In the last few decades, innovations in joint replacement have resulted in more personalized, accurate and sometimes faster surgeries using implants that last longer.
Dr. Vineet Tyagi, an orthopedic surgeon with Atlantic Health, shares what’s new in knee replacements and hip replacements, and what we can expect in the future.
What is joint replacement surgery?
Joint replacement surgery, also called arthroplasty, is a type of surgery in which a doctor replaces all (total joint replacement) or some (partial joint replacement) of your joint. The two most common joint replacement surgeries Dr. Tyagi performs are hip and knee replacements. Any joint that’s large enough, including ankles, wrists and shoulders, is a candidate for arthroplasty.
People who have experienced a fracture or have arthritis are sometimes candidates for joint replacement surgery. The procedure can help relieve pain, stiffness and swelling, and allow for an increased range of motion.
Cemented vs. cementless implants
During joint replacement surgery, your surgeon will first remove damaged cartilage and bone.
“The primary components of most of our hip and knee replacements are made out of titanium, which is one of the metals that has a density similar to bone,” Dr. Tyagi says.
Often, polyethylene, a high-density plastic liner, is used to create artificial cartilage in conjunction with the titanium. Cartilage covers the ends of your bones, reducing friction when you move.
In the past, most joint replacements were cemented. Cemented implants require bone cement to join the implant to a patient’s bone. However, in the past five to 10 years, Dr. Tyagi says he’s witnessed non-cemented implants, also called cementless implants or press-fit implants, becoming more popular. Cementless implants have a special coating that helps the implant bond and become part of the existing bone.
If you’re a candidate for a cementless implant, your surgeon will shape your existing bones to fit into the implant, which has a rough surface, providing a surface for new bone growth. In some cases, screws help to hold the implant in place until new bone grows.
Cementless implants are often used in younger patients with good bone quality. Sometimes, bone quality is best determined during surgery itself. In this case, your surgeon will decide during surgery which type of implant is best for you.
Dr. Tyagi says there’s little difference between cemented and cementless implants in relation to recovery and outcome. However, cementless implants do reduce the time spent in surgery, because you don’t have to wait for the cement to cure.
“The length of surgery is proportional to infection rates, so we’re always looking for ways to safely cut down on the length of time in the operating room,” Dr. Tyagi says.
Longer-lasting implants
In the past, joint replacements were expected to last 10 to 15 years. Thanks to modern materials, today’s implants can last 20 years or more. This is good news, Dr. Tyagi says, given that younger people in their 40s and 50s are now more likely to have joint replacement surgery.
Longer-lasting implants enable Dr. Tyagi to perform surgery on younger patients without the concern of the implant failing too soon.
3D models and robotic surgery
Dr. Tyagi has also witnessed an increase in the use of robotic joint-replacement surgery. One type of replacement surgery Atlantic Health offers is the Mako™ Robotic-Arm Assisted Surgery System. “Before surgery, we take a computed tomography (CT) scan of your knee or hip to create a detailed 3D model and use it to create a personalized surgical plan. This technology helps us preserve healthy bones and ligaments.”
“It also allows us to be more precise in terms of how we’re placing the implants,” he says. “As the surgeon, I’m still the person performing the operation. But the robot is a tool that helps us be more precise and more accurate.”
Smart implants
Dr. Tyagi is also excited about the development of smart implants.
“Smart implants have a built-in sensor that remotely communicates certain data points and information to us,” Dr. Tyagi says. “We’re currently interpreting that data, deciding what’s clinically relevant or not. Over the course of the next 10 years, I see that being the next big horizon.”
From bedbound to a life fully lived
No matter what new technologies are introduced, Dr. Tyagi says he’s deeply gratified seeing people regain mobility. He recalls working with a patient who had endured multiple surgeries due to a lower limb injury, which eventually led to severe joint pain and limited movement. The patient was experiencing significant discomfort in both the hip and knee, making walking nearly impossible.
Dr. Tyagi performed separate hip and knee replacements to alleviate pain and help the patient regain mobility.
“It’s nice when somebody has really limited mobility, then they get up and start moving,” Dr. Tyagi says. “You see their whole life change, and they come in smiling instead of crying.”
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