Total knee and hip replacement surgeries have been around for more than 50 years. But thanks to advances such as robotics, computer navigation, 3D printing technology and new pain-reducing medications, patients today bounce back quicker ? many leaving the hospital the same day as their procedure ? and with less discomfort.
It鈥檚 definitely not your parents鈥� joint replacement anymore.
鈥淚n the last few years, there鈥檚 really been an explosion in technology,鈥� says , an orthopedic surgeon with who specializes in knees and hips. 鈥淎 total knee replacement used to be a very artsy operation, with the surgeon eyeballing the knee without a lot of data. Today, we have better vision with augmented reality and advanced imaging, we are able to make extremely precise cuts with the robot and our implant materials are much better.鈥�
Just as important to Dr. Suarez as the latest technology is the reduction or elimination of opioid use for pain relief. He is leading a clinical trial (more information below) to study a non-addicting, non-opioid medication.
Juan C. Suarez, M.D., an
orthopedic surgeon with
Baptist Health Orthopedic Care.
Every year, there are nearly 1 million hip and knee replacement surgeries performed in the U.S., according to the American Academy of Orthopaedic Surgeons, and by 2030 the organization estimates there will be 3.5 million total knee replacement surgeries alone annually. An aging population that can no longer take part in regular activities because of the pain from osteoarthritis and rheumatoid arthritis, joint degeneration, fractures and other injuries, is driving the increase in cases.
Robotic joint replacement
While not every patient is a candidate for a robotic-assisted joint replacement, the procedure continues to be adopted by more and more surgeons as they better understand the advantages for each patient. 鈥淩obotics is here to stay,鈥� Dr. Suarez says. 鈥淎 surgeon鈥檚 eye doesn鈥檛 really know what 2 degrees is, but the robot does, and this is the accuracy we are talking about.鈥�
Tiny tracking devices placed around the knee or hip of a patient before a robotic-assisted surgery communicate position and location data to the robotic arm. If surgeons decide an adjustment needs to be made during the procedure, the computer can be recalibrated.
When the implant is in position, doctors can also determine the alignment and balance of the new joint, ensuring a customized fit with less risk of instability and pain.
3D models and printing
Real-time 3D images also provide extra information to help surgeons assess implant placement, and 3D printing is helping them manage significant bone loss and challenging cases they were unable to treat surgically before, Dr. Suarez says.
鈥淜nee implants have been heavily cemented in the past,鈥� he says. 鈥淏ut today鈥檚 3D-printed materials are more similar to bone. This allows the bone to grow into the structure, providing biological fixation. We don鈥檛 have to use the same cement to adhere it to the bone and ligaments, and other structures around the knee don鈥檛 have to adapt to a totally new environment.鈥� Doctors are hopeful that the new implants will last longer than the typical 15 to 20 years most people get from a total joint replacement.
How phenotypes and smart devices may impact surgery
Your knee isn鈥檛 necessarily like your brother鈥檚 or your neighbor鈥檚, and doctors are also learning more about the differences in knee anatomy and alignment between men and women and even among ethnic groups. The study of knee phenotypes, or those bows and bends in a leg, leads to a classification that Dr. Suarez believes will eventually help surgeons understand what type of implant and technique is best for a particular patient.
鈥淲e used to do a knee replacement the same way for every patient and we tried to make everyone鈥檚 legs straight with an implant,鈥� Dr. Suarez explains. 鈥淏ut everyone鈥檚 anatomy is different. And, as we collect more data, the joint replacement of the future will improve even more.鈥�
Implantable smart devices are also in the works, collecting and providing data on range of motion, walking speed, gait biometrics and other milestones physicians can use to gauge progress. 鈥淚magine in the future if we were able to detect an infection early on,鈥� says Dr. Suarez. 鈥淭he information we are beginning to gather now will be game-changing.鈥�
The vital move away from opioids
Managing pain before and after implant surgery, and many orthopedic procedures in general, has been a challenge for doctors, who once prescribed opioids for most patients. But with a focus on the opioid epidemic (the World Health Organization says that more than 75 percent of drug overdose deaths involve an opioid) doctors are looking for alternatives.
Dr. Suarez is the principal investigator of a comparing total knee replacement patients who are administered Zynrelef, a gel pain relief medication applied at the end of surgery, to a control group receiving the standard postsurgical analgesia, often opioid prescriptions.
鈥淔or the best outcomes and for patients to handle rehabilitation, they need to have their pain managed. But if a patient is still taking pain medications 90 days after surgery, we know that there is an extremely high chance of becoming addicted,鈥� he says. 鈥淲e are hopeful that this local anesthetic better controls pain in the days following surgery and reduces the need for opioids.鈥�
Outpatient and short-stay joint replacements are becoming more common, thanks to more in-depth patient education, surgical preparation and pain management.
For more information on joint replacement surgery or to find a physician affiliated with Baptist Health Orthopedic Care, click .
