Joint Replacement Surgery: New Technologies Transform Care

Total knee and hip replacement surgeries have been around for more than 50 years. But thanks to advances such as robotics, computer navigation, 3D printing technology and new pain-reducing medications, patients today bounce back quicker ― many leaving the hospital the same day as their procedure ― and with less discomfort.

It’s definitely not your parents’ joint replacement anymore.

“In the last few years, there’s really been an explosion in technology,” says Juan C. Suarez, M.D., an orthopedic surgeon with Baptist Health Orthopedic Care who specializes in knees and hips. “A total knee replacement used to be a very artsy operation, with the surgeon eyeballing the knee without a lot of data. Today, we have better vision with augmented reality and advanced imaging, we are able to make extremely precise cuts with the robot and our implant materials are much better.”

Just as important to Dr. Suarez as the latest technology is the reduction or elimination of opioid use for pain relief. He is leading a clinical trial (more information below) to study a non-addicting, non-opioid medication.

Juan C. Suarez, M.D., an orthopedic surgeon with Baptist Health Orthopedic Care.

Every year, there are nearly 1 million hip and knee replacement surgeries performed in the U.S., according to the American Academy of Orthopaedic Surgeons, and by 2030 the organization estimates there will be 3.5 million total knee replacement surgeries alone annually. An aging population that can no longer take part in regular activities because of the pain from osteoarthritis and rheumatoid arthritis, joint degeneration, fractures and other injuries, is driving the increase in cases.

Robotic joint replacement

While not every patient is a candidate for a robotic-assisted joint replacement, the procedure continues to be adopted by more and more surgeons as they better understand the advantages for each patient. “Robotics is here to stay,” Dr. Suarez says. “A surgeon’s eye doesn’t really know what 2 degrees is, but the robot does, and this is the accuracy we are talking about.”

Tiny tracking devices placed around the knee or hip of a patient before a robotic-assisted surgery communicate position and location data to the robotic arm. If surgeons decide an adjustment needs to be made during the procedure, the computer can be recalibrated.

When the implant is in position, doctors can also determine the alignment and balance of the new joint, ensuring a customized fit with less risk of instability and pain.

3D models and printing

Real-time 3D images also provide extra information to help surgeons assess implant placement, and 3D printing is helping them manage significant bone loss and challenging cases they were unable to treat surgically before, Dr. Suarez says.

“Knee implants have been heavily cemented in the past,” he says. “But today’s 3D-printed materials are more similar to bone. This allows the bone to grow into the structure, providing biological fixation. We don’t have to use the same cement to adhere it to the bone and ligaments, and other structures around the knee don’t have to adapt to a totally new environment.” Doctors are hopeful that the new implants will last longer than the typical 15 to 20 years most people get from a total joint replacement.

How phenotypes and smart devices may impact surgery

Your knee isn’t necessarily like your brother’s or your neighbor’s, and doctors are also learning more about the differences in knee anatomy and alignment between men and women and even among ethnic groups. The study of knee phenotypes, or those bows and bends in a leg, leads to a classification that Dr. Suarez believes will eventually help surgeons understand what type of implant and technique is best for a particular patient.

“We used to do a knee replacement the same way for every patient and we tried to make everyone’s legs straight with an implant,” Dr. Suarez explains. “But everyone’s anatomy is different. And, as we collect more data, the joint replacement of the future will improve even more.”

Implantable smart devices are also in the works, collecting and providing data on range of motion, walking speed, gait biometrics and other milestones physicians can use to gauge progress. “Imagine in the future if we were able to detect an infection early on,” says Dr. Suarez. “The information we are beginning to gather now will be game-changing.”

The vital move away from opioids

Managing pain before and after implant surgery, and many orthopedic procedures in general, has been a challenge for doctors, who once prescribed opioids for most patients. But with a focus on the opioid epidemic (the World Health Organization says that more than 75 percent of drug overdose deaths involve an opioid) doctors are looking for alternatives.

Dr. Suarez is the principal investigator of a clinical study comparing total knee replacement patients who are administered Zynrelef, a gel pain relief medication applied at the end of surgery, to a control group receiving the standard postsurgical analgesia, often opioid prescriptions.

“For the best outcomes and for patients to handle rehabilitation, they need to have their pain managed. But if a patient is still taking pain medications 90 days after surgery, we know that there is an extremely high chance of becoming addicted,” he says. “We are hopeful that this local anesthetic better controls pain in the days following surgery and reduces the need for opioids.”

Outpatient and short-stay joint replacements are becoming more common, thanks to more in-depth patient education, surgical preparation and pain management.

For more information on joint replacement surgery or to find a physician affiliated with Baptist Health Orthopedic Care, click here.