MIS Hip and Knee Replacements |
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Illinois Bone and Joint Institute 9000 Waukegan Road Suite 200 Morton Grove, IL 60053 tel: (847) 375-3000 fax: (847) 296-7190 Newsletter Sign Up Now! Tell a Friend Email This Page |
Facts Versus Fiction Overview Hip and knee replacement operations have proven to be 2 of the most successful surgical procedures ever developed. Patients disabled because of arthritic conditions of the hip and knee are able to return to active, pain-free lifestyles because of these innovative procedures. Several hundred thousand joint replacements were performed in the United States last year alone! Recently, the news media has reported on so-called “minimally invasive” joint replacement procedures, showing that some patients go home the same day. We hope to share some of the facts and fictions associated with these reports, as well as discuss some of Dr. Wayne M. Goldstein’s and his associates’ state of the art techniques. Hip Replacement Surgery Modern hip replacement surgery was developed in England in the 1960’s and radically changed the way people afflicted with hip arthritis were able to live their lives. The metal components of these early hip replacements were attached to the bone with acrylic cement. As research progressed, implants became available which allowed the bone to grow into the metal creating a life-long bond. Recently, much media attention has been given to minimally invasive hip replacements. News reports have shown patients who have gone home the same day after the operation. The surgeons featured in the news reports claim that it is a new surgical approach which allows patients to go home the same day. Unfortunately, these reports and articles often fail to tell the whole story. It is well known in the medical community that surgery, such as hip replacements, not only affects the hip joint, but other body systems like the heart, lungs, and brain as well. Dr. Goldstein has published the results of his minimal incision hip replacement technique in a major scientific journal and found that although patients do feel better sooner, the operation still affects the other body systems in the same way. Because of this, he and his associates feel that it is best for his patients to be cared for by a physician and nursing staff in the days after the operation so any changes in the body after surgery can be diagnosed and treated quickly. Research has also shown that the most important thing for creating a durable, long-lasting hip replacement is absolute precision in positioning of the artificial hip. Dr. Goldstein, in his published article, showed that his minimal incision technique does not compromise this crucial aspect of the surgery. This cannot be said about other minimally invasive techniques. Many of the advertised surgical techniques may place you under an anesthesia much longer, increase your likelihood of a blood transfusion, increase the risk of a fracture of the femur bone, increase the risk of a nerve injury, and could cause placement of the hip in a less favorable position due to difficulty visualizing the surgical site. This could increase the chance of further surgery. We have there fore questioned if this would be worth an earlier discharge. Currently, Dr. Goldstein is using a minimal incision technique in almost all his hip replacements. He has designed some of the most technologically advanced implants and instruments, most of which are available nationally to other surgeons. In his practice, Dr. Goldstein feels that the overall health of his patients is the top priority. And although patients often feel well enough to leave the hospital early, he feels that close monitoring by the hospital staff is an important step in the overall recovery of his patients. Knee Replacement Surgery Although knee replacement surgery was developed somewhat later than hip replacements, it is no less successful. In fact, there were more knee replacements than hip replacements done in the United States last year. Knee replacements have changed dramatically since they were first introduced, with the new designs meant to better reproduce the motion of a normal knee. Dr. Goldstein has been at the forefront of knee replacement research, assisting in the design of the newest implants and procedures. As with hip replacements, minimally invasive knee replacements have also been reported in the news. The surgeons describe a technique in which they claim no muscle or tendon is cut and patients are able to go home the same day. Newer techniques have shortened the rehabilitation time associated with this surgery, but the operation still affects the same body systems as hip surgery. Dr Goldstein feels that patients going home the same day as their surgery are at risk for serious medical complications which could be diagnosed and treated quickly if the patient were in the hospital. Additionally, it is well known that an infection in a knee replacement can be devastating for the patient. The skin is the most important barrier between the artificial knee and the outside world, and if the skin is damaged by excessive retraction by a surgeon trying to do the surgery thorough an incision that is too small it puts the patient at an increased risk of infection. And although a small skin incision is cosmetically pleasing, it is not the length of the incision which allows a faster recovery. Dr. Goldstein has always used what is known as a “tissue-sparing” approach to knee replacement surgery. This approach does not cut the main tendon or the quadriceps muscle, but simply separates the muscle fibers as they would naturally split in order to perform the operation. The skin incision is tailored to each individual patient for their size and their implants size, usually about 4-6 inches long. This can be done in a short procedure without needing surgical drains or blood transfusions. Along with anesthesiologists, Dr. Goldstein has also been in the forefront of post-operative pain relief. At a national meeting of over 30,000 orthopedic surgeons he showed his specialized nerve block technique which allows a far more comfortable recovery after knee replacement surgery. As with the hip, the long-term success of knee replacement surgery relies on precise implantation of the artificial knee. Any techniques which compromise the ability of the surgeon to position the implants in exactly the right way are simply not worth it. Another critical step in providing patients with a long-lasting, pain free knee is the type of knee the surgeon chooses to implant. Although a normal knee seems to act as a simple hinge, its motion is much more complex. Dr. Goldstein has participated in the study of a novel artificial knee which not only bends, but also rotates much like a normal knee. He has implanted more of these newer “rotating platform” artificial knees than anyone else in the country and has found that his patients are able to bend further and are able to be more active than with previous designs. Summary Dr. Goldstein’s goal is to provide his patients with the best, comprehensive care available. This involves not only the use of state-of-the-art techniques and implants, but a team approach to the overall care of his patients. As chairman of orthopaedic surgery at Rush North Shore Medical Center in Skokie, IL he has been able to streamline the care of his patients. From his collaboration with anesthesiologists to provide a far more comfortable knee replacements to the spearheading of the new orthopedic nursing unit designed for patients with hip and knee replacements, Dr. Goldstein is involved in all aspects his patients care. To learn more please visit the other areas of this website or make an appointment. Downloads  Click here for the Patient Position Statement on minimally invasive joint replacement surgeryClick here for the Physician Advisory Statement on minimally invasive joint replacement surgery Links The American Association of Hip and Knee SurgeonsMinimally Invasive Hip Replacement surgery information |
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