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A "joint" is the term used to describe the location where two individual bones meet.  The human body has several different types of joints ranging from stiff and immobile (such as the joints between the bones in your skull) to the freely moveable synovial joints found in our arms and legs.  The most common joints replaced in the body include the knee, hip and shoulder.  Less commonly replaced joints include elbow, ankle and wrist.  Joints in the fingers, toes and spine can also be replaced!

In a synovial joint, the bony ends are covered with a smooth material called cartilage that allow the bones to glide back and forth with little friction and no discomfort.  The joint is contained within a joint capsule where the lining produces a very slippery fluid called synovial fluid. In an arthritic knee, the smooth cartilage breaks down leaving the raw exposed bone ends to rub on each other "bone-on-bone." It is this process of joint degeneration that causes arthritis.  Oftentimes the arthritic joint will try to produce more synovial fluid to lubricate itself leading to "water on the knee."  

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Normal knee

Arthritic knee

Knee replacement was first performed in 1968 followed by the hip in 1969 and was still considered an emerging field of medicine through the  70's and early 80's.  Over the last several decades, major advances have been made in the field of joint replacement to improve surgical technique, infection control, implant design and long term reliability.  Today, a modern hip or knee replacement can be expected to last 25-30 years! 

Regardless of the joint being replaced, the replacement process involves removing the worn out and diseased cartilage and replacing those parts with smooth metal and plastic parts.  Many parts of the joint (ligaments, muscle, tendon, knee cap, etc.) are not replaced.  Because of this, a joint replacement can more accurately be thought of as a cartilage replacement.  



Since the first hip replacement was performed in the United States in 1969 there have been several major advancements that have drastically improved patient outcomes and the longevity of the joint.  Among these advancements include the development of press-fit cups that do not require cement to hold them into the pelvis, improved plastic manufacturing and most recently, the use of the anterior approach (also called the direct anterior approach).  While the first two on this list improve the long term reliability of the joint, the use of the anterior approach has shortened the patient's recovery significantly.  The surgery is almost exclusively performed as an outpatient and most patients are able to tolerate the recovery with nothing more than mild pain medications.  Furthermore, no physical therapy is required!

In addition to the drastically reduced recovery time, the anterior approach also provides the following benefits:

  • Significantly lower dislocation rate 

  • No need for post-operative hip position precautions

  • More reliable implant positioning due to the ability to use X-Ray in the operating room

  • Muscle sparing approach = Faster return to activity, golf, sport, etc. 

  • No need for formal Physical therapy in most cases

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A total knee replacement refers to the procedure where all three cartilage compartments of the knee are replaced.  Knee replacements are among the most commonly performed surgeries with exponential growth expected due to the prevalence of knee arthritis and the overwhelming success of the procedure. The vast majority of knee replacement patients are able to go home the day of surgery!

Introducing the Smart Total Knee Replacement:

Dr Noble is the first surgeon in our region to use the Zimmer Persona "Smart Knee."  This technology incorporates a small orthopedic sensor into the worlds most popular knee replacement implant, transforming it into a powerful tool for your care team.  Without monitoring private information such as your location, the Smart Knee records important data about your recovery including: step count, knee motion, walking speed, stride length and walking cadence.  If something about your recovery is not going according to plan, we will be alerted to make the necessary adjustment before it is too late!

The best part about the Smart Knee is that it does not change the way the knee replacement procedure is performed in any way and is covered by all insurances.  

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Approximately 5-10% of patients who develop knee arthritis will have isolated arthritis only to the inside half of their knee joint.  In these cases, 75% of the knee joint has minimal to no arthritis. A partial knee replacement, as its name implies, is a procedure where the surgeon only replaces part of the knee joint.  In patients who qualify for a partial knee replacement, the benefits include:

  • Faster recovery from less joint irritation

  • Natural feeling knee

  • smaller incision

  • faster return to sports (golf, bowling, etc.)

  • earlier discharge from physical therapy.

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