Joint Replacement

Degenerative osteoarthritis (OA) of the hip, knee and shoulder are increasingly common as the general population ages. Treatment of OA generally starts with anti-inflammatory medication, activity modification and injection of corticosteroids or polymer agents to relieve symptoms and delay surgery if possible. Surgical treatment of joint disease has become increasingly common and the number and diversity of surgical implants and techniques has increased dramatically in the last decade. In addition, many joint replacement manufacturers have begun direct to consumer (DTC) advertising, increasing the amount of confusion for patients. Nonetheless, joint replacement surgery remains one of the most effective procedures in orthopaedics to relieve pain and improve quality of life.

Number of total joints replacements in California over time

My approach in treating patients who are candidates for joint replacement focuses on the expectations of the patient and trying to give them the most realistic estimate of their recovery, outcome and function. Many patients will come in to the office with a preconceived determination of which implant and approach they would like. A common example is patients requesting joint resurfacing procedures. These operations are typically are much larger surgeries with longer recovery than total hip replacement. The number of patients who are good candidates is actually very small and there is no long term data that currently exists to show any benefit of hip resurfacing over total hip replacement. Another common request is to have the surgery performed through a specific approach. Again, evidence based medicine has demonstrated that the functional outcome of joint replacement in the long term is independent of surgical approach but is related to the proper implant position and soft tissue balancing around the joint. Regardless of which approach I use, I attempt to minimize the soft tissue trauma when performing joint replacement surgery. My philosophy is to consider long term outcome and function of my patients rather than attempting to place the implants through the smallest incision possible or using the latest surgical approach, especially if outcomes data and evidence based medicine demonstrate no benefit. My recommendation for approach and implant type are determined by the age, health and activity level of the patient, the anatomy of the joint and the need for future revision surgery. For example, the likelihood of a 40 year old active man needing some type of revision surgery in the future is quite high despite improvements in the longevity of the implants. Any joint replacement procedure should take into consideration this likelihood. In contrast, the likelihood that a 75 year-old patient would require revision joint surgery is very low and this would influence my recommendation for the type of implant I recommend. My pledge to my patients is to be as objective as possible and to explain my rationale for what approach and implant I recommend as well as give my patients an honest assessment of what they can expect during the entire recovery process.

Primary  Hip Replacement

Hip Resurfacing

Revision Hip Replacement

Partial Knee Replacement

Patello-Femoral Replacement

Total Knee Replacement

Revision Knee Replacement

Total Shoulder Replacement

Reverse Shoulder Replacement