‘GPS’ improves knee and hip replacement outcomes

When you get new tires on your car, it’s important that they are balanced and in alignment. This will keep the car from vibrating or pulling in one direction and help the tires last longer.  

But you wouldn’t expect your mechanic to check tire alignment and balance just by eyeballing it. They have specialized tools to help them. It’s the same when the joints in your knees or hips are replaced.  

For many years, surgeons largely relied on bony landmarks and their intuition to make sure joint implants were placed in the correct position and properly aligned, leading to a straight leg. But not every person’s body is the same, so even an experienced surgeon could miss the mark by just a little. Being even slightly out of position can lead to an implant wearing down unevenly, requiring a new one years before expected.  

With people living longer and more people having joint replacement surgery at a younger age, it’s more important than ever to do what we can to extend the life of these implants and reduce the number of future procedures a person may need.  

Related reading: Am I too young for knee or hip replacement?

Thankfully, many surgical teams, including ours, now have surgical navigation systems that help position and align new joints with a degree of accuracy we can’t get by eyeballing it.  

‘GPS’ for knee and hip replacement

In traditional joint replacement surgeries such as knee replacement, we would use simple tools such as alignment jigs and rods inserted along the thigh bone (femur) to help us see and feel when the knee was properly positioned and aligned.  

A surgical navigation system is similar to a GPS system in a car. We input where in the limb we want to go, and the system shows us, in real time, the location and movement of our instruments. We can clearly see and test position, alignment and ligament tension every step of the way. 

Surgical navigation systems are similar to GPS in a car. Showing location and movement of our surgical tools in real time. via @MedStarWHC

There are two types of navigation systems:  

  • Computer-assisted navigation systems provide information about our surgical tools and the implant in relation to the target position.  
  • Robot-assisted navigation takes this one step further, using robotic arms to align cutting guides and increase the precision of bone cuts. This doesn’t mean the robot does the procedure; it just refines our surgical execution. The surgeon still controls every step. This technology is still emerging and fairly expensive, so it’s not as common as computer-assisted navigation.

Benefits of using navigation during joint replacement surgery

Every person’s body is a little different, which can make getting an implant into the correct position tricky. We can’t always rely on bony landmarks and a patient’s anatomy. For example, if you have hip arthritis in addition to a spine disease, you may hold your pelvis in an odd way. Without a navigation system, we may place the implant slightly off of where it should go because of how you’ve held yourself for years.  

Navigation systems give us an extra set of eyes, along with a certain amount of confidence and predictability. Some benefits include:

  • Providing the surgeon with real-time information and the ability to correct potential errors during surgery
  • Improving overall function of the new joint, including greater stability and range of motion
  • Potentially allowing the use of less-invasive surgical techniques because the system gives us improved visualization of the field without large incisions
  • Increasing the life of the implant and reducing the need to replace the implant, known as revision surgery  

Revision surgery often is more complex than the original knee replacement or hip replacement surgery. The surgeon may need to remove some of the bone because the implant may have grown into it. This would require a bone graft, or transplanting a piece of bone from either another part of the body or from a donor to replace the removed bone along with the implant.  

A 2015 study showed that 5.2 percent of patients who had a total knee replacement without computer navigation needed revision surgery within nine years, compared with 4.6 percent who had computer-navigated surgery. This may look like a small variance, but if you have 1 million knee replacements, it could mean the difference of 6,000 of them avoiding revision surgery within nine years.  

Joint replacement surgery can dramatically improve a person’s quality of life, and demand for these procedures is growing. The American Academy of Orthopaedic Surgeons says nearly 1 million knee and hip replacements are performed every year in the United States. The organization predicts that number will rise to 4 million, due to an aging population and increase in obesity and osteoarthritis.  

As these procedures become even more common, computer- and robot-assisted navigation will continue to play a larger role in helping us improve patients’ outcomes and increase the longevity of their implants.

Am I too young for knee or hip replacement?

A 30-year-old man came to our emergency room with excruciating pain in both hips. He had been experiencing pain for several years, but it had become so bad he hadn’t been able to walk for a couple weeks. Imaging showed advanced bilateral hip arthritis—bone was rubbing on bone.

After a total hip replacement and physical therapy, he’s back to work and tells me he has more mobility than he’s had in years. Thirty may seem young for a joint replacement, but a growing number of younger people are getting these procedures.

Our team performs more than 400 joint replacements each year, and the average age of our patients is 60. But according to the American Academy of Orthopaedic Surgeons, the number of:

  • Total knee replacements increased by 120 percent from 2000 to 2009, and 188 percent for patients age 45 to 64.
  • Total hip replacements increased by 73 percent in that timeframe, and 123 percent for patients age 45 to 64.

