Total Joint Replacement

Knee, Hip, & Shoulder Total Joint Replacement | DEUCE™ Knee | Knee Replacement | Minimally Invasive Surgery
Arthroscopic Surgery | Computer-Assisted Surgery | Hip Arthroplasty | Hip Resurfacing

Knee, Hip, & Shoulder Total Joint Replacement

While the symptoms of joint pain may be tolerated with medications and lifestyle adjustments, there may come a time when surgical treatment is necessary. Total joint replacement surgery, also called arthroplasty, removes the damaged portion of the joint and replaces it with artificial implants called prostheses. Arthroplasty is a treatment option that can relieve pain and restore function for most people. At Boulder Orthopedics, Physical Therapy and Sports Medicine in Boulder and Lafayette, Colorado, our Board-Certified Orthopaedic Surgeons employ the latest techniques in shoulder, hip, and knee replacement. We are dedicated to providing you with a seamless continuum of care and offer physical therapy rehabilitation to help get you back in action following your procedure. Are you considering joint replacement? Call the friendly professional staff at Boulder Orthopedics at 303-449-2730 to learn more.

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DEUCE™ Knee

The JOURNEY™ DEUCE™ knee system is an innovative early intervention joint replacement option for people with painful knee arthritis. The revolutionary knee implant is called “DEUCE” because it only replaces the two parts of the knee, the inner knee (medical compartment) and kneecap (patella), which are most frequently affected by arthritis. Unlike other implant systems, DEUCE preserves healthy bone, the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL). The DEUCE knee system is just one of the latest innovative procedures employed by the orthopedic surgeons at Boulder Orthopedics. If knee pain is limiting your activities, call (303) 449-2730  to learn more about early intervention with DEUCE knee system.

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Knee Replacement

Knee replacement surgery is indicated when arthritis is severe, when the articular cartilage has worn away to the extent that bone on bone contact is present. The type of knee replacement recommended depends on the nature and location of arthritis within an individual’s knee. Arthritis often involves all three compartments of the knee, the medial, lateral and patellofemoral compartments, in which case the total knee arthroplasty or replacement is indicated. For arthritis confined to one compartment, most often medial, occasionally lateral or patellofemoral, a unicompartmental replacement may be indicated. For arthritis involving two compartments, the medial and patellofemoral, a new bicompartmental replacement, the Deuce knee replacement by Smith and Nephew™ may be indicated.

A significant advantage of total knee replacement over partial replacement is the long track record of success with several studies finding 90% of components still functioning twenty years after implantation. Partial knee replacements have had long term success rates in the 80% range at twenty years in most studies.

Polyethylene wear of the tibial component has been a problem with knee replacements. Mobile bearing knees such as the LCS and the PFC Sigma by DePuy – J&J, as well as the Oxinium ceramic coating on the femoral component of the Genesis and Journey knees by Smith and Nephew™ are innovations designed to decrease polyethylene wear and improve longevity of the components. Recent gender specific and high flexion TKA designs are now available. The advantages of partial knee replacement are quicker recovery, preservation of both cruciate ligaments with improved stability, and better range of motion.

Another advancement in knee replacement surgery is computer navigation. Anatomical landmarks including the center of the femoral head, center of the ankle, and bony landmarks on the distal femur and proximal tibial are digitized into the computer, which then provides visual information to navigate the cutting blocks to maximize accuracy of the bone resections and alignment of the total knee. Most studies show improved component alignment with computer navigation. Our doctors have extensive experience with the various options and knee replacement systems. X-rays, exam and a discussion with your surgeon is required to determine which option is best for your knee.

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Minimally Invasive Arthroscopic Surgery

Means small incision surgery - Minimally Invasive Surgery for hip and knee replacements involves smaller incisions with less muscle and soft tissue damage. This allows less post operative pain and a quicker recovery. Our surgeons use the smallest possible incision which still allows them to insert the implants in the proper position.

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Arthroscopic Surgery

Minimally invasive arthroscopic surgery requires only small incisions and uses an arthroscope to guide the surgery. An arthroscope is a narrow tube that contains a miniature camera, light, and viewing instrument. The arthroscope allows the surgeon to see inside of a joint instead of using a large incision and opening the joint.  Further, thin surgical instruments can be used with the arthroscope during procedures. Arthroscopy is commonly used for hip and knee surgeries and may be used for smaller joints as well. Because arthroscopic surgery uses such small incisions, it is associated with less pain, bleeding, infection risk, and a quicker recovery time than traditional open surgeries. 

