Technology advances boosting outcomes

WORN OUT: The number of hip and knee replacements in Australia is on the rise as the Baby Boomer population ages.
WORN OUT: The number of hip and knee replacements in Australia is on the rise as the Baby Boomer population ages.

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The number of hip and knee replacement operations in Australia is increasing every year. This is partly a function of an ageing population and the baby boomers reaching the average age for  joint replacement. 

“In my practice the average age for a knee replacement is 68 and hips slightly younger at 66,”  Broadmeadow-based surgeon Dr Jorgen Hellman  said.

“The  most common disease process that leads to the need to replace a joint is idiopathic osteoarthritis, which means a joint that has just worn out due to age. 

“Other factors such as sporting-related injuries, torn cartilages or ligament ruptures can predispose a knee to early onset arthritis.”

Hips can be affected by growth defects occurring in childhood that can lead to the need for hip replacement at a younger age. Both hips and knees can suffer through significant trauma, fractures and dislocations that lead to joint replacement. 

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The main indication to have a hip or knee replaced is pain and/or dysfunction that impacts on the quality of life and outweighs any risks of surgery. With hips the pain is usually a chronic dull ache, felt in the groin.

“This can be mistaken for a muscle strain,” Dr Hellman said. “Pain can spread through to the buttock, thigh and occasionally felt only in the knee. The hip can become so stiff to movement that it becomes difficult to do day-to-day tasks, such as dressing and washing. 

“Knee arthritic pain is mostly felt only in the knee itself and does not cause a referred pain, as can occur with hips. Sometimes the knee can become unstable and give way, causing falls.

“With both hips and knees the pain comes and goes initially, but with time, sometimes over many years, the symptoms gradually increase. If simple measures, which can be discussed with your family doctor, fail to control your symptoms then it may be time to consult an experienced joint replacement surgeon.”

Total hip replacement has been described as the operation of the century. Both hip and knee replacements aim to dramatically reduce pain and restore function. 

Patients can expect to go home from hospital within a week of surgery. State of the art rehabilitation services are available for patients who require extra assistance or a longer stay in hospital. Dr Hellman closely supervises patient’s recovery and regularly reviews their progress. Return  to  near  normal  activities usually occurs within weeks to months of a joint replacement.  

Australia's National Joint Replacement Registry indicates that less than 10% of joint replacements fail over 15 years.

“The risks of joint replacements are as they are for any major surgery, but the majority of the time the benefits far outweigh the risks and the misery of not having the joint replaced,” Dr Hellman said.

”New manufacturing techniques, newer designs, minimally invasive soft tissue sparing surgery and computer assisted surgery have led to better recovery and better function with longer lasting successes.” 

Dr Hellman has pioneered  computer assisted hip replacement surgery and robotic assisted knee replacement surgery in Newcastle. 

For the last four years he has been using an Australian developed Optimised Positioning System, OPS, to customise and more accurately implant hip replacements. 

“OPS takes into account the way the patients hip moves with day-to-day activity and then through a computer simulation advises on the best position to place the artificial hip,” he said.

“This is then achieved during surgery with customised anatomic patient specific guides and laser guidance to accurately align the components in the patient.”

With knee replacements there has been a shift in aligning the components from the traditional method to what is called Kinematic alignment. 

“This can be thought of as customising the knee replacement to the patient’s own anatomy and recreating the mechanics of that knee prior to the arthritis setting in,” Dr Hellman said. 

“Kinematic alignment has shown better satisfaction than traditional methods.”

People should ensure  all non-operative measures have been exhausted before embarking on major surgery. 

“Simple things must be tried first,” Dr Hellman advised. “General risks and specific risks as pertain to your own circumstances should be discussed. The potential outcomes, length of recovery and how long the joint replacement should last needs to be understood. 

“Only when you understand what you are likely to go through can you make a decision on whether or not your quality of life is diminished enough to warrant a joint replacement.”

Dr Hellman’s offices are located at Suite 2/18 Lambton Road, Broadmeadow. He also does monthly visits to Nelson Bay.

For more information, ring (02) 4969 8275 or visit www.drjorgenhellman.com.au.