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LEXINGTON Hip and knee replacement and revision surgeries are on the rise, increasing more than 3% nationally from 2009 to 2010, according to a report published in Orthopedic Network News, July 2011.

The orthopedic and joint replacement specialists at the Lexington Clinic Orthopedics – Sports Medicine Center have seen this increase in volume first-hand. Christian Christensen, MD, David Burandt, MD, FACSM, and Harry Derderian, MD, who perform hip and knee replacement and revision surgeries, see nothing but increased volume in the future for their practices. There are a number of factors driving the demand for hip and knee replacement. “Weight, weight, and weight are the number one, two, and three reasons that cause hips and knees to wear out early,” Christensen says. He also cites an ageing senior population that is living longer, baby boomers who want to live pain-free, active lifestyles, and advances in joint replacement systems.

In 2011, Christensen performed approximately 800 joint replacement surgeries including total hip and knee replacements, uni-compartmental knee replacements, and total knee and hip revisions. His surgery schedule is Monday, Wednesday, and Friday with up to five or six surgeries per day. “I feel that the volume of my work and the successful outcomes for my patients are the result of my training and the support given to me by the Lexington Clinic partners and staff and the staff at Good Samaritan Hospital. When I came here, it was a great opportunity to develop a practice.”

Christensen joined Lexington Clinic in 2003 after completing specialist training at Duke University and a fellowship at New England Baptist Hospital in Boston, where he trained under Drs. Dick Scott and Ben Bierbaum. The opportunity to practice in a physician owned practice and his wife Emily’s nearby family in Tennessee made his decision to move to Lexington, Kentucky an easy one.

Burandt joined Lexington Clinic in 2001 after completing a residency at the Henry Ford Hospital in Detroit, Michigan and a fellowship in knee and sports medicine at Baylor College of Medicine in Texas.

Derderian joined Lexington Clinic in 1983. He is board certified in orthopedic surgery and specializes in total knee and hip joint replacement and arthroscopic knee surgery. Dr. Derderian’s office is located at the Lexington Clinic East facility.

Anterior Approach in Hip Replacement

Christensen and Burandt have training in the posterior, lateral, and anterior approaches in hip replacement, but both now prefer the anterior approach. Christensen states that the anterior approach gives him “clear and easy access to the hip joint without cutting through the muscle mass of the posterior approach. Outcomes are clearly better with much less scarring and soft tissue trauma. Also the incisions are much smaller,” he says.

Patient recovery using the anterior approach is exponentially improved, Christensen says, and recovery is remarkably quicker. He recalls visiting a female patient less than 24 hours after her surgery. When he asked her how she felt, she swung her legs out of the hospital bed, grabbed her walker and then walked across the room. She stopped, turned, and lifted the walker in the air. “’I feel pretty good,’ she said. I was amazed and thrilled for her,” Christensen says.

Christensen estimates that he now uses the anterior approach for most of his primary hip replacement surgeries. Burandt echoed his preference for the anterior approach and sees the use of the technique continuing to rise. Christensen emphasizes that he uses the posterior approach when the situation dictates, and notes that there are clinical factors that determine the approach. “Having the anterior approach available has been a real positive for appropriate patients, however the more traditional approaches are still excellent techniques with a proven record of excellent outcomes,” says Christensen.

The patient population for hip replacement is varied, and “getting younger and is equally split between genders,” says Christensen. He now sees 40 year olds as well as the more traditional joint replacement candidate of 65 years and older. More women than men, 60%–40%, seek knee replacement.

Christensen and Burandt share a diagnostic philosophy that drives high positive outcomes. They counsel patients to exhaust alternatives before seeking joint replacement surgery, such as diet, exercise, physical therapy, and according to Christensen, “getting new and better shoes.”

Christensen says he dissuades possibly 75% of his clinical patients from joint replacement surgery because he doesn’t think that surgery will improve their condition to the patient’s, or his, level of expectation. “I have to be 99% convinced that I can improve my patient’s condition before I will operate on them,” he says, “because after I put in a new joint, there’s no returning to what they had before.”

Burandt also says that “managing patient expectations is a challenge.” Many patients have friends or relatives who have had joint replacement surgery, and expectations can be unrealistic. Burandt tells his patients that “recovery will be the hardest thing they’ve ever done, even more difficult than the pain they currently have.” If Burandt is not convinced that his patients will commit to the post op therapy regiment, he won’t proceed with the replacement surgery.

Improved Joint Systems and Technique

Advances in joint replacement systems are helping fuel the boom in joint replacement surgeries. Christensen and Burandt applaud the development of new metals, plastics, and the new lattice work designs that allow living bone material to graft itself onto the replacement parts. Both prefer the improved techniques of using non-cemented fastening of the joints which allow natural bone grafting, which previously did not occur because the cement was an impervious barrier.

“We don’t see the loosening of the joint and the resulting pain from the cement break down after a few years,” Burandt states.

Expanding the Team

To handle the projected increased volume and demand for joint replacement surgery, Lexington Clinic is adding a new orthopedic surgeon. Tharun Karthikeyan, MD, is completing his fellowship in joint replacement at OrthoCarolina, in Charlotte, North Carolina. Karthikeyan will join Lexington Clinic in August, 2012.

For patient referrals, contact Drs. Christensen and Burandt at (859) 258-8561 or Dr. Derderian at (859) 258-5225. For more information about Lexington Clinic Orthopedics-Sports Medicine Center visit