The decision to have a stress test is left to the discretion of your cardiologist. Like any procedure, a thorough pre-operative workup is required for your safety. This includes general medical clearance, as well as any specialty clearance that is deemed necessary (depending on any pre-existing conditions). This would likely involve some sort of cardiac workup in the face of known cardiac issues, regardless of age.
For an elderly patient with known heart blockage, is a stress-test necessary for a micro-invasive hip replacement (SuperPATH)?
May 19th, 2012My 73 yo mother had an unsuccessful hip replacement which has left her with not one day free of pain. I am going to bring her to you for evaluation. What do you do if the bone chips or cracks during the operation?
February 21st, 2011If the bone cracks during the operation, then I fix it at that time. There are many ways to do so, and they have a wide range of applications depending on the type and location of the crack. I always have a few backup plans on hold if this occurs.
The main issue is to recognize this potential prior to the operation, and understand that no matter how much we prepare for an operation, there will always be circumstances that we could neither prepare for nor control.
I have read the +’s and -’s of the different bearing materials. A local doc recommended ceramic-on-poly or ceramic-on-ceramic (with metal-on-metal third in preference). He said he hasn’t had any squeaking with the DePuy Option Delta head and liner. If you were age, 57 what material would you use? Do you still do COC and if so what company/model would you likely use and what size head likely?
February 21st, 2011I have used ceramic-on-ceramic (COC), and favor the Wright Alumina ceramic (due to it’s unsurpassed wear characteristics), but I prefer not to use them in my male patients. The main reason is that men tend to be harder (in terms of impact) on their hips than female patients, which can lead to ceramic fracture. The Depuy option has Delta Ceramic (which is more fracture resistant, but also less wear resistant).
Squeaking has been directly attributed to “system” problems, and seems not to be related to the specific bearing, but rather which stem & cup are being used with that bearing. Neither Depuy nor Wright have had major issues with squeaking.
Current trends are moving away from COC bearings in favor of newer Highly Crosslinked Ultra High Molecular Weight Polyethelene (HXL UHMWPE), which is the latest, greatest plastic. Wear rates are not quite as low as COC, but the difference may be clinically negligible.
Even though Metal-On-Metal (MOM) bearings are arguably the most excellent bearing surface (with the most options and the longest track-record… in some cases >30 yrs!) recent litigation is forcing surgeons to steer away from its use due to extremely rare but catastrophic complications.
The current trend in joint replacement is one of the following for young hip bearing surfaces:
- All companies: Delta Ceramic on HXL UHMWPE
- Wright Medical specific: large diameter head Alumina Ceramic (also known as Big Ceramic Head, or BCH – this gives great wear resistance, and the larger head decreases the chance of head fracture) on HXL UHMWPE
- Smith & Nephew specific: ceramicised metal (aka- “Oxinium”) on HXL UHMWPE. The combination is known as “Verilast”.
The idea is to maximize toughness while also maximizing wear resistance. My personal preference is BCH on HXL UHMWPE for most applications. Head sizes for BCH often go above 40mm, which has the nice side-effect of also minimizing dislocation risk because it more closely resembles your natural hip size. I have also used Delta & Verilast for specific circumstances.
What do you think about doing simultaneous bilateral Total Hip Replacement (THR) vs. 2-stage bilateral THR? Would I need a urinary catheter for one THR or simultaneous THR?
February 21st, 2011I prefer to do bilateral (both) hips as a staged procedure, one THR then the other 6 wks later. I have on occasion done simultaneous bilateral THRs, but only on my healthiest patients, since it can be more dangerous in terms of blood clot, blood loss & cardiac risk.
I almost never use a catheter, unless medically necessary. Simultaneous Bilateral THAs would require a urinary catheter.
Am I a SuperPATH candidate if I have had previous hip surgery?
January 21st, 2011Q: I had a right hip fracture repaired with screws and then the screws started coming out and would catch the tendon on the side of my leg, so the surgeon removed them. When I was finally released by the surgeon, I was told I had arthritis in that hip and I should consider a hip replacement. I am still limping around well over a year after surgery. Am I a candidate for SuperPATH hip replacement? If so, how do I begin the process of being evaluated for it?
A: Pretty much anyone who is a candidate for standard hip replacement would be a candidate for a SuperPATH procedure. I have converted many patients from a hip fracture fixation to a total hip replacement with SuperPATH. There are subtleties to the procedure that I may have to adjust/plan for given the increased difficulty of the case.