It’s a common misconception that knee replacements and hip replacements are just for the elderly. I’ve heard patients say, “Grandma didn’t get a knee replacement until she was 80. I figured I’d just have to deal with the pain until then.”

If you’re unable to live the life you want due to pain, consider joint replacement surgery sooner than later.

Listen: Dr. Thakkar discusses more myths about joint replacement surgery on the Medical Intel podcast.

Why are younger people getting joint replacements?

A couple decades ago, most hip and knee replacement patients were older than 70. That was largely due to the fact that our implants weren’t nearly as good as they are now. They only lasted about 10 years, so doing surgery wasn’t always worth it if you knew you were going to have to redo it two to three times during someone’s life.

Our implants now are much better and last much longer. In fact, a 50-year-old who gets a knee replacement has a 70 percent chance of it lasting until they are 80. That’s 30 years of being able to work, run, bike or play golf pain-free. And current hip replacements are lasting up to 25-30 years.

Osteoarthritis, which is a common reason for hip and knee replacements, is connected to wear and tear on the joints. It’s only natural that your risk of getting it increases as you age. But we’re also seeing it in more patients who are middle age or younger. This could be due to two factors:

  • Popularity of high-intensity sports: Repetitive actions and injuries, such as tears to the cartilage that cushions the joint, increase the risk of arthritis. More people are taking part in activities, such as running and biking. For example, according to Running USA, 17 million people finished a race in 2015, compared with less than 5 million in 1990. While healthy, these activities also can be hard on the joints.
  • Obesity: Carrying extra weight puts increased stress on the joints. Being 10 pounds overweight can put an extra 40 pounds of pressure on your knees. One study found that obesity was strongly associated with the need for knee or hip replacements, with 72 percent of the study group (age 18-59) classified as obese compared to 26 percent of the general population.

"Being overweight puts increased stress on the joints. An extra 10 pounds adds 40 pounds of pressure to the knees." via @MedStarWHC

When should I consider a knee or hip replacement?

Don’t think about your age when considering joint replacement surgery. Instead, consider your pain and mobility. Do you struggle to walk a short distance or drive a car? Are you unable to perform work duties? Do you consistently take medication to control the pain?

Conditions, such as arthritis, also can affect your general health. You may find yourself giving up activities one by one as they become too painful. Eventually, lack of exercise may cause weight gain and conditions that can accompany it, such as diabetes and high blood pressure.

You may benefit from a knee or hip replacement when:

  • Pain and stiffness limits everyday activities or interrupts rest or sleep
  • It becomes necessary to use a cane or walker to remain mobile
  • Treatments, such as anti-inflammatory medication, cortisone injections, physical therapy or less-invasive procedures fail to relieve pain
  • An abnormality develops, such as bowing in or out of the knee

Our bodies sometimes break down, affecting quality of life. Fortunately, in some cases we can replace the faulty parts and return mobility. While those new parts may wear down eventually, advancements in technology help us give younger people more years to do what they love—pain-free.

Request an appointment to see if joint replacement surgery is right for you.

Keep moving to avoid and relieve back pain

Physical activity is vital for overall health, including for a healthy spine. Most people can avoid chronic back or neck pain by maintaining an active lifestyle and making a few simple posture changes.  

But what if you’re already experiencing neck or back pain? Is it too late to make a change? For most people, it’s never too late to improve spine health.  

Need a spine health check up? Schedule an visit with an orthopaedic specialist today!

I often see patients who come in with sudden, severe neck and back pain. It often flares up unexpectedly, such as when performing household chores. These patients often worry that they’ve damaged their spines. But in the vast majority of cases, physical therapy and sometimes non-narcotic medication will provide neck and back pain relief.

Let’s take a look at how a healthy spine works and why physical therapy is so effective to help you recuperate from and prevent future back pain.

Supporting your spine

Maintaining a healthy spine depends upon strengthening the muscles that bear its weight. The muscles around your back (often called “core” muscles) take some of the load off the spine’s lumbar vertebrae. These five large bones provide a supporting frame for the spine, but they aren’t made to hold its weight.

People experience back pain when their core muscles are too weak to support the lumbar vertebrae. If these vertebrae and the joints surrounding them bear too much weight over time, it can accelerate arthritis of the lower back, resulting in the sudden, intense pain I described earlier.    

It’s important to exercise the core muscles around your abdomen and lower back to stay strong. Many back problems are caused by inactivity and smoking.  

Inactivity and spine health

Americans spend an average of nearly eight hours per day sitting. Given that most adults have desk jobs, that number isn’t too surprising. But prolonged periods of sedentary behavior can have surprisingly severe effects on your health, so much so that this group of conditions has been given a name: “sitting disease.” Sitting disease increases your risk of obesity, high blood pressure, heart attack, cancer and more. And it also affects your spine.  

