By Daniel Markowicz, MD
The hip and knee joints are two areas of our bodies that are most prone to wear and tear over time, given their vital role in human movement. When the cartilage that cushions the bones within these joints begins to ebb away (from a lifetime of use or as the result of an injury to the joint), the result is osteoarthritis.
Osteoarthritis, also known as degenerative joint disease, is the most common form of arthritis. Other types of arthritis include rheumatoid and psoriatic arthritis which are inflammatory and involve joint swelling. At Hospital for Special Surgery (HSS) we see patients with varying forms of arthritis, including post-traumatic arthritis, which is caused by a bone fracture suffered in the past that extends into the joint and then speeds up cartilage loss.
If you’re suffering from hip or knee pain which is limiting your mobility, it’s time to see an orthopedist who specializes in treating these joints. During an examination, we typically find patients are challenged by limited motion, pain with motion, or tenderness when the knee or hip is palpated.
Arthritic conditions are especially prevalent in those aged 60 and up. At HSS, we also see younger patients with arthritis, in their 40s and 50s. Often, their conditions may be due to a congenital developmental problem in which their anatomy has accelerated levels of wear and tear over time.
With imaging — either an x-ray, CT scan or MRI — we often see loss of joint space. In the hip, the ball is moving closer or rubbing against the hip socket. With the knee, the end of the femur or thigh bone is getting closer to the tibia or leg bone. In the worst scenarios, the cartilage is completely worn out and there is painful bone on bone contact.
Non-Operative Treatments
For some patients, non-operative treatments are advised, at least initially. One goal is to slow down the progression of arthritis with a range of non-surgical treatment options. Every pound on the scale feels like three to four added pounds on your knees and hips, so weight loss is an important non-surgical treatment.
Options to help treat the symptoms of arthritis include anti-inflammatories; physical therapy; modalities like heat therapy, cold therapy, ultrasound and electric stimulation to modulate pain and inflammation; braces to help offload pressure on a portion of the joint; steroid injections to decrease inflammation or gel injections for lubrication; and acupuncture.
Time for Joint Replacement
Some telltale signs for when hip or knee replacement is advised is when a patient’s joint pain is so pronounced that their mobility and quality of life become compromised and non-surgical treatments have failed to provide acceptable pain relief.
Technology Improves Precision, Accuracy
HSS is at the forefront of computer- and robotic-assisted joint replacement capabilities. We have conducted research in this area, helped design some of these technologies and often trial them before general release to the public.
I use some form of advanced technology like robotics or navigated computer assistance for all first-time joint replacement patients. Advanced technologies improve precision and accuracy during surgery, both in preparing the bones and inserting implants used to hold the new joints in place.
Robotic-assisted surgery allows us to develop a surgical plan with much greater precision before even entering the operating room. We can obtain a pre-surgical CT scan to create a virtual 3D model of a patient’s joint to help inform our surgical planning.
Computer-assisted tools allow us to adjust our surgical plan intra-operatively, using a patient’s leg movements and ligaments to guide implant positioning.
Precision = Better Outcomes
With joint replacement surgery, we want to be as exact as possible as we are often dealing with measurements in millimeters and degrees for bone preparation and implant insertion. Robotics and computer-assisted tools allow us to dial in very small changes to help deliver a well-functioning new hip or knee versus one that may be slightly unstable or does not feel quite right.
With these new capabilities we are not removing the art of medicine from surgery. Surgery still demands a hands-on approach by the surgeon, but there are limits to what a surgeon’s hands can do with the very small incremental changes needed to deliver greater precision and better surgical outcomes.
These enhancements dovetail with our overall philosophy at HSS. We’re always researching and seeking better and more efficient ways to treat patients.
Future: Ongoing Improvements
We will continue to see enhancements not only in joint replacement techniques but also in the materials used during these procedures. One example is device makers using 3D printing technology to produce better, more long-lasting joint implants. Another example of using technology to help perform surgery is Augmented Reality (AR). HSS was the first hospital to perform a total knee replacement using AR.
Software navigation tools are also improving, helping surgeons work better and faster. The footprint of the robotic equipment we use is getting smaller as processing power increases. These advances combined with software upgrades ensure greater benefits for patients.
Daniel Markowicz, MD, is an orthopedic surgeon specializing in hip and knee replacement at HSS Orthopedics with Stamford Health.
