Comprehensive Joint Replacement Study
September 15, 2008 – 7:11 pm Dr. Mitchell SheinkopA comprehensive study using our data on hip and knee replacements is under way. My preliminary data raises some concerns about the new surgical techniques of hip resurfacing and unicondylar knee replacement.
Hip and knee replacements are amongst the most frequent surgical operations performed; however there is little evidence to compare the patient outcomes of hip and knee replacement with the many types of surgical techniques and prostheses used to replace the joint. We don’t have a national joint replacement registry wherein immediately following surgery, patient characteristics, the type of prostheses, and the surgical technique used to replace the joint are memorialized with the aim of providing patients, healthcare professionals and regulators with evidence to assess these prostheses and techniques.
In order to identify the revision rates - how often the hip or knee replacement has to be re-done , I have entered every surgical patient in to a long term outcomes surveillance data base over the past 35 years.
I am now reviewing revisions for any reason in the past years following a hip or knee replacement with particular attention to hip resurfacing and unicondylar knee replacement, two techniques that are increasingly used but about which there is little long term evidence of performance. Hip resurfacing was introduced in 1990s for younger patients or those with less severe disease. Rather than replacing the head of the femur, as happens in total hip replacement, the diseased surface of the joint is replaced with a metal component. In unicondylar knee replacement only the damaged part of the knee is replaced
and it also results in shorter recovery time.
As expected the patients who had cemented prostheses - cement being used to position the metal implant in place in the original replacement surgery - had the lowest revision rates. For hip replacements, the highest revision rates were experienced by women who had undergone hip resurfacing rather than total joint replacement. Of patients who had undergone knee replacement operations, those who had unicondylar prostheses have the highest revision rates.
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2 Responses to “Comprehensive Joint Replacement Study”
I would like to know what the best procedure is after hip surgery to reduce the risk of blood clots. One surgeon uses comadin and another gives lobinox shots for 10 days and aspirin for 30. Is one better than the other?
How do I find out if resurfacing is an option for me? No one has suggested it. I live in TN. Is there someone here who does this? I hear about the newest hip replacement that uses a special table and tools. Is this an option I should persue?
By Diana Brown on Sep 26, 2008
I am a 73-year-old with onset bilateral slipped capital femoral epiphyses at age 12. I have had hip pinnings, vitallium cup arthroplasties and total hip replacements (5 on left and 4 on right). Am now in a precarious position of having a loosening prosthesis on the left side and have been told (here in Kalamazoo, Michigan), that there is no further help that can be provided me to relieve the pain of this joint loosening. My original surgeries were performed at Cook County Hospital,and I have had surgery at both Northwestern Memorial Hospital (Dr. Wixson, and University of Chicago Medical Center (Dr. Martell). Needless to say, mine appears to be an extremely challenging situation (no physician in Kalamazoo has attempted surgery on my hips because they lack the necessary expertise, they say). I am wondering if anyone at this practice might like to take on this challenge. Please respond to my email address as I do not have a blog and can’t grasp the details of setting up a blog. I would appreciate any help you can provide. By the way, I am taking Norco 10/325 five tablets a day along with Flexeril 10 four tablets daily and Robaxin 750 two tablets daily. I anxiously await your response.
By Vera Bogan on Oct 13, 2008