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Focus on the patient, implant and surgery will support a long-term TJA

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ORLANDO, Fla. — Attention to the entire triad of joint arthroplasty variables, which include the patient, implant and surgeon, will move modern total joint arthroplasty toward becoming more of a long-term solution for patients, according to a presenter at the Current Concepts in Joint Replacement Winter Meeting.

Fares S. Haddad

Fares S. Haddad, MD, FRCS , who is an Orthopaedics Today Europe Editorial Board Member, said, “Right now, the long-term joint arthroplasty is still a challenge.”

Patient factors that he said must be addressed include osteopenia, osteoporosis and sarcopenia; infection; patients who are living longer and are more active; and the goal of greater patient satisfaction.

In terms of the implant and surgeon components of the triad, Haddad said, “We now need to refocus on preservation and less-invasive surgery, on better implants and bearings, on better patient education and selection and ultimately, above all else, on the optimized surgical experience.”

Haddad said he sees a greater role for unicompartmental knee replacement or “unis” in patients due to the preservation of the joint ligaments that result, for example. He noted that in his practice, the “best arthroplasties” are unis.

“Uni knees may yet have a wider reach, but we are going to have to think what else we can do with the hip; but, there are some successes,” he said.

Cementless fixation may play a role in changing how knee arthroplasty is done in the future, according to Haddad.

“Ultimately, perhaps the key message to longevity of implants is the surgeon. The surgeon gets to choose the patient, choose the procedure and what to do at what stage of the patient’s life. I think that, and courses like this, are critical to getting it right and assuring the long-term survivorship of arthroplasties.” – by Susan M. Rapp

Reference:

Haddad FS. Paper #1. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 13-16, 2017; Orlando, Florida.

Disclosure: Haddad reports he is a consultant for and receives royalties from Corin, MatOrtho, Smith & Nephew and Stryker.