Did you know... “Americans spend an average of nearly eight hours per day sitting.”

When you’re sitting, your core muscles aren’t being worked. They sit dormant, becoming weaker the less they’re used. Making this problem worse is the fact that many people have poor sitting posture. Slouching can make it more difficult for the core muscles to bear weight and causes issues with spinal problems over time.  

Sedentary lifestyles are a common theme among my neck and back pain patients. When you’re younger, you can live an inactive life for years without back pain. But those years are silently taking a toll on your spine.  

If you must sit for most of the day, you can take proactive steps to guard against future back troubles. And if you already have back pain, these techniques are especially important to prevent it from getting worse.  

Developing healthy spine habits  

You can keep your spine healthy and avoid serious back pain by making a habit of exercising and stretching. I tell my patients they need to make core muscle exercises a part of their daily routine, just like brushing your teeth. Strengthening the core muscles helps keep your spine healthy. It’s that simple. Some exercises that I recommend include modified planks, the “superman” stretch or yoga. You may need to exercise a specific subset of core muscles depending on your condition, so ask your physical therapist or doctor which exercises you can perform to improve your spine health.  

If you sit at work, consider getting a standing desk. My patients rave about how much better their backs feel after they start using one. According to a growing body of research, reducing your sedentary time with a standing desk can also reduce your risk of cardiovascular disease and obesity, help you focus and avoid feeling tired while improving your mood at work.  

When you do sit, make sure to use proper posture. Keep your back straight and shoulders back. This posture helps maintain the natural curvature of the spine. You also should change your sitting position regularly, and get up to move around at least once per hour.    

sitting posture correction
A healthy sitting posture. Your head to kneecaps should make less of a letter C and more of a letter L.

You should be on your way to a healthier spine if you stick to these habits. But if you’re still experiencing pain, or your pain begins to radiate into your arms or legs, you could have a back condition that requires more intensive treatment.  

If you have back pain, or sit for long periods of time, don’t wait for the problem to get worse. Be proactive about your spine health – you’ll feel the benefits of being flexible and active, and enjoy years free of back pain.  

Request an appointment to discuss physical therapy options or call 202-877-6000 to learn more.

Solutions for Sports Injuries

Whether you’ve been dealing with an old sports injury or are nursing a more recent pain, be sure to understand all the options, ­­surgical and non-surgical, that can help return you to fighting form.

Evan Argintar, MD, a member of MedStar Orthopaedic Institute and assistant director of Sports Medicine at MedStar Washington Hospital Center, sees athletes and non-athletes alike, for issues ranging from rotator cuff inflammation to sprained ankles and everything in between. One of the most common injuries is patellofemoral pain syndrome, a broad term to describe pain in the front of the knee and around the kneecap.

Typically, Dr. Argintar’s first recommendation is to practice RICE, which stands for rest, ice, compression and elevation. RICE minimizes the painful consequences of swelling but allows the body to continue healing.

“Inflammation is a good thing. It brings blood to the site of injury and blood has growth factors and can help stimulate healing,” says Dr. Argintar. “The problem is the stiffness caused by the swelling, so it’s a bit of a balancing act. You want to maximize the good stuff coming with the blood and minimize the bad side effects.”

Dr. Argintar also recommends that anyone with an injury be evaluated by a specialist as soon as possible. Though some patients may be tempted to grit their teeth and ignore the injury, pain is your body’s mechanism of telling you that something is wrong.

“Ignoring the pain creates more problems that will ultimately take longer heal,” says Dr. Argintar.

A specialist can determine the origin of injury and determine a regimen to help the body heal. Many patients use a combination of activity modification, physical therapy and sometimes an anti-inflammatory steroid injection. A steroid injection, or cortisone injection, is a direct injection of the medicine that decreases inflammation.  Some patients receive a one-time injection, while others receive a shot every few months to combat inflammation and avoid surgery.

If surgery is required, there are minimally invasive options that allow for quick recoveries and continued mobility. “Fortunately, I operate on a very small minority of my patients,” he says. “Surgery is always the last option.”

Dr. Argintar’s advice for avoiding injury all together?

“The best way to prevent injuries is to have a strong defense.”

Many injuries are caused or exacerbated by a simple lack of flexibility. Exercise, stretching, and strengthening core muscle groups are crucial to preventing future injuries. Under a physician’s care and with a dedicated exercise routine, many patients are able to return to playing sports and enjoying pain-free physical activities.

Tune in to Dr. Argintar’s full podcast interview.