Degenerative osteoarthritis (OA) of the hip, knee and shoulder are becoming increasingly more common as the general population ages. Treatment of OA generally starts with anti-inflammatory medication, activity modification and injection of corticosteroids or polymer agents to relieve symptoms and delay surgery if possible. Surgical treatment of joint disease is growing in number and diversity of surgical implants and techniques has increased dramatically in the last decade. In addition, many joint replacement manufacturers have begun direct to consumer (DTC) advertising, increasing the amount of confusion for patients. Nonetheless, joint replacement surgery remains one of the most effective procedures in orthopaedics to relieve pain and improve quality of life.
We focus on patients’ expectations try to give you the most realistic estimate of your recovery, outcome and function. After doing their own research, patients often come to the office requesting a specific implant and/or approach. Evidence based medicine has demonstrated that the functional outcome of joint replacement in the long term is independent of surgical approach but is related to the proper implant position and soft tissue balancing around the joint. Regardless of the approach, we attempt to minimize the soft tissue trauma when performing joint replacement surgery. It is much better to consider long term outcome and function of my patients rather than attempting to place the implants through the smallest incision possible or using the latest surgical approach, especially if outcomes data and evidence based medicine demonstrate no benefit. Approach and implant type are usually dictated by the age, health and activity level of the patient, the anatomy of the joint and the need for future revision surgery. For example, the likelihood of a 40 year old active man needing some type of revision surgery in the future is quite high despite improvements in the longevity of the implants. Any joint replacement procedure should take into consideration this likelihood. In contrast, the likelihood that a 75 year-old patient would require revision joint surgery is very low and this would influence implant recommendation.