Please visit Boulder Orthopedics' Patient Education Library to learn more about minimally invasive arthroscopic surgery for orthopedic conditions.

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Computer-Assisted Surgery

The Board-Certified Orthopedic Surgeons of Boulder Orthopedics are experienced in computer assisted surgery. The image-guided system provides explicit information about a joint’s position. Computer-assisted navigation allows our surgeons to select the size and shape of a joint implant, align an implant, and secure an implant with precise accuracy. Computer-assisted surgery assists in accurate placement of the prostheses. If you are contemplating joint replacement surgery, please call Board-Certified Orthopedic Surgeons of Boulder Orthopedics at 303-449-2730 to learn more about computer-assisted surgery.

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Hip Arthroplasty

In the last few years there have been many exciting advances and improvements in total hip arthroplasty. One of the most significant areas of improvement has been in the bearing surface technology. The original total hip design used a metal head articulation on a polyethylene (plastic) socket. Wear of the plastic lead to wear debris which caused bone loss and loosening of the components. Recent developments have focused on improvement of the quality and durability of the polyethylene and on new durable hard bearing surfaces.

Currently there are several choices in bearing surfaces. At the present time there is no perfect bearing surface. The traditional choice is a metal or ceramic ball on the new technology polyethylene socket. Since approximately 2000 ceramic on ceramic and metal on metal bearing surfaces have been developed and perfected. Each bearing surface option has strong advantages and some small disadvantages.

Metal on metal bearing surfaces are very strong and will not wear out or break. They offer the option of larger head sizes which have certain advantages. They do not squeak. They do wear at the molecular level. This produces elevated levels of cobalt and chromium in patients’ blood. This abnormal level has never been shown to cause any medical conditions or diseases.

Ceramic on ceramic bearing surfaces are also very strong and produce very little wear debris. They do not have the problem of elevated metal ion levels in blood. They do have an extremely small risk of fracture or breakage. Also a very small percentage of ceramic on ceramic bearing surfaces have exhibited an audible squeak. This may be minor and barely audible or it could be loud enough to be heard with every step.

Other known risks of hip arthroplasty are dislocation, infection, leg length inequality, incomplete pain relief and the possibility of future revision surgery. The risk of dislocation is approximately 3%. The risk of infection is 1% or less. Leg length difference is a difficult problem. Mild lengthening makes the soft tissues around the hip tighter and decreases the risk of dislocation. Sometimes at surgery a decision has to be made to either lengthen the extremity or leave the hip mildly loose. If you are long on the operated side, you might have to use a small lift inside the heel of your opposite shoe. Generally a small leg length difference does not produce pain, a limp or future problems with the back or knee.

Hip resurfacing arthroplasty is a new technique which is an ideal alternative to full hip replacement surgery in certain patients.  This technique involves resurfacing or recapping of the femoral head and inserting a new metal liner for the socket.   The procedure preserves more of your own bone in the proximal (upper) femur which is an advantage if you require revision surgery in the future.  It is a good alternative for younger active patients who plan on returning to an active lifestyle.  Hip resurfacing generally allows patients to return to a higher level of activity than is generally recommended for total hip replacement patients.  This technique requires that you have excellent quality bone. 

Hip resurfacing arthroplasty was first performed in Birmingham, England in 1997.  It was released by the FDA for use in the United States in May 2006.  7-10 years results are now available and show excellent outcomes in properly selected patients. Healthy men under 60 and healthy women under 55 are generally ideal candidates for this technique.  The risks of this surgery are femoral neck fracture (1%), dislocation (1%) and elevated levels of cobalt and chromium in the blood postoperatively.  The metal on metal bearing surface is very durable and does not wear out.  However, it does wear on a molecular level to produce the elevated cobalt and chromium levels in the blood.  This has been studied and has not been shown to cause any medical conditions or problems.  

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Hip Resurfacing

Boulder Orthopedics is proud to be one of the first practices to offer state-of-the-art hip resurfacing. This new procedure is used to relieve pain and restore function for people with arthritis. Unlike traditional total hip replacement, hip resurfacing does not remove the bones in the joint, but instead resurfaces the bone with smooth metal. Hip resurfacing conserves bone and allows easier revision surgery in the future. Schedule your consultation today by calling 303-449-2730 to find out if you are a candidate for hip resurfacing and look forward to enjoying your favorite activities without pain.

Please visit Boulder Orthopedic's Patient Education Library to learn more about hip resurfacing.

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