EXPERT: Hip Tech

Dr.

Adolph Lombardi, Jr.

Dr. Adolph Lombardi, an orthopaedic surgeon, was one of the founders of New Albany Surgical Hospital, which opened in 2003 and became part of Mount Carmel Health Systems in 2007. He is vice chairman of the hospital management company.

Lombardi received his bachelor’s degree from Saint Joseph’s University and his medical degree from Temple University. He completed postgraduate training in general surgery at Temple University Hospital and in orthopaedics at Albert Einstein Medical Center in Philadelphia. He joined Columbus-based Joint Implant Surgeons, Inc. in 1987 and is now its president.

He is a Clinical Assistant Professor at The Ohio State University in the Department of Orthopaedics and the Department of Biomedical Engineering.

Lombardi is also president of Operation Walk USA, a nonprofit organization that provides free hip and knee replacements to patients in need.

In addition, Dr. Lombardi is the past president of The Hip Society.

Injuries

and aging can take a toll on joints, especially hips and knees. Orthopaedic surgeon and New Albany resident Dr. Adolph Lombardi, Jr. gives an inside look at the cutting-edge technology used to perform modern hip and knee replacements – and shares his work with nonprofit organization Operation Walk USA.

Q&A:

What conditions cause the type of damage that necessitates knee or hip replacement, and what other types of treatments are available for these diseases?

As an orthopaedic surgeon, I see a large number of patients with hip and knee disease. Before taking a patient to the operating room, doctors will treat with anti-inflammatory medication – your typical over-the-counter drugs. We also encourage patients to take glucosamine and chondroitin sulfate. We use cortisone-type injections and we may use the lubricant shots of hyaluronic acid and we may consider using arthroscopic procedures not only in the knee but also in the hip. However, the majority of patients with true osteoarthritis will probably come to joint replacement of some type.

What are some of the more recent technological advances in knee and hip replacement surgery?

There are several newer protocols on the horizon for knee replacement and hip replacement. One of the newer protocols that we’re using is preoperatively obtaining CT scans or MRIs of the hip, knee and ankle. This allows for 3D reconstruction of the patient’s anatomy. From these reconstructions, guides or jigs are made to help orient the components of the replacement joint on the bone. In the past, typically we have used guides that we have placed outside or inside of the bone, such as metal rods and angle guides. This new protocol is more of a personalized, individualized approach with patient-specific guides. The next step is the creation of personalized kits to perform a patientspecific surgery.

What are the benefits of these advances?

The advantage of this technology is it has improved the implantation of these devices, which will ultimately improve their longevity. Additionally, it has decreased time in the operating room which means decreased anesthetic complications and other complications that occur with protracted or longer operative times.

Is it better to have partial knee replacement surgery compared to a full joint replacement?

If a patient comes in and the whole knee is not worn out, why replace the whole knee? We now have refined the technology for partial knee replacements. When you can diagnose which part of the knee is worn out – medial (inside compartment of the knee), lateral (outside) or patella femoral (kneecap) – you can selectively replace a section of the knee. Any of these procedures, these partial replacements, can be done on an outpatient basis. Incisions are smaller, recovery time is shorter and the knee feels more normal because you have only replaced the diseased portion of the knee.

How painful and how quick is recovery from a hip or knee replacement?

I think the whole impetus in the arena of adult reconstruction of the hip and knee is rapid recovery – trying to get the patient up and out of bed as soon as possible. Our hip and knee patients typically spend one day in the hospital as long as they have someone to help them when they go home, and a lot of these partial type replacements are being done on an outpatient basis to facilitate a more rapid recovery.

We are very pre-emptive about pain, administering a narcotic before the surgery, using a local injection at the site of the wound, using techniques like nerve blocks – all of these things are done in tandem so the patient doesn’t experience that initial pain when he or she wakes up out of the anesthetic. With these types of modalities, it curtails the amount of pain throughout the whole recovery phase. If I operate on you in the morning, you’re up, out of bed and walking in the afternoon. The importance of this fast track recovery is that it minimizes post-operative complications such as blood clots and pneumonia and all those potential complications that occur when a patient spends too much time in bed or in the hospital.

Are there restrictions on mobility or activities after recovery from a knee or hip replacement?

Patients can return to all normal activities for daily living and all sporting activities that do not involve direct loading – such as walking, but not running. For tennis, we recommend doubles instead of singles just to decrease the amount of impact. Many of our patients enjoy a variety of sporting activities including downhill skiing, water skiing, golfing, biking and a variety of fitness exercises.

How long do replacement joints last?

These are man-made devices with man-made materials. I would say the average lifespan of a hip or knee replacement is dependent on a number of factors: age of patient, level of activity, height and weight. But in general, it is about 20 years until it wears out, and many times just part of it has to be replaced, such as a plastic liner.

What is Operation Walk USA and what is your role in it?

Operation Walk USA was founded out of Operation Walk International, which was itself founded about a decade ago. There are about 15 chapters of medical professionals that would travel to countries such as Nicaragua, Guatemala and Haiti, doing surgery there for free and bringing the equipment and personnel to get this done.

About a year ago, I asked the gentleman who started Op Walk International if he would mind if I started Op Walk USA. We started Operation Walk USA to help those in the United States who can’t afford to have hip or knee replacement – those patients who don’t have Medicaid and don’t qualify for any kind of government assistance. Last year on Dec. 2-3 we had 85 full or partial knee and hip replacements done across the country with 65 centers involved and 80 surgeons. Everybody came together to do these for free for the patients who qualified. This year, Dec. 7-8, we have 105 surgeons and about 250 patients whom we’re going to treat.

The other side of this is that, as the patients apply for this, they get evaluated to see if they qualify financially. In addition to those who qualified for Operation Walk USA, we identified another 20-30 patients who qualified for Medicaid who didn’t realize they qualified. So it not only helps those who can’t afford it, it also helps those who don’t realize they qualify for assistance.

Wesley Glen will open a new WELLness Center early in 2012. The center will include a lap pool with classes offered by the YMCA, state of the art physical therapy and rehabilitation areas, fitness center that overlooks the pool, therapy pool, wellness clinic and a juice bar!

All you need for Living the WELLlife in 2012!