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Joint Replacements Can Be 'Life-Altering'
By Lois Thomson



Dr. Edward D. Poon of Washington Health System's Orthopedics and Sports Medicine Group said not all advancements introduced in joint replacement worked out well. "The traditional hip and knee replacement is a metal surface on a plastic surface. In the hip, you have a metal socket and a metal ball, but there's a plastic liner that snaps into the shell. Recently there was a lot of interest in doing metal-on-metal hips, the idea being that metal on metal would wear less than metal on plastic in young, active patients. But a lot of complications have been associated with metal-on-metal hips. There are problems with patients developing pseudo tumors in the hip or having a bad reaction to the metal debris. So now we're going back to metal on plastic again. There are advances as you go along, but some aren't as good in hindsight."


Dr. Edward D. Poon and his colleagues at Washington Health System's Orthopedics and Sports Medicine Group handle all types of orthopedic care, including hands, feet and ankles, knees, hips, shoulders, arms and elbows, and fractures, among others. But Dr. Poon's specialty is joint replacement. "I enjoy joint replacement because I'm able to get people back on their feet and active again," he said.

He said that for his group, "Total knee replacements and total hip replacements are definitely the most common replacements that we do, and for whatever reason, we do a lot more total knees than total hips."

Dr. Poon explained that the decision of whether to perform a joint replacement is based on a combination of factors, including the appearance of the X ray, the patient's level of pain, and the patient's age. "The older the patient is, the more liberal we're going to be with the total replacement because the success rate in those over 60 is tremendous." He said it's not unusual for replacements to last 30 years or longer, so older patients are generally good candidates.

"For patients who are younger, we try injections, physical therapy, or other modalities, because – since they're younger, they're more active, and they're going to potentially wear out the replacements."

Dr. Poon has seen a lot of changes during his 16 years of practice. "When it comes to surgery you generally hear things like 'smaller incisions' or 'less-invasive surgery.' But the greatest advancement in joint replacement for hips has been the quality of the plastic, because that's the part that wears out. The current plastic used in a hip replacement is an Ultra High Molecular Weight Polyethylene. It is a very stable and reliable plastic that has reduced the risk of wear.

"For knees, I think the quality of the plastic has also improved, as well as the size of our incisions, and our understanding of trying to minimize muscle-cutting."

Dr. Poon said he became interested in orthopedics in college when his major was biomedical engineering. "Orthopedics has a lot of applications to biomedical engineering, so it was one of my interests from the very beginning when I went to medical school."

The joint replacement came about during his residency, rotating through the different orthopedic disciplines at the University of North Carolina at Chapel Hill. Dr. Poon followed up with a fellowship in joint replacement at Rush-Presbyterian in Chicago. He said he came to the Pittsburgh region because he was looking for a position in a relatively big city. He met a local group of orthopedic physicians here and joined their practice, and the group later became the leading Orthopedic practice owned by WHS. Dr. Poon is now the current Chairman of Orthopedics for the Washington Health System.

And since then, Dr. Poon has been handling joint replacements and changing people's lives. "Patients come in, completely disabled, unable to perform the activities of daily living: walking, sitting, getting in and out of a car. But after they've had successful replacement, they're back to normal. It's a life-altering procedure."

For more information, call (724) 206-0610, or visit www.whsdocs.org.

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