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Some injuries and some cases of arthritis are just too extreme to repair biologically. Accepting that you need an artificial implant is tough to do—but it’s the right decision when natural therapies are not effective. Here is some hopeful news about the decision to replace your joint.
Joints are covered by smooth, white articular cartilage: the shiny surface in the chicken wing. Injury and arthritis can wear that surface down to the bone. When bone is exposed on both sides of the joint, and the X-ray shows no space remaining, the best option is often to resurface that worn-out area. This is usually done with a metal and plastic implant.
Patients often tell us that they were told to live with their pain, wait until they are older, reduce activities, and stay in the pool or on a bike to remain healthy. Such advice was reasonable when the implants had relatively short lifespans and the revisions had a toss-up success rate. This is no longer the case. The advent of computer-generated 3D imaging of the joints, combined with new, robotically-assisted joint replacement techniques, means that current implants are likely to be placed far more accurately and last longer.
Why? Because only the worn out parts need to be resurfaced: a partial knee, for instance, or a cap for the shoulder joint. And when the arthritis is more widespread, a total knee replacement can now be performed without the use of cement—which eliminates the chance of the cement loosening during sports. The fine cuts from the robotic saw are so precise that the surgeon can use implants with porous metal backs, permitting bone to grow into the metal. This provides a better anchor than any cement. Once secured by the bone, the fear of loosening the cement from sports is gone. And while sports may wear out the plastic over 20 to 30 years, it can usually be easily replaced. Cases in point? Our patients are skiing 100 days a year, mountain climbing, and playing tennis. Some even choose to run—though most gave up running years ago, focusing instead on sports that are kinder to their aging joints. By increasing their activities, they strengthen their bones and muscles and preserve the implant’s fixation.
At The Stone Clinic, we retain our bias to always restore the meniscus, articular cartilage, and ligaments first in our biologic joint reconstruction programs. We also extend the lifetime of the repair with lubrication and growth factor injections. But when there is widespread bone-on-bone disease, going with un-cemented total joints is an easier decision than ever before. And for the patients, the ability to get rid of pain, improve range of motion, and return to sports now—rather than waiting years in frustration—is a huge benefit.
Every decade is precious. We don’t know how many we will have. The creative solutions available today may not be perfect, but they are far better than living with deformity and disability. Our goal is for you to exit this world doing the activities you love, not missing the activities you used to do.