What Really Matters to Joint Replacement Patients

18 May 2016 Doctors, General, Media , ,

Written by: Ali Dalal, MD

view post on original source – LinkedIn

5/17/16 – Orthopaedic surgeons are often guilty of being “high tech” but “low touch.” Throughout our training we are taught that the best way to care for our patients is to do a good surgery. In joint replacement, surgeons quantify excellence by things we can measure: the efficiency with which the surgery was done, the length of the incision, the appearance of the x-rays after surgery. This however, neglects the patient’s perspective on their disease, and why they sought out care.

There can be a disconnect in results after joint replacement. Some patients achieve satisfaction without reaching what some surgeons consider routine post-operative goals. This is not as frustrating as the opposite scenario when patients are dissatisfied despite exceeding what many surgeons would consider an excellent result. The latter can occur anywhere from 10-15% of time after hip and knee replacement.

Patients in need of joint replacement surgery have a disability that affects their independence and can cause anxiety. This anxiety can be carried into the preoperative period as a fear of their disability becoming worse after surgery. Many of these fears can be addressed pre-operatively by giving patients high quality information on what to expect before and after surgery as many of the questions patients have are similar— “When can I drive?  How do I get my home ready? How long can I expect to be out of work?” The similarity of patient questions makes guides such as mine very helpful. Attending a joint replacement class like the one offered at Tucson Medical Center can also be a therapeutic in demonstrating to patients that they are not alone in the process and that other people have the same fears and questions as they do.

Addressing the similarities of the condition and the process however, is only one part of completely caring for a joint replacement patient. Finding out what individually matters to each person can go a long way.  A study found that satisfaction will not occur unless the patient achieves their most important reason for having the operation. This can mean something different to each person—not limping in public, being able to get on and off the floor with grandchildren, or being able to get back to taking walks or biking. By asking patient’s what their goals are after surgery, we can effectively counsel them on whether they have a realistic expectation of what the surgery has to offer. Being sensitive to people’s cultures or occupations can also be very important in helping set expectations. For example, patients that kneel during worship or work should be counseled that this activity could be difficult or painful after knee surgery.  Patients may not always know what questions to ask, it is our job to anticipate our patient’s needs.

Joint replacement surgery is offering patients longer lasting implants, new techniques in pain management, and accelerated rehabilitation. Patients are leaving the hospital and getting back to their homes and jobs sooner than they expected. Pairing these advances with effective surgeon-patient communication and good surgical technique can make joint replacement a positive experience for the vast majority of patients.

1. Dorr LD, Chao L.  The emotional state of the patient after total hip and knee arthroplasty. Clin Orthop Relat Res. 2007 Oct;463: 7-12

How Long Do Modern Joint Replacements Last?

31 Mar 2016 Doctors, General, Media , ,
Written by: Ali Dalal, MD

view post on original source – LinkedIn

3/31/2016 – Every patient that has bone-on-bone arthritis in the hip or knee has thought of this question when considering whether or not to have surgery.  All mechanical parts have a working life, but trying to answer this question for parts that are implanted into people is difficult because each person is different, and may put different demands on their artificial joints.  Nevertheless, it is important to give patients an idea of what they can expect out of their surgery.  The question becomes harder to answer as significant improvements are made in artificial joint design, but these advances also hold the promise of providing better longer lasting implants.

The biggest scientific advancement in total hip and knee replacement has been in the polyethylene or “plastic” liners. The majority of hip and knee replacements implanted in the United States consist of a metal and plastic articulation or bearing surface. This is the part of the joint replacement that actually moves.  One of the most common sources of failure is the metal or “hard” surface wearing away the plastic or “soft” surface. A recent article on the long term results of new plastic liners in hip replacement found that at 13 years after surgery in relatively young, high demand patients (age 45-65), 100% of the hip replacements done with new plastic had survived. Furthermore, none of those hips had any indication of plastic wear visible on x-rays.

The newer plastic technology was adopted later in total knee replacement, and long term data are not as clear. Mechanical simulator testing, however, has shown no wear in knee replacement plastic liners after one million cycles.  A recent study found that when including all risk factors for failure of knee replacement including those that are unforeseen such as infection, 95% of artificial knees lasted at least 10 years.

As doctors we must give our patients a thorough explanation of risks, benefits, and alternatives to joint replacement surgery.  That being said, delaying an effective and durable treatment that has been shown to improve quality of life because of a fear of implant failure may not be necessary for a large number of patients.

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