Joint replacement surgeries are now less invasive, more effective

Dan Briscoe, of Downers Grove, Ill., played basketball, racquetball, golf and tennis until osteoarthritis in both hips slowed him down. "It started in my early 40s," says Briscoe, now 50. Three years ago, he underwent hip-replacement surgery at Rush University Medical Center in Chicago; his other hip was replaced last January.

Not long ago, conventional wisdom held that a 50-year-old was too young for joint-replacement surgery. Doctors hesitated to install a device that could wear out in 10 or 15 years. But new-model implants for hips and knees — the most common replacements — can last up to 25 years.

No matter how old (or young) you are, you face replacement surgery if osteoarthritis has progressed so far that your bones have begun to erode. A surgeon may, however, be able to forestall replacement with arthroscopic surgery. In that procedure, the doctor uses instruments that look inside the joint and clean out loose bone or trim cartilage.

"When arthritis is in its very early stages, some cartilage flakes off or gets a little torn, which can be painful. Arthroscopy smooths cartilage out," says Dr. Richard Berger, an orthopedic surgeon at Rush Medical Center. Surgeons also use the procedure to repair tendons and ligaments.

On paper, joint-replacement procedures seem like a simple construction project, with tools including a power drill, a mallet and screws. The surgeon makes an incision, removes the damaged bone or cartilage, smooths the surface of the remaining bones and inserts the artificial joint. Then the surgeon applies bone cement or uses a cementless procedure to keep it in place.

Weight-bearing materials, such as stainless steel, titanium and ceramics, are used for hip implants, along with heavy-duty plastic. Knee implants, which require flexibility, rely mostly on plastics.

With traditional replacement surgery, you spend several days in the hospital and at least six weeks rebuilding with a physical therapist. If your job requires that you stay on your feet or do any lifting, you could be off work twice as long.

As a salesman for Hewlett-Packard, says Briscoe, "I couldn't be out of commission for six weeks." He discovered minimally invasive surgery, in which doctors use a muscle-sparing incision to insert the implant. "Recovery takes weeks, not months," says Berger, who developed the technique.

Briscoe was back at work part-time after two weeks. Most surgeons recommend modifying your activities after replacement surgery — say, by swimming rather than running or by using a treadmill instead of a track. Briscoe, who figures he has regained 90 percent of his range of motion, says, "I'm not going to do splits, but I'm very satisfied. I have all the mobility I need."