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Twenty-three years ago Sal Foti was a high school student who couldn't get enough of the Rolling Stones. But vinyl wasn't the only thing the 18-year-old was wearing out. Juvenile rheumatoid arthritis had all but destroyed the Waterbury teenager's major joints, leaving him confined to a wheelchair in what should have been the glory days of his youth.
In 1974 Foti underwent a double hip replacement at the Orthopaedic Center at Waterbury Hospital. "I was lucky," recalled Foti, now 41. "The right prosthesis lasted 23 years and got me through two careers, a marriage and two kids." His left hip prosthesis was revised - or replaced - in November at the Orthopaedic Center.
Replacing the replacement
While
Foci's case is unique - relatively few teenagers undergo total hip replacement - he is among thousands of patients nationwide who are currently in the process of "replacing their replacements." That's because Foti and others who received new hips, knees and other artificial joints during the last two decades are now hearing the clock tick on revision. In fact, this year alone, more than 100,000 Americans will "upgrade" their artificial joints.
What's in store for these second-time-around patients?
According to Kristaps J. Keggi, M.D., of the Orthopaedic Center, they can expect improved surgical techniques, advances in prosthesis design and generally faster recoveries.
A regional pioneer in the field of joint replacement, Dr. Keggi began performing the surgery at Waterbury Hospital in the late 1960s. Today, Dr. Keggi and his surgical team perform more than 600 hip and knee revisions each year. The Orthopaedic Center also performs approximately 250 primary - or first-time - joint replacements annually, making it among the busiest centers in the state for all joint procedures combined.
Dr. Keggi also developed a modified anterior (frontal) approach for total hip replacement that has improved outcomes for both primary and revision patients. By approaching the surgery from the front, the team is able to work faster, simultaneously reducing blood loss and speeding recovery time.
When it comes to a new prosthesis, a greater number of options now exist for patients. At one time surgeons used a heavy stainless steel prosthesis. Today, the Center uses implants made of titanium alloy, a lightweight, state-of-the-art material that can last between 10 and 20 years - or longer - depending on individual use. The Center is also part of a nationwide investigational study of a new ceramic prosthesis. With its harder surface and superior bearing properties, the ceramic device is expected to increase joint longevity by preventing inflammation and bone loss caused by excessive friction.
More complex surgery
Despite advances in surgery and prostheses, revision surgery is still an intricately delicate procedure. Noted Dr. Keggi, "Revisions surgery is much more complex due to the patient's distorted anatomy (due to the normal aging process), bone destruction and scar tissue. The surgeon must be prepared for a multitude of different bone configurations -areas of intensive bone loss which require grafting and/or special implants."
Sal
Foci's right hip revision presented just this sort of complication. "The prosthesis had cracked off before surgery," recalled Foti. "During surgery, it had to be removed in pieces." An orthopaedic team prepared for all emergencies prevented what might have been a problematic surgery. "Over the past 25 years, we've accumulated a large inventory of implants to handle all possible problems," noted
Laurie Zagorsk, R.N., an operating room nurse on Dr. Keego's team.
Up and moving
Both Larose and Foti also received intensive patient education prior to their surgeries at the Waterbury Hospital center. "Everything was explained to me; it gave me a real feeling of comfort,"
Larose said. "Never once did I feel like I was being rushed into a decision."
When it comes to deciding about revision surgery, the two patients advise doing some homework. "Find a surgeon who will give you clear options and then leave the decision up to you," noted Foti. Added
Larose, Ask if the surgery is really necessary and then get a second opinion. When you make the decision, make sure it's a surgeon with a good track record. Look for someone who specializes in revision." | 
