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Ask The Expert - Marshall P.Allegra, M.D.
10/30/2011

Ask The Expert - Marshall P.Allegra, M.D.


Marshall P.Allegra, M.D.
879 PooleAvenue
Hazlet, NJ
(732) 888-8388
www.allegraortho.com


Dr. Marshall Allegra has a private practice in Hazlet and has affiliations with Riverview Medical Center, Bayshore  Community Hospital, Shrewsbury Surgical Center, and Metropolitan Surgical Institute. Dr.Allegra has been in  continuous private practice in Monmouth County since 1988. His education and training includes Undergraduate  Education at Bucknell University, Medical UAG/RWJ at Jersey Shore Medical Center and Surgical and Orthopaedic training at UMDNJ Newark.Dr.Allegra is a Fellow,American Academy of Orthopaedic Surgeons and a Diplomate on the American Board of Orthopaedic Surgeons.



Dr. Allegra, being in practice for over 20 years youmay have seen many cases where a patient is a candidate for  either arthroscopic or joint replacement surgery. Can you tell our readers what criteria dictate one or the other?

Surgical treatment of arthritic joints has evolved over the 23 years I have practiced in Monmouth County. The emergence of arthroscopy in the late 1970s offered hope for less invasive care of joint pain. Orthopedic surgeons later  realized that arthroscopy had limited use in the treatment of severe arthritis, and with the improvement of joint  replacements, arthroscopy was relegated to a secondary role in these cases. Arthroscopy is best suited for younger,  active patients with limited arthritic involvement of joints. The goal in arthroscopy in these patients is to delay eventual  joint replacement surgery. Total joint replacements are best suited for those patients over 60 years of age who are not  obese. These are not intended for extremely active patients, like runners, as such activity will increase the rate of wear  of the implants. While these guidelines are not absolute criteria, we have witnessed an increase in patients that are  heavier, younger, and more active that require joint replacements. Older patients have become more active as well, and  life expectancy has been extended. Newer techniques, including minimally invasive replacements, limited joint replacement (less than total joint replacements) and arthroscopy-assisted joint replacements are emerging. These  techniques are used with greater frequency today.



On a similar note, when is a partial joint replacement (minimally invasive) procedure appropriate?

In general, partial joint replacement refers mainly to the knee, which is divided into three compartments. Patients will  often present with one or two of the three compartments affected. The procedure replaces only the diseased areas of the  joint, leaving the healthy joint spaces and ligaments intact. The advantage is that recovery is quicker and usually more  activity is allowed for the patient. Typically, it is offered to the younger (less than 65), more active patient with limited  arthritis. It can also be performed in an outpatient setting, utilizing regional anesthesia, and allowing for a same day  return to home.



Can you also comment on the differing surgery's recovery period and what a potential candidate would need to  be aware of for the respective surgeries?

Total Joint replacements of the hip and knee typically require a hospital stay of 2 to 4 days, with most patients spending  some time in a rehabilitation facility, usually 3 to 7 days after discharge from the hospital. Partial knee replacement and  total shoulder joint replacement are typically performed in an outpatient surgical center setting or as an overnight stay  in a hospital. Total joint replacement patients require longer periods of recovery before returning to work, usually (but  not always) 2 to 3months,whereas partial joint replacement patients recover in about one half that time.



For the procedures that you personally specialize in, can you comment on the mobility after and the length of  time these surgeries can provide a normal lifestyle?

In general, the total joint replacement offers predictable, lasting relief of painful, arthritic joints. The typical patient  treated this way can expect pain relief and the ability to walk without a cane or crutches within the first 3 to 4weeks,  and will experience continued improvement up to 12 to 18 months post operatively. Patients often report that the joint  has a more natural feel 1 to 2 years post operatively. Good to excellent outcomes are in the 95% range. The typical  modern hip and knee replacement can be expected to last 20 to 25 years within a 95% probability. These are best suited  for an older population, but at times the indication for surgery is extended to much younger patients. Mobility is usually excellent, but this should not lead people to believe they can place unreasonable demands on the implants, such  as distance running. Partial joint replacement offers less invasive surgery, more rapid recovery and generally more  mobility. These procedures should be viewed as a stop-gap measure in many younger, more active patients who will  eventually require revision to total joint replacements when they are older. The use of smaller incisions in hip and knee  replacement surgery has resulted in less blood loss and faster recovery. The typical hip replacement in my practice can be performed through a 4 to 5 inch incision. Partial replacements of the knee use even smaller incisions.




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