David Halsey, MD, an orthopedic surgeon, is medical director of Adult Reconstructive Surgery at the UVM Medical Center Orthopedics & Rehabilitative Medicine.

David Halsey, MD, an orthopedic surgeon, is medical director of Adult Reconstructive Surgery at the UVM Medical Center Orthopedics & Rehabilitative Medicine.

More than 700,000 total knee replacements and over 300,000 hip replacements are performed in the United States each year, according to the Centers for Disease Control and Prevention. Why?

The short answer is osteoarthritis, a disease that typically affects people in their 40s and beyond.

Osteoarthritis is the most common diagnosis on the planet that requires medical attention, more so than even cardiovascular disease. Osteoarthritis is widely prevalent and has a negative impact on work productivity, independent living, and quality of life. Yet, we do not know the cause. We know things like the pathophysiology of heart disease or diabetes – not so with osteoarthritis. Science is working on it, but we do not have definitive answers – so we have not been able to engineer a definitive biologic treatment. Until then, there are two ways to manage this disease:

  1. Symptom suppression:  We can manage the symptoms of osteoarthritis through lifestyle changes, adaptations and modifications, including weight loss and management, activity moderation, oral medication, as well as joint protection through exercise. We will explore those in detail during the first half of my Community Medical School talk. Specifically, I will share data that shows what we currently know about symptom suppression techniques.
  2. Surgery: In the absence of a definitive biologic solution, as osteoarthritis progresses, it becomes gradually worse and symptom suppression is no longer adequate. That can be a depressing reality for a patient. At this point, the disease truly becomes suffering. Fortunately, the field of orthopedics allows patients to change that through joint replacement surgery.

There are very few disease processes that affect humans that you literally can get rid of; with many diseases, such as diabetes or cardiovascular disease, you manage, adapt and live with the disease. In orthopedics, we get rid of the problem through a surgical solution. That’s the good news about surgery. The challenge is the risks that are associated with surgery. That’s where the tension lies for patients; the dilemma is “I have a way to get rid of this, but the surgical risk and recovery time concern me.”

We have new strategies for minimizing risk, and we will touch on all of those during my talk. They include:

  • Anesthesia risk
  • Infection risk
  • Blood clot risk
  • Bleeding and blood transfusion
  • Mechanical problems (instability, fracture, and wearing out of the new joint)

Finally, for patients there is the question of recovery time: “When can I get back to work, life, play, driving, etc.?”

We are addressing that two ways:

  1. Patient education: The Orthopedic Specialty Center at the University of Vermont Medical Center offers joint replacement “school” every Monday for patients who are undergoing, or who are planning to undergo joint replacement surgery. It’s an opportunity to listen, learn, and ask questions. Patients and their caregivers are invited to attend.
  2. Advancing the science of minimally invasive surgery. In my talk, we will review new state-of-the-art surgical techniques that include direct anterior hip replacement, mini posterior hip replacement, patient-specific instrumentation, and partial joint replacement. Each one will be covered in-depth class.

 

David Halsey, MD, an orthopedic surgeon, is medical director of Adult Reconstructive Surgery at The UVM Medical Center Orthopedics & Rehabilitative Medicine. He is also an associate professor at the Larner College of Medicine at UVM. Watch a video interview with Dr. Halsey

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