Dr. Redmond's Philosophy on Joint Replacement in 2018
We are going through an exciting revolution in joint replacement surgery! Hip and Knee replacement have completely evolved since I started learning these procedures at Mayo Clinic in 2006.
Hip Replacement Surgery
The majority of my hip replacements are now performed through a direct anterior approach. I started utilizing the direct anterior approach for hip replacement in 2012, and later studied the technique with several other surgeons during my fellowship training. I’ve taken technical pearls from most of the surgeons I’ve trained with and now adopted my own technique. Over the past two years I’ve been working on a method for performing this surgery that is even less invasive to the patient.
I’ve now perfected an approach that safely works between the muscles of the anterior thigh. I preserve the patients hip capsule for repair at the end of the case (something very few surgeons do, based on my travels), which allows my patients to avoid hip dislocation precautions. I now use a specialized reaming system that allows for less surgical dissection during surgery. I also use specialized retractors that allow for minimal soft tissue disruption. All of these technical advances allow my patients to recover faster with less pain!
Perhaps the biggest advantage of direct anterior hip replacement is the use of live x-ray in the operating room. I obtain several intraoperative x-rays during the case to ensure the acetabular component and femoral component are placed appropriately. I can adjust the position of the patient’s leg during the case and get x-ray feedback that it is correct. This is something surgeons haven’t been able to do historically because the surgery is performed with the patient on their side. Ultimately this helps ensure the hip replacement feels natural and optimizes longevity.
Knee Replacement Surgery
Perhaps the biggest advance we’ll see in knee replacement surgery in 2018 is the utilization of robotics. I started using a robot to perform partial knee replacements in 2011, and hips in 2014. This year is the first year a total knee replacement package is available.
Robotic knee replacement offers patients a customized approach. The technology involves obtaining a pre operative CT scan, which allows us to create a virtual three-dimensional model of the patient’s knee. Prior to surgery I plan the exact position and size of the patient’s knee replacement. Then intra-operatively I’m able to make small changes to the position of the knee replacement to balance ligaments in the knee. This will potentially make the knee replacement feel more natural for the patient!
The robot makes the actual cuts in the bone, and does so more accurately than any human can. This type of accuracy may lead to longer implant survivorship, and I’m excited to watch this technology evolve over the years to come.
Hip and Knee replacement surgery has made dramatic leaps forward in the past couple years!
If you, or your family member, are considering having hip or knee replacement surgery I’d be happy to discuss this further in person!
Dr. John Redmond