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Question: What have been the key breakthroughs in your field?

Joseph Zuckerman: Well, I think they come in two areas. First of all, over the last 20 or 30 years, the innovations in treating arthritic joints have been astounding. I mean, basically we now can take arthritic, worn out joints, replace them with artificial joints, and provide patients with 95% or more certainty that they will have a successful result, be relatively pain-free, improve their activity, improve their quality of life. I mean, that's a very powerful thing to do.

Now, keep in mind that orthopedic surgery is a specialty that, for the most part, doesn't deal in life and death situations. We deal with quality of life situations. So, we focus on improving people's quality of life. And whether it be hip replacement or knee replacement, shoulder replacement, or even elbow replacement. These types of procedures take patients who are terribly disabled and allow them to become more mobile, walk, play athletics, do the things that they want to do when they really didn't think it was possible before. So, to me, that's a very powerful thing.

Now, that's on the treatment side. There's a lot of research being done on the prevention side preventing joints from getting to that point where they need a joint replacement. You know, that has to do with manipulating the genetic basis of articular cartilage and the structures around the joint and I think that holds great promise. It's not here yet. Ultimately, things like that may decrease the need for joint replacement.

 

Question: How is longer life expectancy a challenge?

Joseph Zuckerman: Well, the key element in joint replacement is longevity. Taking a person who needs a joint replacement and giving them a replacement that will last the rest of their lives.

Now, when joint replacement first started being done in the '60's, or even the '70s, it was reserved for people in their 60's and 70's, or such because there was concern about the longevity. However, over the last 30 years, advancements in the design, the materials that are used for joint replacement have allowed the joint replacements to last longer and longer. So, it's possible now to take a 50-year-old, or a 40-year-old, replace their hip or knee, and anticipate that they will have that replacement in place for the rest of there lives. So, the rest of their lives is different when defined as 30, 40, or 50 years as opposed to maybe 10, 15, or 20 years. And I think that's where the advancements are going to come, in the materials that are being designed and to a certain extent the design.

 

Question: Which joints get the most attention?

Joseph Zuckerman: Well, it's interesting. Hip and knee replacement has tended to get the emphasis in the area of joint replacement because hips and knees are really necessary for your mobility, the ability to walk, work, do the things that you have to do each day; to get out of bed, walk to the bathroom, walk around the kitchen, to do all the things that are considered necessary. Your mobility.

 

Shoulder and elbows have generally taken a back seat to a certain extent primarily because, if you can't do something with one arm, well you can probably compensate for it with the other arm. So, it tends to get less attention. In addition, there's the perception that the shoulder and elbow is not a weight-bearing joint like the hip and the knee. And that's true to a certain extent, although there are significant forces that are generated across the shoulder and the elbow such that when they're arthritic, they can be very painful.

More from the Big Idea for Tuesday, May 14 2013

Medical Ecology

The study of the human microbiome is a fast emerging field of scientific endeavor, driven by the idea that we need to rethink our relationship to the 100 trillion microbes that reside in the human... Read More…

 

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