What’s new in joint replacement surgery?
Joint replacement surgery is an option for some people living with arthritis to help address pain and mobility. It’s an increasingly common surgery: according to the 2018 Canadian Joint Replacement Registry annual report, in 2016–2017, 55,981 hip replacements and 67,169 knee replacements were performed, representing increases of 17.8% and 15.5%, respectively, compared with five years earlier. Let’s take a closer look at some of the new surgery techniques, tools and approaches, bearing in mind that they may not be appropriate for every patient or available in every region.
“I would say the biggest innovation is not really a technological advance, but [rather] the rapid recovery protocol,” says Dr. Sarah Ward, an orthopaedic surgeon at St. Michael’s hospital in Toronto, and provider of subject matter expertise to the Arthritis Society. Rapid recovery refers to an approach that helps get the patient up out of bed much faster than before. Some knee joint replacement patients, for example, are able to go home the same day as their surgery, rather than recovering in a hospital or rehabilitation unit for a week. The anesthetic approach is different as well, Dr. Ward says.
The anesthesiologist uses very specific nerve blocks for good pain control but the muscles still function. Post-surgical pain control has seen changes too. “We use a combination of multimodal medications for pain control, so using things like acetaminophen (Tylenol,) non-steroidal anti-inflammatories (NSAIDs) like Advil or naproxen, and as small amount of opioid medication as necessary to control the pain. The opioids have a lot of side effects—they make you feel drowsy, they make you feed nauseated, there’s the possibility of addiction. When you use less of those you can get people feeling better and moving faster.”
In rapid recovery, healthcare professionals like nursing staff and physiotherapists work with joint replacement patients to get them up and going more quickly, and to learn how to manage recovery at home. “The more you move, and the faster you get moving, the better you feel,” says Dr. Ward. “There is less chance of getting a urinary infection, getting a blood clot, having a problem with your breathing.” She adds that post-surgical nausea and vomiting side effects are generally eased too. In the majority of cases, patients do better when they are recovering in their own home, pointing to lower rates of infection, better motion in the joint and lower rates of being readmitted to hospital, compared to previous post-surgical protocols.
Synthetic cartilage for the big toe joint
Synthetic cartilage is a new option for treating osteoarthritis in the big toe joint. This artificial cartilage is made of polyvinyl alcohol hydrogel (the same material as some contact lenses) and it’s undergoing clinical trials in Canada and the UK. It provides an alternative to fusion, the traditional approach to treating problematic OA in the big toe joint. A 2018 study published in the medical journal Foot & Ankle International looked at 112 patients (mostly women over age 50) at the two-year mark and five-year mark post-surgery and found improvements in pain, function and mobility.
On the horizon
Medical researchers are exploring new approaches and techniques—some that are being used in a handful of Canadian hospitals, others that are still in the research phase. Some interesting ones include robotics, where the exact location and measurements of a knee joint are planned by the surgeon on a computer, and the surgeon guides a robotic arm during the surgery, which allows for very precise incisions and optimally a faster recovery time.
An anterior approach to hip surgery, where the surgeon cuts through the front of the body to access the hip joint, rather than the side or the back, is a new method used by some surgeons trained in the technique, with studies suggesting that since fewer muscles are cut, recovery time in the initial stages is improved.
Replacement joints themselves are also under study, as medical researchers are exploring ways to use 3D printing to construct a joint from biodegradable material, then using a patient’s own cells to grow new tissue on the replacement joint. Research in this area is still quite new and it may be years before becoming a reality, but researchers continue to seek innovative approaches to improve joint surgery.
If you’re considering joint replacement surgery, talk to your health care provider about your options.
Want more information? Visit the Arthritis Society’s Surgery pages.