by Tara D. McClary, Public Relations

Community Liaison Hip and knee replacement surgeries are among the most frequently performed reconstructive procedures in orthopaedic surgery with about 300,000 knees and 200,000 hips operated on every year in the United States. Studies measuring quality of life such as the SF 36 and WOMAC scales have shown a greater improvement in quality of life per health care dollar invested after hip and knee replacement than any other surgical procedure. In 1997, MUSC’s department of orthopaedic surgery performed more than 400 total joint replacements.

Studies show that America’s population is getting older. In 1986, 12 percent of the people were 65 and above. The projected increase in the elderly population during the next 40 years is 21 percent. With this rise in population age and with men and women working longer and participating in recreational activities, like golf and tennis, well into their 80s, there is an advancing demand for total hip and knee arthroplasty.

South Carolina has a rich heritage in hip and knee replacement surgery. In the late 1950s, Austin Moore, M.D., a Columbia surgeon, developed one of the most effective hip implants at that time in the world. Later developments, including the design of a successful cementless type hip implant, have originated in South Carolina as well. There are a variety of hip and knee implants and techniques currently available. The results of these procedures vary significantly from one implant to the other and also with differing techniques. Unfortunately many of the implant designs on the market have not demonstrated a clinically successful track record equal to some of the early designs. It is important to develop and select those implants and techniques which will be successful not only for the short term but up to 20 to 25 years. Richard Friedman, M.D., professor of orthopaedic surgery, and Del Schutte, M.D., assistant professor of orthopaedic surgery, are involved in clinical and basic science research to further improve the success of these implants and procedures. This has included collaboration with other centers in the United States and internationally.

A promising effort is the collaboration with the hip replacement center in Exeter, England. This past fall in Charleston, Del Schutte, chaired the first Exeter hip symposium in the United States. This group, which has developed one of the most successful hip replacement implants and techniques, has demonstrated a greater than 90 percent success rate at up to 26 years for primary hip replacement. Their work in revision hip surgery and techniques has been shown to not only replace the implant but restore bone for the patient. This has been especially important in patients who may have had more than one prior arthroplasty and lost significant amounts of bone through wear and/or stress shielding.

The success of total joint arthroplasty requires a combined, multi-disciplinary effort. The support and skills of surgery technicians, implant selection teams, nurses, surgeons, internal medicine physicians, rheumatologists, rehabilitation units, and physical therapists are essential to the patient’s positive outcome. Future goals of MUSC include the establishment of an arthritis and joint replacement center which will network with other surgeons including international groups like that in Exeter to collect data for future outcome evaluation and research. Without proper data collection and the development of programs to systematically collect data and evaluate outcomes, it will be difficult to determine which procedures are ultimately most successful for patients.

Angus McBryde, M.D., chairman of the Department of Orthopaedic Surgery, says, “Consistent with the Medical Center’s mission of providing excellence in patient care, teaching and research, and accountability for outcomes, the Department of Orthopaedic Surgery, in conjunction with the Medical Center and affiliated departments, is looking forward to initiating and developing an outcome-oriented joint replacement service which will facilitate and document the highest quality patient care.”