osteoarthritic joints.
When a Joint Replacement is indicated, there is little disagreement in the Orthopedic Joint Replacement Centers of Excellence regarding the symptoms, limitations of function, and changes on both X-Ray and MRI that will lead to a surgical recommendation. On the other hand, an adverse outcome to a Total Joint Replacement is a difficult challenge for the patient and the surgeon. Infection, failure to regain a functional range of motion, intraoperative fractures or ongoing pain to name a few potential reasons for a failed joint replacement, may be permanent and difficult to treat if not impossible to correct.
In the scientific publication cited above, 8.6% of the population studied did not meet the recognized inclusion criteria for a Total Joint Replacement. I don’t know why the surgery then was recommended or undertaken; but when there is a question, get a second opinion. I have been asked to provide an expert opinion in a failed total hip replacement wherein the patient prior to surgery was playing golf and tennis. The physical findings were consistent with symmetrical hip motion. Because of occasional pain, an MRI had been prescribed and was compatible with acetabular labral degeneration. The preoperative X-ray excluded anything greater than grade 2 osteoarthritic changes. While the patient had sought a possible arthroscopic remedy, the surgeon had recommended a Total Hip Replacement based on the theory that the patient would “probably” develop an arthritic hip in the next five years and then require a Total Hip Replacement. Nine months after the Total Hip Replacement. the patient underwent revision surgery to correct a postoperative leg length inequality of greater than ¾ of an inch. The patient has never returned to golf or tennis. It is more likely than not, an orthobiologic intervention would have prevented the unsatisfactory, life-changing outcome.
To learn more, visit my website at www.sheinkopmd.com. Better yet, call and schedule a consultation at (847)390-7666.