Joint Replacement and the Rise in Revision Surgery
Total joint replacement is one of the most cost effective and successful surgeries in medicine. But even though total joint replacements are highly successful, the national need for revision or “redo” surgery has been skyrocketing.
What is total joint replacement surgery?
Total joint replacement surgery, or arthroplasty, is a surgery performed on the joints in the body—hips, knees, shoulders, and even ankles, fingers, elbows, or intervertebral discs. These surgeries involve removing part of the joint and replacing it with an implant, which allows the patient to regain their ability to enjoy their daily lives with little to no pain.
During a total knee replacement, the surgeon removes the worn-off cartilage, and resurfaces the joints with a metal alloy implant. This implant gives the patient the smooth movement they once experienced and allows a return to weight-bearing daily activities.
Total hip or total shoulder replacement is a more complex procedure as these are “ball and socket” joints. During replacement surgery, what is known as an articulating ball is replaced, and implants are inserted into the central canal of the bones.
A "good" surgery involves more than the process of implantation. It also must balance and preserve the tissue, ligaments, and tendons around the joint. This will allow the patient to maintain stability and an appropriate balance of force and strength. Patients struggling with arthritis, deformity, and stiffness can get a new lease on life, but only if surgery is done right.
What is joint revision surgery?
Simply put, a revision surgery is a "redo" of the initial surgery. For any number of reasons, a person who has had joint replacement surgery may find that they need to have the surgery again. Some people who had an initial surgery done 20-plus years prior may find that they need revision surgery as the materials in the initial implant have worn down. Occasionally, people find themselves needing joint replacement surgery much sooner—sometimes within a year.
The rising need for revision surgery
Medicare statistics suggests that most total joint replacements in the United States are performed by community orthopedic surgeons who do less than 25 such surgeries a year. The lack of experience and the increasing numbers of joints done with aggressive indications leads to many surgeries needing redoes.
The results of surgery and its success are directly dependent on:
- surgeon experience
- surgical efficiency
- presence of standardized medical care protocols
When it comes to successful joint replacement surgery, nothing is more important than experience, careful planning, and a quality hospital system using well accepted protocols that follow clinical evidence and research. Advanced technology like navigation and robotic surgical systems and sophisticated technologies have been designed to compensate for surgeon skill and accuracy in joint replacement surgeries. However, a review of current research suggests no difference in leg alignment or long-term functional outcomes. It’s mind over matter – nothing trumps experience. Have you asked your joint surgeon what is their rate of revisions and if they are comfortable in continuing to care for you if things don’t go as planned?
Total joint care done right the first time
At the Total Joint Center, we continually work to optimize total joint care to produce superior outcomes. Those outcomes are not only backed by word of mouth but also results and statistics from thousands of our patients.
We participate in a national joint surgery registry that allows benchmarking, comparisons, and standardization with national results. We carefully collect information on:
- patient function before surgery
- details of the operation (anesthesia, surgical time, implants used, blood loss)
- length of hospital stay
- repeat visits to the emergency department
- patient function at three months and 12 months, including distance walking, stairs, pain, and overall satisfaction
This data allows precise monitoring of surgeons’ work to make sure our patients receive the best care. Our goal is to do it once and do it right.
Unlike a community hospital practice wherein surgeons may focus on general orthopedic care, all the surgeons at the Total Joint Center specialize and focus all their time on joint replacement surgery. To achieve such expertise requires dedicated fellowship training, spending extra time to learn all details of joint replacement including minimally invasive techniques, modern anatomic approaches, implant designs, and industry best practices.
It all again comes down to experience – building experience and learning from the best. Our surgeons are fellowship trained at notable institutions including Massachusetts General Hospital, Harvard, Mayo Clinic, Baylor, and Columbia, after already completing more than five years of orthopedic surgical training. Have you asked your surgeon if they are fellowship trained in total joints?
Our surgeons are also training the next generation of joint replacement specialists by actively participating in the Brown Adult Reconstruction Fellowship program. We train future surgeons who will continue to excel in what they do. To use the analogy of car mechanics, at the Total Joint Center we do not just do oil and filter changes. We understand how the engine works so we can appropriately diagnose and fix the problems that patients bring to us.
High quality joint replacement surgery near you
Quality is defined as the standard of something as measured against other things of a similar kind. Understanding the definition of quality is the first step in achieving it. The Total Joint Center has consistently excelled by:
- defining the national standards
- closely following institutional and surgeon-specific patient results
- benchmarking against national standards
- focusing on improvement processes to further optimize results
The proof of the quality of our program is in our national accolades, patient satisfaction data, and community support. This is the place where other surgeons go for their questions, education, difficult cases, and conundrums.
If you need revisions to a joint replacement, our experts are here for you. But of course, we would rather do the procedure right the first time around and show you what the proven national registry outcomes are all about.
About the Author:
Valentin Antoci, MD, PhD
Dr. Valentin Antoci is an orthopedic surgeon with the Total Joint Center at The Miriam Hospital and director of the Total Joint Replacement Program at Newport Hospital. He has a particular interest in unicompartmental partial knee replacement, minimally invasive surgery, complex reconstructions, failed total joints, preservation techniques, and trauma.
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