• General
• Knee Surgery
• Hip Surgery

General

Q: Can I learn about the experience of someone who has had a hip or knee replacement?

A: Yes, you can learn about the experience of someone who has had a hip or knee replacement. Patient testimonials have been submitted by previous patients and include information such as diagnosis, operation, gender and age as well as a personal account of their surgery experience.

Q: Is a cemented or uncemented femoral prosthesis better?

A: In a 1994 Consensus Statement from the National Institutes of Health, leading national figures in joint replacement surgery stated that "cemented femoral components" were state-of-the-art. Most surgeons continue to debate this opinion.

The survivorship (length of time to revision) of few uncemented femoral implant designs have matched that provided by the best performing cemented femoral implants. Suffice it to say, durable pain free hip replacements can be done using either cemented or uncemented fixation for the femur and is a decision best discussed with your surgeon.

Q: Why should I have my surgery at Columbia?

A: In the annual U.S.News & World Report study, in which more than 250,000 leading doctors were asked to name the nation's best physicians in various specialties - those "to whom you would send members of your family", New York Presbyterian Hospital was named to the Honor Roll of America's best. Also in 2001, more physicians from New York Presbyterian were named to America's Top Doctors than from any other hospital in the nation.

This distinction is the most recent indication that New York Presbyterian Hospital provides among the best care in America. New York Presbyterian Hospital physicians provide excellence in patient care.

The Center for Hip and Knee Replacement is committed to learning about the long-term survival of implants through clinical trials. This strong dedication and concern for patient treatment can be found nowhere else.

On the northern tip of Manhattan, New York Presbyterian Hospital is conveniently located for New York, New Jersey and Connecticut tri-state residents. Patients are frequently seen from Orange, Rockland, Putnam, Fairfield, Westchester counties and more.

Q: What do I need to know about recalled implants?

A: First and foremost, the surgeons of the Center for Hip and Knee Replacement at Columbia University have never used implants which have been involved with any product recalls.

In the past few years, two major orthopaedic implant manufacturer companies have had to recall their hip replacement products after early failures were seen in patients.

Most recently, a zirconia ceramic femoral head component was recalled by its French manufacturer St. Gobain Desmarquest on August 14, 2001 because it was fracturing at a higher rate than expected in some patients 13 to 27 months after being implanted. The component is the ball portion of the hip prosthesis that connects the femoral stem to the pelvis. St. Gobain Desmarquest distributes zirconia and alumina ceramic femoral heads worldwide to most of the orthopedic industry. Our surgeons still view ceramic articulations with some skepticism and any novel implants we may use in the future will be discussed thoroughly with the patient regardless of FDA-approval status.

Announced on December 8, 2000, Sulzer Orthopedics was forced to recall nearly 25,000 hip implants due to a manufacturing error in the production, one that left machine oil on the socket portion of the implant preventing it from adhering to the patient's pelvis. These sockets do not allow the patients body to heal properly and the oil prevents the bone from growing into the porous surface of the implant. Sulzer Orthopedics develops, manufactures and markets implantable medical devices and biological products for orthopedic markets worldwide.

Q: Is computer-assisted hip or knee surgery for me?

A: You may have heard about a couple of new-fangled hip or knee replacement ideas, including the use of robots, and so-called designer joints. Robots are being used experimentally to help in joint replacement surgery. The results aren't in yet on the subject of whether this improves the outcome of surgery-that is, how much pain you have-and how long the joints last. Beware of gimmicks!

As for designer joints, this was a big idea in the 80s-in which the artificial joints were custom-made on site. This sounds terrific-but in fact, it didn't pan out.

Q: When is it necessary to use antibiotics for dental work after having had a joint replacement?

A: According to the American Academy of Orthopaedic Surgeons and the American Dental Association, in the first two years following total joint replacement, all dental patients who are undergoing an invasive procedure, such as dental extractions or dental implants, should have antibiotic prophylaxis. After two years, only high-risk patients who are undergoing invasive procedures should have antibiotic prophylaxis. High-risk patients include those who are insulin-dependent diabetics, have had previous prosthetic infections or hemophilia. No antibiotic prophylaxis is recommended for any patient with a total joint replacement-even a high-risk patient-who is undergoing a low risk dental procedure such as fluoride treatment, X-rays or orthodontic appliance adjustment.

This statement provides guidelines to supplement practitioners in their clinical judgment regarding antibiotic prophylaxis for dental patients with a total joint prosthesis. It is not intended as the standard of care nor as a substitute for clinical judgment. Practitioners must exercise their own clinical judgment in determining whether or not antibiotic prophylaxis is appropriate.

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