Robot technology in hip and knee replacement surgery has created a lot of interest in Adelaide this year. There are two types of systems available or in development - large robotic arms that position the cutting tool for the surgeon and smaller hand held instruments that the surgeon positions while the robot retracts the cutting tool if it is in the wrong place.
I often get asked by patients considering knee replacement surgery if stem cells are any good for knee arthritis. My view is that they are snake oil, quackery and possibly fraud.
Clark Stanley was known in the wild west as the ‘The Rattlesnake King’ travelling the country with an elaborate show including rattlesnakes. He spruiked the benefits of his snake oil as a cure all for many conditions including ‘rheumatism’ an old term for painful joints. He eventually came unstuck when his snake oil was tested by the US government and found to not contain any snake oil. Since then the term ‘snake oil’ has come to mean any false cure.
As a surgeon who does both anterior and posterior hip replacement surgery I get asked every week which approach is better. The answer is not as simple as you might think. Both approaches have risks and benefits and each hip is different.
They key benefit of the anterior approach is that it does not involve cutting any muscle, while the posterior approach does require a small amount of muscle to be cut and repaired. In theory this could result in faster recovery and less risk of instability and dislocation. A recent meta-analysis reviewing 17 high quality scientific studies (2302 hips) gives qualified support to this. There was a slight reduction in length of stay in hospital and dislocations using the anterior approach but they also found no clear superiority of either approach.
A highly polarised debate has been raging for years regarding the best choice of graft in Anterior Cruciate Ligament Reconstruction (ACLR). There are strong advocates for either the hamstring or patella tendon technique, or for various versions of artificial ligaments.
For most patients the key question when having a hip or knee replacement is "How long will it last?"
It is now easy for Australian surgeons to answer this question thanks to the long term data on revision rates recorded by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). A revision is when an operation is performed to change one or more joint replacement components due to complications or other issues with the joint. The latest report shows that the average revision rate of hip and knee replacements at 10 years is approximately 5-10%. There is however a lot of variation depending on the implant used and the surgeon.