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Oct. 1, 2011

NEW PARTS - REPLACING KNEES BY FAR MOST POPULAR SURGERY

Jack Sirard contributing writer
Sitting in the dugout, Bill Salerno was summoned by his manager to trot out to first base to be the designated runner for one of his hobbling teammates.

Salerno, who plays for the Hershey Mills senior softball team in Pennsylvania, couldn’t have been more excited. “In years past, I too had trouble running, so in 2005 I had both my knees replaced at the same time and now just five months later, our coach is using me as a pinch runner. I couldn’t have been happier,” says Salerno, now age 68.

And after having both knees replaced, Salerno went back under the knife in June 2006 to have his left shoulder replaced. Six months later, you could find him back playing winter ball in The Villages, Fla.

He currently plays January through April in The Villages and then May through August in a senior league in southeastern Pennsylvania.

Miracle man?

Not quite. While having three body parts replaced is still unusual, Salerno is one of hundreds of thousands of Americans who have had a hip, knee or shoulder replacement in recent years in an effort to restore their quality of life.

And judging from a query to readers of Senior Softball USA, hundreds of players across the country echo Salerno’s story.

Dr. Harry Khasigian, an orthopedic surgeon at Methodist Hospital in Sacramento, says that the number of total knee replacements has been going up by 100 percent a year.

“We are doing seven knees surgeries for every hip replacement surgery and shoulders are even fewer,” he says.

“With knees, the older you get the greater chance you might need replacement if you have had a previous injury.

“We are able to much more precise work than we were years ago. MRI and CT scans pre surgery allow us to make precise movements in our surgery. The recovery process is now down to spending a day or two in the hospital where we get them up quickly and then they are really up and walking around in a few weeks and some are out participating in sports in as little as three to four months.”

Obviously, the older age groups don’t heal as fast as some of our younger patients, Khasigian, a 30-year veteran surgeon, adds, “but once they get the implants cemented in, that is it. The tissue around the knee is the only thing that could slip up the healing process.”

The advances have also sped up the time in surgery. “Knee surgery can take anywhere from 40 to 60 minutes and with the new titanium parts, this will last forever,” Khasigian says. “We consider the parts themselves to be indestructible. While the alignment could be put in a bit slanted and will wear abnormally, it is not the fault of the material.”

What about the risks?

The Sacramento surgeon notes that there “is always a risk of infection or post-op blood clots, but we have treatments for them and the complications are really less than 2 percent. We often say that the operation is 95 percent successful, but in reality it is even higher than that.”

Khasigian, 63, points out that surgeons “usually do these replacement surgeries for those past age 50, but unfortunately we do have young people who have had birth defects or congenital problems who need artificial hips as early as age 20.

“And of course, sometimes we see those young people who may have had a football injury who need the hip replacement. Usually an injury will cause the joint to no longer be as smooth as it needs to be which leads to abnormal motion allowing arthritis to set in.”

While the surgery for knee, hip or shoulder replacement is very successful, he says that surgeons won’t do it unless it is absolutely necessary.

“You need to know that with the risk only being 2 percent or less, if it’s you, it’s 100 percent. So if you get an infection, it can be a quite involved process to get over it…sometimes as long as four to six months. That’s why we don’t do it for everyone who walks in the door,” he adds.

Dr. William R. Gallivan Jr., a Santa Barbara, Calif., orthopedic surgeon, says that his goal is to get patients home as soon as possible. “Our goal is to get a person who has a single knee replacement home a day after surgery. Since we now use computer navigation to do the surgery, it is less evasive and we do multi-modal pain management, using less narcotics, meaning that patients can be more awake during surgery.”

“We like to see patients up and walking a few hours after surgery. If it’s both knees, then that’s a different story. We recommend that with the success of doing one knee that patients who need both knees replaced to come back in several weeks. There is evidence that the risk of doing two knees at the same time has a higher risk than one plus one equals two.”

He points our that the principal reason some patients have to have their surgery redone is that “there has been a biological failure of the implant and the bone not growing together correctly.”

How long will they work. “With the advances we’ve had in recent years, we expect to see the implants working for at least 20 years and in some cases, 30 years.

Salerno says that his knees started to bother him and then got a whole lot worse. “It got to the point where walking was painful and running was worse. I was still playing senior softball, but I wasn’t having any fun,” he recalls. Having retired at age 58, he was forced to give up softball just four years later.

In 2005, Salerno went to see his doctor who told him that Xrays showed his knees were down to bone on bone as his cartilage had worn out. “The doctor left the decision on surgery up to me and I jumped at the chance. I was in a considerable amount of pain that day so at the end of August in 2005 I entered the hospital. I went in on a Thursday night, had the surgery on Friday and on Monday I went to rehab for a week at a separate facility. They had me up and walking right away without any crutches or walkers and then I had therapy at home two to three times a week for six weeks.”

Salerno continued to have therapy done in the Philadelphia area and then headed down to Florida in January. Within the month he was back to playing, running the bases as he had when he was 10 years younger and in no pain.

In a normal knee, four ligaments help hold the bones in place so that the joint works properly. When a knee becomes arthritic, these ligaments can become scarred or damaged. During knee replacement surgery, some of these ligaments, as well as the joint surfaces, are substituted or replaced by the new artificial prostheses, according to the According to the American Academy of Orthopaedic Surgeons (AAOS).

Two types of fixation are used to hold the prostheses in place. Cemented fixation uses a fast-curing bone cement (polymethylmethacrylate) to hold the prostheses in place. Cementless fixation relies on bone growing into the surface of the implant for fixation.

The AAOS notes that Knee replacement operations, whether they use cemented or cementless fixation, are highly successful in relieving pain and restoring movement. However, the ongoing problems with wear and particulate debris may eventually necessitate further surgery, including replacing one or more parts of the knee replacement (revision surgery).

During the surgery, an orthopaedic surgeon will replace your damaged knee with an artificial device (implant). Although replacing the total knee joint is the most common procedure, some people can benefit from just a partial knee replacement.

Implants are made of metal alloys, ceramic material, or strong plastic parts, and can be joined to your bone by acrylic cement. There are many different types of implants. Your surgeon will discuss with you the type of implant that best meets your needs.

The AAOS points out that more than 90 percent of individuals who undergo total knee replacement experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living. But total knee replacement will not make you a super-athlete or allow you to do more than you could before you developed arthritis.

Next: Hips
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