The evaluation process can be started by simply calling my office @ 602.553.3113 x6. My assistant will be in touch with you regarding obtaining necessary information and pre-operative work-up. More information can be found here, here & here.
How long do robotic partial knee replacements (MAKOplasties) last?
November 2nd, 2010I really can’t comment on the longevity of our newest-generation partial knee (aka uni-knee arthroplasty, or UKA) implants.
Historically, total knee replacements (aka total knee arthroplasty, or TKA) have nearly a 90% survivorship at 10-15 yrs. Newer-generation TKAs we expect to surpass that, but none of them have been around long enough to say.
Historically, UKAs have had only an 80% survivorship at 8-10 yrs, most of the failures likely due to flaws in implantation. Newer-generation UKAs are still seeing similiar results, but may have a slight improvement to this.
Newest-generation UKAs (ie- robotic) are seeing an astounding success in the short-term (3 yrs), with the added new possibility of continued resurfacing of other parts of the knee if they wear out in the future. Historically, if the partial knee was doing OK, but your arthritis progressed to the other side of your knee, your only option was a conversion to a TKA. Now, we can reliably implant a new UKA or patellofemoral joint (PFJ) knee arthroplasty to the other portions of your knee to match your original one.
So, many robotic, minimally-invasive & UKA surgeons believe that robotic UKAs have solved 2 major issues for failure of traditional UKAs: 1) less-than-perfect implantation and 2) progression of arthritis. Unfortunately, this technology is too new to tell. The first one ever placed in a human being was done in 2006.
Regardless of the longevity of the implant, you will find that the surgical impact to your knee, and the speed of recovery, is an order of magnitude easier than that of a TKA. For this reason, many of my patients request a robotic UKA, even accepting the potential for future surgeries (which also exists for TKA).
Are your procedures covered by Medicare and AARP Medicare Supplement?
October 5th, 2010Q: Considering your hip and knee surgeries: Are the procedures now covered by Medicare and AARP Medicare Supplement? One article on your website from 2009 said they are not covered by Medicare.
A: Yes, all of my procedures are now covered by Medicare & all insurances in the same fashion as any standard procedure. The article you are referring to is out-of-date, and the coverage issue has been addressed. I am sorry for any confusion.
“Submit a Testimonial” form is now working.
September 30th, 2010Thank you all for your patience.
My “Submit a Testimonial” form is broken on my website.
September 12th, 2010I am sorry for any inconvenience. It should be fixed shortly.
How do you feel about “rocker bottom” (ie- MBT, Sketcher’s Shape Up, etc) shoes for people with hip or knee issues?
September 11th, 2010It really depends on how your body reacts to wearing them. Walking mechanics can vary greatly from person-to-person.
On average, your natural foot position is in a few degrees of “plantar-flexion”, meaning that a slightly raised heel in a shoe’s foot-bed would be the most supportive and natural for walking. Most walking/comfort shoes are designed this way, and you will find most have a 1-2″ heel. This should be the most natural for walking, and the “easiest” on your hip & knee joints for the average person.
The MBT style shoes are designed and marketed as a form of “exercise-in-a-shoe”. They purposely make it harder for you to walk, forcing you to use more muscles than you would naturally during a normal gait. This is done by forcing a slightly lowered heel (sort of a reverse high-heel), a very unnatural foot position for walking. Additionally, most experts agree that very flat shoes (ballet flats, flip-flops, etc), while fine on an occasional basis, are detrimental long-term due to overall lack of support. They lack an adequate heel, arch support and foot-bed. Of course, very high heels may have the same shortcomings for the opposite reasons. Any of these shoes may increase forces across your knees & hips.
Any shoe-wear that changes your natural stride can alter your mechanics around your hip & knee. Whether that hurts or helps your problems depends on how your body reacts to wearing them. It is best to gradually introduce yourself to new footwear, starting with short wearing times and increasing that daily until the desired wearing time is achieved comfortably. This is true of all shoes: from MBTs to flats to walking shoes to the highest stilettos.
A good rule of thumb is this: Listen to your body. If wearing any sort of footwear causes your back/hips/knees/ankles/joints to hurt, then your body is telling you to “back off”. This is nearly universally true for all activities and the human body. The “no pain, no gain” mantra for exercising refers specifically to effort, stretching, muscle fatigue & conditioning. You should not do any activity that increases or causes pain inside your joints.