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John N. Hall, MD
Martha Jefferson Hospital
Dr. John Hall received his medical degree from the University of Virginia. He completed a residency in orthopedic surgery at the Atlanta Medical Center and a fellowship in hip & knee replacement at UVA. He and his wife, Stephanie, have two girls and a boy ages 8, 6 & 4. Dr. Hall loves to cook and his signature dish is macadamia encrusted mahi-mahi with risotto. In keeping with his attention to healthy joints, he loves to cycle. He and his family also enjoy camping. In 1995, Dr. Hall and his wife took a year off to travel around the world including destinations such as Nepal, New Zealand, Australia, Europe, Thailand and Tibet.
Treatment can be divided into two main components, surgery and everything else. Surgery is reserved when conservative treatment fails. Non-surgical treatment includes the orthopaedist's NSAID du jour, physical therapy, steroid injections, viscosupplementation, and bracing in some patterns of knee arthritis. Generally, depending on the duration of symptoms and previous treatments one or all of conservative treatments may be implemented.
When conservative treatment fails, and the patient reports significant and severe pain that interferes with the quality of their life or exercise demands, consideration is given to replacement surgery. Although hip replacement has been around since the late 1960's and knee replacement since the 1970's, significant advances have been made. For hip replacement, methods of fixation and alternative bearing surfaces have given surgeons more options. The use of bone cement in hip replacement has gone from routine use for both the acetabular and femoral components to selected use in the femur when the bone is more osteoporotic. Age is a consideration but as long as the bone is suitable, pressfit or fixation without cement is preferred. Acetabular components are routinely pressfit. New technology has led to the use alternative bearing surfaces. Traditionally, polyethylene-metal has been the bearing surface of choice. Advantages of this construct include greater than twenty year follow up, multiple intra-operative choices, and predictable wear patterns. Disadvantages include wear that can lead to loosening of the other components, and since polyethylene wear is dependent on the number of cycles, younger patients are more susceptible to early wear. Metal on metal and ceramic bearing surfaces offer advantages in younger patients.
Knee replacement has not drastically changed in the last thirty years, but advances in implant design and instrumentation has created reproducible surgical techniques that has led to 95% joint survival rates at 15 years and 90% at twenty years. The most important factors of survival have been shown to be correct alignment and ligament balancing of the implants. The most recent advancement in both hip and knee replacement has been minimally invasive surgery. There are three distinct techniques in hip replacement, a two incision technique that requires intraoperative x-ray, a standard technique with smaller incisions and a single incision that does not violate any muscular planes. These techniques are still in the early stages of follow up and require more investigation prior to general acceptance.
When conservative treatment fails, and the patient reports significant and severe pain that interferes with the quality of their life or exercise demands, consideration is given to replacement surgery. Although hip replacement has been around since the late 1960's and knee replacement since the 1970's, significant advances have been made. For hip replacement, methods of fixation and alternative bearing surfaces have given surgeons more options. The use of bone cement in hip replacement has gone from routine use for both the acetabular and femoral components to selected use in the femur when the bone is more osteoporotic. Age is a consideration but as long as the bone is suitable, pressfit or fixation without cement is preferred. Acetabular components are routinely pressfit. New technology has led to the use alternative bearing surfaces. Traditionally, polyethylene-metal has been the bearing surface of choice. Advantages of this construct include greater than twenty year follow up, multiple intra-operative choices, and predictable wear patterns. Disadvantages include wear that can lead to loosening of the other components, and since polyethylene wear is dependent on the number of cycles, younger patients are more susceptible to early wear. Metal on metal and ceramic bearing surfaces offer advantages in younger patients.
Knee replacement has not drastically changed in the last thirty years, but advances in implant design and instrumentation has created reproducible surgical techniques that has led to 95% joint survival rates at 15 years and 90% at twenty years. The most important factors of survival have been shown to be correct alignment and ligament balancing of the implants. The most recent advancement in both hip and knee replacement has been minimally invasive surgery. There are three distinct techniques in hip replacement, a two incision technique that requires intraoperative x-ray, a standard technique with smaller incisions and a single incision that does not violate any muscular planes. These techniques are still in the early stages of follow up and require more investigation prior to general acceptance.