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HEALTH TAKE-AWAY

Dr. Kevin Mitts: Sorely needed joint replacements have resumed after two years of pandemic delays

Doctor holds replacement knee joint

Many patients undergoing knee and hip replacements today are going home the same day, compared to just a few years ago, when most spent two or three nights in the hospital.

Millions of U.S. patients who were unable to have hip, knee and other joint replacements during the peak of the COVID-19 pandemic are finally having those surgeries scheduled and performed.

Hospitals and orthopedic surgical facilities nationwide had to put those and other elective surgeries on hold as they managed through the staffing and safety demands of the pandemic. The resumption of joint replacement surgeries is a great relief to patients suffering pain and reduced mobility from a wide range of age and injury related joint problems.

The pandemic postponements were a temporary pause in one of the fastest growing, most clinically successful areas of modern medicine. Driven by steady innovation in technology and techniques, total and partial joint replacements have become easier, faster and far less invasive — with much better outcomes than ever.

Recovery time and post-operative pain also have been dramatically reduced. Many patients undergoing knee and hip replacements today are going home the same day, compared to just a few years ago, when most spent two or three nights in the hospital.

There was a time not too long ago when many patients who were candidates for joint replacement took a pass on the surgery, settling instead for anti-inflammatory pain medications, an occasional injection and some physical therapy.

Nowadays, because of the dramatic progress in orthopedic technology, a growing number of people are choosing to have joint replacements. Prior to the pandemic lull, more than 450,000 total hip replacements and nearly 1 million total knee replacements were being performed in the U.S. every year. Those numbers are expected to double by 2030.

The digital revolution that has transformed much of society has also made its way into the operating room. Before the advent of the robot-assisted, computer template-guided, arthroplasty procedures commonplace in orthopedic surgery today, joint replacement was a far more invasive and laborious undertaking with nowhere near the level of precision and successful outcome seen in today’s surgeries.

To use a metaphor, the old approach was basically like putting a chunk of rock in front of Michelangelo and telling him to shape it into a piece of art by hand. In much the same way, orthopedic surgeons as recently as 25 or 30 years ago had to reshape the surface of damaged joints by relatively primitive but certainly outdated means before putting the implants in place.

Today, they can be guided by high-definition, architectural-grade blueprints generated by computers using images from CT scans and MRIs. The new technology creates customized, patient-specific templates for each procedure.

The surgeon can then use videographic, digital navigation tools to perform the joint replacement. This real-time visual information helps ensure the accuracy of bone cuts, implant positioning, ligament balancing, and final alignment of the limb.

All of these improvements in technology have allowed orthopedic surgeons to put in better hips, knee and shoulders that last longer and feel more normal to the patient. The more normal feeling joint replacements, together with advanced medication and physical therapy protocols, have allowed us to mobilize patients more quickly.

We used to think patients needed to stay in bed for days, even weeks after undergoing joint replacement surgery. Nowadays, thanks to the less invasive surgical techniques and also the types and methods of anesthesia used, we are able to get patients moving almost as soon as they’re awake after surgery.

Patients generally are told to expect to use a walker for a couple of days, and many do, but some go home on the same day as surgery with just a cane to steady their movement.

The new age of joint replacement surgery has transformed people’s lives, giving them freedom from pain, renewed motion and a rediscovered quality of life.

Kevin Mitts, MD, is an orthopedic surgeon with Berkshire Orthopaedic Associates, an affiliate of Berkshire Health Systems.

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