- Posted January 26, 2014 by
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Total Joint Replacement Should Be Last Resort
Orthopaedic surgeons improve the lives and the mobility of their patients and work to dispel the misconception that surgery is the only option available for hip and knee problems. They believe that surgery, when absolutely the last resort, results in poor outcomes. Non-surgical solutions should always be considered first.
In his interview in The San Diego Professional Journal Dr Fabi said “The goal of the specialty is to enrich the quality of lives of patients. When quality of life is decreased and conservative measures are not the best choice, then surgery is recommended.”
Controversy has arisen over hip replacements performed from the front (anterior) or the back (posterior). Anterior hip replacements have decreased dislocation rates, quicker recovery and the ability to use x-rays during surgery for more accurate placement that spares muscle trauma. The down side is that there’s a steep learning curve for the procedure, increased fracture risk and increased potential for nerve injuries.
The surgeon must stick to what they are successful at and what works best in their hands and the results. Either approach has excellent results in the appropriate surgeon’s hands. Many surgeons perform both procedures. Many results seem to be equal. A more important factor is whether the surgeon is a high volume joint replacement surgeon. Most high-volume surgeons have favorable outcomes no matter what approach.
Dr. Craig J. Della Valle is one of the top hip surgeons in the nation, associate professor at Rush University Medical Center in Chicago, and concurs with Fabi’s position. “I honestly don’t think it will make a difference in terms of patient based outcomes,” said Della Valle. “I think in expert hands it works, but I am not sure it will make a difference to the patient, which at the end of the day is what is most important.”
That expert opinion is echoed by Dr. Keith R. Berend, internationally known high-volume surgeon at joint Implant Surgeons in OH, co-developer of the Biomet Rapid Recovery Program. “The anterior incision end up being pretty small,” said Berend. “The anterior approach spares muscle and enhances recovery.”
If you are considering joint replacement, the best advice is that patients ask their surgeon about their rate of infection and dislocation rate, and overall patient satisfaction. Look for infection rates of 0.5 percent and dislocations of 1 percent or less. Satisfied patients should be able to return to work within two weeks.
Surgeons should examine all treatment options, including anti-inflammatory medications, steroid or hyaluronic acid injections, along with physical therapy and the use of braces, canes and walkers. If surgery is the only option left, patients should seek clinicians that perform an average of 150 knee replacements and/or 100 hip replacements annually.
Important things to look for an orthopaedic surgeons is one with an established reputation among patients and other physicians, adequate experience and training and a good bedside manner. When combined, these three qualities will quicken a patient’s recovery.
Good doctor-patient relationships will improve treatment outcomes. Individuals need to seek a clinician with whom they have a common interest. “Look for a surgeon who has a wide array of interests and knowledge with which you can make a connection,” said Dr. Fabi. “When a patient and clinician share a connection, that connection will make for a very special experience and help improve outcomes.”
Dr. Keith R. Berend, Implant Surgeons http://www.jointimplantsurgeons.com/
Dr. Craig J. Della Valle, Rush University Medical Center http://www.rush.edu/
Dr. David Fabi The San Diego Professional Journal http://medical.sandiegoprofessionaljournal.com/dr-david-fabi/