My orthopedic practice specializes in hip and knee replacements, and I have witnessed and participated in the most remarkable and wonderful advancements in joint replacement surgery over the past 35 years. Back then, both procedures were considered by many to be“miracle” surgeries that would relieve pain and allow people to once again become active. I still consider them “miracle” surgeries. Routinely, my patients express their gratitude and tell me that I’ve “given them back their quality of life”.  I love my profession.

When I started my practice 35 years ago, twice as many people were having hip replacements, than knee replacements. Now it’s the opposite: twice as many people undergo knee replacement surgery. There has been exponential growth in both surgeries because they have been so successful, with approximately 1.37 million total joint procedures done 2020 and a projected 3.48 million expected by 2030.

What has changed the most in my experience, in a wonderful way, is how much faster and more predictably people are getting well. When I started my practice, patients routinely stayed in the hospital for a week and most then went to a rehabilitation center. Now, almost everyone walks just hours after their surgery and goes home that afternoon or the next day.

This trend has occurred for a number of reasons. The anesthesia, usually a spinal, plus local and nerve blocks combined with multiple medicines from different classes of drugs, given both before and after the procedures, results in patients awakening from anesthesia much more easily and comfortably. Many complications that I saw commonly years ago, such as nausea or confusion, are now avoided. When someone is not having pain and doesn’t feel sick, they get well quicker and have a better experience.

With better anesthesia and better surgical techniques, blood loss during surgery is a fraction of what patients experienced years ago and today the need for a blood transfusion is rare. Patients now also receive tranexamic acid, a medicine which stabilizes blood clots and has made a wonderful difference in decreasing the need for a transfusion.

The surgical techniques to implant a knee or hip are less invasive and more precise than ever before. Historically, after a total hip replacement, I would ask patients not to put their operative leg in certain positions until their soft tissues had healed for fear that their hip could dislocate. My technique has been refined so I now implant the hip components while preserving the surrounding muscles and hip joint capsule. I no longer restrict my patients in any way after their surgery, instead encouraging them to listen to their body and move so they are comfortable. Hip dislocation after surgery has become exceedingly rare.  I routinely see patients who return two weeks after their surgery walking without a limp, and many do not even use a cane.

The patients who are the happiest after a knee replacement are those who have the alignment of their leg optimally restored and the soft tissue sleeve that supports and guides their knee perfectly balanced. Robotics allows me to consistently realign someone’s leg and rebalance their soft tissue sleeve by more precisely, aligning the position of both the femoral and tibial components in multiple planes. This has resulted in less soft tissue releases and is proving both more reproducible and longer lasting. I could not be more pleased with how quickly my patients recover and resume full activities after both partial and total knee replacements.

The prostheses that we implant today are more refined, predictable and tested than ever before. The part of the implant that traditionally wears and which leads to failure is the bearing surface, which includes a plastic liner. The plastics which are implanted are now genuinely a magnitude (10x) better than the bearings that were available before the millennium. Patients who were reconstructed more than 20 years ago with these modern bearings are doing remarkably well and showing very little wear. Many patients who have a hip or knee replacement can look forward to at least another two decades of optimal service and life from their replacement.

I’ve highlighted some of the wonderful improvements in the techniques, technologies,  prostheses and even new drugs that have had a positive and additive effect on improving results after hip or knee replacement surgery. But the care someone receives, and their final result is still very much a “hands on people’s game.”  This has not changed. You need to go into surgery knowing that you will do well because of the confidence and connection you’ve developed with your surgeon and their team.

The Leone Center for Orthopedic Care provides highly personalized, end-to-end orthopedic care for people with hip and knee conditions. Dr. William Leone offers patients the latest, most-promising innovations in joint replacement surgery, in a compassionate, patient-focused setting. He has performed over 15,000 joint surgeries over the course of his career, restoring mobility and improving quality of life for thousands of patients from all over the world.

The Leone Center for Orthopedic Care at Holy Cross Hospital is located at 1000 NE 56th Street in Fort Lauderdale. For more information or to schedule a consultation please call 954-489-4575 or visit holycrossleonecenter.com.