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TOA surgeon, Dr. Matthew Barrett speaks with the Tennessean about the latest in joint replacement surgery

The below article was featured in the September 13th issue of The Tennessean:

As Dr. Matthew Barrett modestly puts it: “I only know how to do two things.” It just so happens, however, that those two things are knee and hip replacements. Barrett, an orthopedic surgeon practicing at Saint Thomas Rutherford Hospital, explains how the patient demographic for joint replacements has changed, and what to expect if you need one.

Talk about the “changing face” of joint care?

Historically, joint replacement was for people in their 70s and 80s. But as implants have improved, physicians have been able to offer them to younger people without the fear of needing to revise or redo the surgery. These days, eighty percent of surgeries last 20 years or longer.

Also, today people want to stay healthy and maintain an active lifestyle longer, which means younger people have become one of the fastest growing patient populations for hip and knee replacements. In short, the face of joint care is changing because implants last longer than they used to and people won’t accept a lower quality of life because of joint pain — both of which are good reasons.

How do you typically determine a patient’s eligibility?

Before recommending a joint replacement, I require two things. First, the X-rays have to show significant cartilage wear. Second, the cartilage wear has to be bothering the person. If you’ve got a situation where the X-rays look bad but it’s not bothering the person, well, you don’t do a joint replacement.

Physicians typically try some non-surgical treatments first, such as anti-inflammatory medicine, steroid injections, lubricant injections, physical therapy, bracing, activity modification and weight loss. If those things fail, and the X-rays are bad enough, then the patient may be a candidate for joint replacement.

What does the future for joint replacement hold?

Knee and hip replacement are two of the best-received operations in all of surgery. Patient satisfaction for a hip replacement is close to 100 percent — like 98 percent — and knee is right up there as well.

Because joint replacement surgery is already very predictable and successful, it’s difficult to make major leaps and bounds. Currently, bearing surfaces are a big topic for the future — trying to find the proper surface that will last longest. It’s a constant search for something just a little bit better. We are also constantly researching methods to decrease surgical complications, shorten recovery time and increase function in these joint replacements, trying to obtain the most “normal” knee possible.

Describe the patient experience, start-to-finish.

After a patient has tried non-surgical treatments and is considering surgery, we sit down and I tell them what the process is like. We talk about surgery and recovery, then they decide if it’s bothering them enough to move forward. If so, we pick a day weeks down the road. At Saint Thomas Rutherford, patients then attend a class to help them prepare for the surgery.

On surgery day, my team and I put the patient under anesthesia and operate. The surgery itself takes one to two hours. Following surgery, a patient is usually in the hospital for one to two days, until they are able to get in and out of bed safely. I see my patients two weeks after surgery, then again at six weeks.

Most of the time patients are 80 percent recovered from surgery within six weeks. But I always tell people it takes almost a year to fully get over joint replacement, so be patient.

What words do you have for a patient considering joint replacement?

Educate yourself. Find a surgeon and hospital you can trust. Be enthusiastic and optimistic. Then, after you have the surgery, attack your recovery so that you can get through it and move on with life. That’s how you can make sure the joint, whether it’s hip or knee, doesn’t rule your life anymore, and you can go back to living.

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