Healing Faster From Joint Repair

“Joint replacements have evolved significantly over the past two decades,” says Dr. Arthur Malkani, chief of adult reconstruction at UofL Health and a professor of orthopedics at University of Louisville School of Medicine.

Advances in surgical procedures, anesthesia, materials used to make the implants, and patient surgery prep have all culminated in a better experience for patients and doctors.

Robotic-assisted surgery

Technological advances allow doctors to perform joint replacements using robotic assistance and more precision. A pre-surgery CT scan provides patient-specific data to the surgeon during the surgery, ensuring that the patient’s individual anatomy is accounted for in the procedure.

“Every patient has a unique anatomy, a unique structure, and it’s not just the bone, it’s also the tension in the ligaments that needs to be addressed,” Dr. Malkani says. “Through the use of intraoperative data, I get information on how to line up the implant specific to the patient’s bony anatomy. This technology has made a huge difference in our ability to do a better job for patients because I am getting data I have never had before. This has markedly increased patient satisfaction from under 80% to over 95% now.”

Material advancements

Technological advances are also enhancing how hip and knee implants are built. Previously, there were off-theshelf options, but now doctors have access to technology that can design custom implants.

Linda Rosenberger has had both of her knees replaced, and her doctor used this customized approach. “About six weeks before my first surgery, I had a CT scan,” she says. “The doctors used the results of that scan to build my new knee. The technology was ConforMIS implants. It ensured that the new knee would fit my bone structure. This was still an emerging technology when I had my first knee replaced, and I did it again when I had my second knee replacement a few years later.”

Advances in materials such as plastics, metals, and surface coatings have also created better implants. One advance in materials promotes inbone growth to the implant during the healing process. “So, when you break your arm, the edges of the bone heal through a biological process,” Dr. Malkani explains. “The same thing is happening now with the bone healing into the metal.” This improves stability and durability and can reduce the need for revision surgery in the future.

Anesthesia changes

The type of anesthesia used during joint replacement has also contributed to better outcomes in surgery. In the past, patients would undergo general anesthesia. This prolonged the initial recovery from the surgery, delayed a patient’s ability to start post-surgery rehab, and had the potential to cause other complications for the patient. Today, surgeons are using regional blocks on patients. This allows the patient to immediately begin in-hospital rehabilitation and sooner achieve the necessary milestones to be released.

Patient prep and care

In addition to technological advances during surgery, doctors are focused on ensuring that patients are in the best possible physical condition prior to surgery. This process can begin a few months before the procedure to allow patients time to lose weight, stop smoking, or address any other underlying health conditions.

Another development is smart implants. Once a smart implant is placed in the patient, it can transmit real-time data to the provider about movement, flexibility, and post-surgery progress. This allows a provider to evaluate individual progress and adjust rehabilitation plans.

The use of smart implants is still in infancy. “We don’t really have that much data yet to show it’s making a meaningful difference, or making something better for the patient, but I think the future of these censors looks promising,” Dr. Malkani says.

Part of this ‘prehabilitation’ is to also to develop strength in the area the replacement will take place. “I had a very structured exercise plan to follow before my knee surgery,” Linda says. “I diligently did these exercises because it helped to strengthen the muscles in my leg, which helped with my recovery.” Early release from the hospital is achieved through a combination of factors. “It’s a culmination of anesthesia, prehab, and patient education,” Dr. Malkani says. Linda was released the same day as her second knee replacement, in contrast with an overnight stay for her first surgery. “The first day when I went home after my second surgery was tough, but by the second day, I was doing much better,” she says. “The key is to have a good care team at home. I could not have been at home the first day without their help.”