David F. Dalury, M.D.

Implant design and innovation continues to develop with technological advances in imaging, implant materials and computer modeling. Implants today are leaps and bounds ahead of their counterparts from 20 years ago in regards to durability and performance. Marketing for these implants has also exploded as implant manufacturers are now going directly to the patients with “gender specific” or high performance “athlete” implants. In general, implants used today by orthopedic surgeons are very durable and will help patients regain function regardless of the marketing behind them. Implants in general fail at a rate of about 1% a year meaning that at year 10 there is a 90% chance the joint is still working well and an 80% chance it is still performing at year 20. Entrust your surgeon to analyze the data versus the marketing hype and determine what particular implant will work best for your demands and anatomy.

Custom implants have shown no increase in durability or function and in some studies, demonstrated poorer outcomes.  One size does not fit all, but modern implants have great versatility and sizing options available for your surgeon.  Preoperative radiographs and other imaging tools are utilized by your surgical team to ensure the proper implant and size are available.

Speak to your surgeon if you have specific requests for your implant.  Typically, surgeons have a few manufacturers and models that they prefer and have spent hundreds or even thousands of surgeries honing their skills with that particular instrumentation.  It would not be advisable to switch based on some great marketing material you came across in a magazine or the internet.  Within their arsenal, your surgeon will have an implant that will meet your expectations.

This refers to the polyethylene bearing placed in the knee between the two metal components.  Some patients refer to this as their new “meniscus or cartilage”.  Traditionally, the polyethylene locks into the metal tray and is referred to as a “fixed bearing”.  A rotating platform or mobile bearing allows the polyethylene to rotate independently from the metal tray.  Theoretically, a rotating platform or mobile bearing would reduce wear of the polyethylene and more closely mimic the movement of the patient’s natural knee.  Studies performed have not shown an advantage in patient satisfaction, durability or function between the two options.  The rotating platform has been marketed as an “athlete’s knee” or the “golfers knee”.

The use of newer technologies such as robots is at the discretion of the surgeon.  At this time, no studies have demonstrated improved outcomes with robotic assistance.  These surgeries typically are considerably more expensive as well as longer in duration.  As technologies continue to develop, robotic assistance will begin to play a more integral part of the surgical process.

The vast majority of the implants available on the market are composed of surgical stainless steel and highly crosslinked polyethylene.  This high quality steel is composed of chromium, cobalt and nickel.  These metals are found to have great durability and are typically very inert in the body.  Implants no longer employ metal on metal bearing surfaces like they did in the past.  These “old style” implants could cause metal ion buildup in the tissues surrounding the implant and ultimately cause failure.  These issues have been resolved with newer more advanced bearing surfaces.

It is not uncommon for patients to have skin metal sensitivities that typically arise from contact to jewelry or eyeglasses.  This DOES NOT imply that you will have a similar reaction to the implant in your body.  There has been no indication that patch skin testing or blood tests to determine metal allergies are beneficial to determining whether you will have an adverse reaction to the implants.  If you have concerns in regards to metal sensitivity or allergy to your implant, talk with your surgeon to determine if an alternate implant may be necessary.

No, we cannot use any implants that have been recalled.  All implants used are FDA approved and have not been part of a recall in the past.  We will keep the serial numbers and implant information and you will be contacted according to federal law if any of your implants were to be recalled in the future.

Typically there will be no distinguishable difference in leg length following total hip or knee replacement.  The collateral ligaments around the knee are preserved thus making it difficult to lengthen or shorten a leg after total knee replacement.  If the patient was afflicted with a very knock kneed (valgus) or bowed knee (varus) preoperatively, then the leg may feel longer postoperatively.  In total hip replacement length differences are a risk.  They are rare and typically do not require any treatment or intervention.  In order to insure a stable hip it is sometimes necessary to lengthen a leg slightly.

Yes, Dr. Dalury will be the one conducting your indicated surgery.  He utilizes a team of skilled physician assistants, nurses and orthopedic surgical techs to assist him in the operating room during his cases.  He currently does not participate in the training of orthopedic fellows, but occasionally has orthopedic surgical residents participate for educational purposes.  He has spent over 30 years developing his surgical skills and building his reputation as a world class hip and knee replacement specialist.  It will be his hands that handle the intricacies of your particular case.