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The Evolution of Joint Replacement: A Doctor’s Perspective 

Posted on June 12, 2024

Joint replacement procedures like hip and knee replacements have undergone significant advancements in recent decades to improve longevity, reduce pain, and enhance surgical precision. We sat down with experienced orthopedic surgeon Dr. Robert Thomas to learn about the major ways this field has progressed during his career. 

Improved Materials and Longevity 

One of the biggest changes Dr. Thomas has witnessed is the evolution of materials used in joint implants to increase their lifespan. He explained that older implants used to be cemented into the bone, but now they more commonly use “biomaterials” with special coatings that allow the patient’s own bone to literally grow onto and integrate with the implant surface. 

“It tricks the bone into thinking that the implant itself is bone. So the bone grows onto the implant and locks it in forever,” Dr. Thomas said.  

The plastic components have also vastly improved their durability. Early on, they would use materials like Teflon that degraded quickly. But around the late 1990s, manufacturers started using high molecular weight polyethylene, which is an extremely tough plastic that has superior impact resistance and low friction properties, making it ideal for articulating surfaces in joint implants. 

“Now the longevity of these implants could likely be 30 to 40 years,” Dr. Thomas noted. This has allowed surgeons to confidently use joint replacements for patients in their 50s and 60s, whereas previously they tried to avoid it for those under 70 out of concern that the patient would require a second procedure in their lifetime. 

Holistic Pain Management Solutions 

While pain medication options are still relatively limited compared to other medical advances, Dr. Thomas said the comprehensive approach to pain management after joint replacement has shifted significantly.   

Procedures are becoming less invasive, using muscle-sparing techniques like the anterior approach for hip replacements instead of detaching muscles. Anesthesiologists also now commonly use nerve blocks to numb the surgical area for several days in the acute post-op period. 

Perhaps most importantly, rather than relying solely on opioid medications, a “multimodal” strategy is utilized by combining different drug types to cover multiple pain pathways. 

“We’re trying to come at the pain from different attack points rather than just the one [opioids],” Dr. Thomas said. 

Another key aspect is patient education and setting expectations. Dr. Thomas explained that lengths of hospital stay have plummeted, with many joint replacements now done as outpatient procedures.  

“A lot of its due to patient education, the ‘here’s what to expect.’ That plays an enormous role in someone’s ability to tolerate discomfort afterwards,” Dr. Thomas stated. Ensuring patients understand their recovery expectations and have adequate home support systems is essential for managing postoperative pain.  

Robotic-Assisted Precision 

The rise of robotic-assisted surgery systems has allowed for greater accuracy and precision in implant positioning. Dr. Thomas, who has performed thousands of robotic knee replacements, is a major proponent of the technology. 

“My ability to alter, say, my bone preparation by one millimeter, or maybe one degree, I can do that with the robotic device by literally just plugging that into the program,” he explained.  

Robotic guidance ensures optimal implant alignment and soft tissue balancing around the joint for stability. Dr. Thomas added, “I think it’s safer. I think it keeps you from cutting ligaments from the saw blade, I think it keeps you from cutting potentially arteries and veins.” 

While this technology is still relatively new and evolving, Dr. Thomas believes the long-term data will show superior outcomes compared to traditional manual techniques.  

From better materials and patient education to the rise of robotic-assisted surgery, the field of joint replacement has transformed remarkably over the last few decades to improve patient outcomes and longevity. Thanks to doctors like Dr. Thomas who continue to utilize cutting-edge solutions, these procedures can help more patients regain mobility for longer periods of their lives. 

Think you may be a candidate for joint replacement? Request an appointment today. Our orthopedic surgeons utilize the latest technologies and techniques to get you back to what you love. 

Robert Thomas, MD - Joint Replacement Surgery

Dr. Robert Thomas

Robert L. Thomas, M.D., is a board-certified orthopedic surgeon specializing in total joint replacement surgery and fracture care, in addition to sports medicine and general orthopedics.