Joint Replacements: Proper Selection
Guest: Dr. Harry Demos – Orthopedic Surgery, MUSC
Host: Dr. Linda Austin – Psychiatry, MUSC
Dr. Linda Austin: I’m Dr. Linda Austin. I’m talking, today, with Dr. Harry Demos, Assistant Professor of Orthopedics here at MUSC. Dr. Demos, you are very experienced in joint replacement surgery. There’s a lot on TV now, a lot of ads directing patients to choose this knee or that hip, or whatever. How can a thoughtful person think about those options and talk about them intelligently with their doctor? What do you see as being some of the issues when you’re making those decisions?
Dr. Harry Demos: Thank you, Linda. That’s a very interesting question. There are a lot of ads. They’ve even hit primetime now, talking about certain brands of knees or certain brands of hips; knees that rotate, knees that replace part of the knee, and everything else. These joint replacements have been out for awhile. The marketing is what’s new. Many patients come in asking for the new replacement that they just saw on TV, which is, really, not a new knee replacement.
It’s one that’s advertised to us as being tried and true, and proven, that’s most important, rather than the newest and latest and greatest. I think what’s important for patients to understand is that a lot of what is on TV is purely marketing, and it’s not a substitute for a discussion with your doctor about what the best option is for you, as opposed to what’s being shown on TV. I think it’s very important that the physician see and evaluate the patient, evaluate the x-rays, and help the patient make the right choice as to the best type of knee replacement or hip replacement, or even whether a hip or knee replacement is the right answer, before choosing something they’ve seen on TV.
Dr. Linda Austin: So, let’s take knees, for example. How many different brands or models do you have access to?
Dr. Harry Demos: At MUSC, we have access to at least six different manufacturers of joint replacements. And each one has several different lines of joint replacements that they make. That being said, probably 90 percent of my primary joint replacements are all within the same line of joint replacements. However, there are others that are available, and each manufacturer has ones that are similar to other manufacturer’s joint replacements, so there are many different options that we can choose from. And there’s, really, not anything that’s advertised on TV that’s not available to us. Whether or not any of them are the right choice for a given patient is another question.
Dr. Linda Austin: What are some of the patient selection criteria that you think about, or factors, when you’re choosing a particular hip or knee?
Dr. Harry Demos: There are a couple things, and I’m going to focus in on partial knee replacements, or resurfacing hip replacements. Those are both very hot marketing items right now. Patients say, well, I can have a partial knee replacement, instead of a total knee replacement. But it’s very important to know the indications and contraindications of a partial knee replacement, or to a resurfacing arthroplasty. We can do both of those procedures at MUSC, but it’s the rare patient who’s a good candidate for either one of those. The vast majority of patients would end up needing a total hip replacement or a total knee replacement, and to do an operation that would be destined to fail, and have to be revised, is not what we’re trying to achieve. We’re trying to achieve the longest lasting results with the best implant from the very beginning. So, I think it is important to, rather than focus on TV ads, have a thoughtful discussion about this with your doctor.
Dr. Linda Austin: Dr. Demos, thanks so much for talking with us today.
Dr. Harry Demos: Thank you.
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