Five Questions With: Dr. Gary M. Ferguson

Director of The Total Joint Center at The Miriam Hospital, talks about the ever-growing trend of knee-replacement surgeries. More

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Five Questions With: Dr. Gary M. Ferguson

COURTESY THE MIRIAM HOSPITAL
"THE OPERATION has become extremely reliable, techniques to improve the recovery experience are constantly evolving, and public interest in staying active and mobile with aging steadily increases," said Gary Ferguson, Director of The Total Joint Center.
Posted 4/16/12

For many Baby Boomers, one of the symptoms of aging is the breakdown of hip joints and knee joints. In turn, one of the fastest growing fields in orthopedic surgery has become knee replacements.

The Total Joint Center at The Miriam Hospital is on track to do more than 700 knee replacements in 2012.

Providence Business News asked Dr. Gary M. Ferguson, director of The Total Joint Center, to talk about the ever-growing trend of knee-replacement surgeries.

PBN: About how many total knee replacements are done each year at the Total Joint Center at The Miriam Hospital? How does that compare with the rest of Rhode Island?

FERGUSON: At the Total Joint Center, we are on track [to conduct] more than 700 knee replacements in 2012, and more than 1,200 hip, knee, and shoulder replacements combined. When our affiliated Lifespan hospitals are included, our volume accounts for more than half of all similar surgery in all of Rhode Island.

PBN: What is the average age and demographic profile of the patient seeking total knee replacement?

FERGUSON: Partial or total knee replacements are done across a broad age spectrum. Approximately one-third of replacements are done in individuals between the ages of 45-63. The average age has decreased in recent years, from 70 to 68, a trend that continues today. Women outnumber men almost two to one [in knee replacements]. Active employment at most jobs is compatible with the operation.

PBN: There are a number of hospitals in Rhode Island that now offer competing technologies and surgical techniques. Why do you advocate a total knee replacement?

FERGUSON: This question addresses a common misconception. For knee disease, a partial replacement, surface replacement, robotic replacement, and total replacement are all operations that put implants into the joint.

They differ in two main ways: how the implants are actually inserted at surgery, and whether all or part of the joint surface actually gets an implant. Certain technologies offer an alternative to accomplish these two, but have not been shown to improve safety or last longer.

The best suggestion is that patients should seek out surgeons who do large numbers of replacement surgeries and have the procedure performed at an institution that also cares for a large volume of patients. These two features have been shown to correlate with the best outcomes.

PBN: As baby boomers enter into Medicare coverage at an increasing rate, is this surgery going to be an increasing trend, given Rhode Island's aging population?

FERGUSON: Yes, the demand for implant surgery for knee disease will increase in Rhode Island, both among younger adults and those entering into Medicare coverage. The operation has become extremely reliable, techniques to improve the recovery experience are constantly evolving, and public interest in staying active and mobile with aging steadily increases. One of our biggest challenges will be preserving the Medicare system itself so that we all have access to this great technology in the future.

PBN: What kinds of activity restrictions are there following surgery? How long does recovery take?

FERGUSON: The surgery involves between two and three days in the hospital, about 10 days of home-based physical therapy, then about six weeks of outpatient therapy. Returning to work in an office setting can begin at eight weeks after surgery. Partial workdays can begin sooner.

Permanent restrictions include running and high-impact exercise routines. Walking, biking, swimming, climbing, golf, doubles tennis, carrying heavy things can all be accommodated. Take care of your new joint replacement, and it will take care of you!

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