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Summer 2007

Hip and Knee Replacement Surgery Makes Strides

Smaller incisions. Less pain. Faster results. The orthopaedic team at UCLA is making great strides to accelerate recovery from joint replacement surgery using new surgical techniques and anesthesia protocols to complement design refinements to artificial hips and knees.

"We’re becoming increasingly elegant in the way we do these surgeries," says Daniel Oakes, M.D., chief of the joint replacement service at Santa Monica-UCLA Medical Center and Orthopaedic Hospital. "Our team is thrilled to see patients going home sooner with less discomfort and better results."

Improvements in instrumentation have reduced the average length of hip and knee replacement incisions to less than five inches, compared with 12 to 18 inches only a few years ago. "The key to a successful joint replacement continues to be proper and careful positioning of the implants. That's job one. But now we’re able to do the job through a smaller and less invasive window," says Dr. Oakes.

Just as important, however, are new approaches to surgical anesthesia and pain management that ease the rigors of surgery and rehabilitation. Use of sedation during surgery rather than general anesthesia means less nausea and disorientation upon awakening and less potential for certain post-surgical complications, such as blood clots. Rather than treating post-surgical pain with narcotics, UCLA anesthesiologists administer oral pain medications prior to surgery and use regional pain blocks that numb the nerve from the hip down to the foot for as along as 48 hours after surgery, notes Alireza Sadoughi, M.D., a UCLA anesthesiologist.

At the same time, advances in hip implants have dramatically increased the size of the femoral ball that fits into the artificial hip socket. The larger ball size means better range of motion and less risk of dislocation during normal use. Knee implants, meanwhile, come in an increasing range of sizes and are now designed with male and female femur anatomy in mind, easing the work of the surgeon and better restoring the patient's anatomy.

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