Total Joint Revision Comes to Great Falls

Dr. Jace Bullard is a fellowship-trained hip and knee replacement orthopedic surgeon who uses the most current techniques and minimally invasive approaches. He also performs revision surgeries on replacements that have failed, giving patients relief from pain caused by their replacements wearing out, infections, trauma, or unresolved issues from their original surgeries. We caught up with him for a Q&A about total joint replacements and revisions.

How has joint replacement changed?

Twenty years ago, joint replacement meant two weeks in the hospital on heavy anticoagulants and pain control. Now you go home the same day or the next day, you’re up walking immediately, and you’re taking aspirin to prevent blood clots. We’re seeing great outcomes with less invasive ways of doing replacements. A hip is not a hip is not a hip. We’ve learned about how variable patients’ anatomic and functional needs are, and modern implants allow us more flexibility to tailor a hip or knee prosthesis. With improvements in design and the use of computer navigation and robotic technology, we’re getting closer to a truly patient-specific hip or knee replacement. 

How is a joint revision different than a joint replacement? 

Revision is replacing an artificial joint that has failed due to wear, instability, infection, or trauma. When the conservative options to extend the life of the joint have failed, we can do a revision. It’s a more complex surgery. Sometimes we are working with ligaments that won’t hold the knee or significant bone loss. People nowadays live longer, so there’s more time to break a femur above an artificial knee, for example.

Have you seen a need in northcentral Montana for joint revision?

I’m seeing people who haven’t pursued care because of the complex logistics and expense of going far away for treatment. Many patients don’t recognize persistent pain as being abnormal after their joint replacement, so they’ve just been “dealing with it.” Having revision surgery as an option in their own backyard means it’s much easier to get care and improve the quality of their lives.

What does the recovery time look like? 

As with all medicine, much of recovery is patient specific. Hip replacement is typically easier to recover from than knee replacement. Revision surgery is typically a longer recovery as well. Physical therapy is a crucial element of rehabilitation following knee replacement and may be necessary following hip replacement. In general, my goal is for patients to participate in activities with minimal assistance at two-four weeks following surgery.  

Do you treat younger patients as well? 

The youngest total joint replacement I’ve done was for a patient in their 20s with avascular necrosis, which is when the bone dies because it’s not getting blood and the joint deteriorates. It can happen with a sports injury or car crash. The blood supply network to the hip is rather fragile for all it does. As recently as 15 years ago, joint replacement was almost exclusively reserved for older patients due to the relatively short lifespan of some of the prosthetic materials. With improvements in the longevity of those materials, we are seeing hip and knee replacements lasting much longer and age has become less of an issue. This allows us to help many younger patients with early arthritis secondary to previous trauma or other medical conditions. 

Is surgery always the best option?

The short answer is no. There are many effective non-operative treatments for hip and knee arthritis that we will exhaust before performing a hip or knee replacement. Non-operative treatment can also help delay or avoid a revision. Sometimes another surgery performed by a different specialist may prevent the need for a joint replacement. For example, some younger patients with altered hip anatomy may respond well to an arthroscopic procedure that can delay the onset of hip arthritis. 

What does joint replacement surgery mean for patients?

The people I take care of have given up pieces of their lives piece by piece until they can’t work or even tie their shoes. Bone is grinding on bone. In a few hours, their life completely changes. My first patient at Benefis was Doug Miller, who drives a school bus. After his hip replacement, he yelled out in the waiting area, “Dr. Bullard is a miracle worker!” His hip replacement took his pain away and will keep him doing what he wants to do. I see a lot of societal benefit as well. Three of my own children use the public bus system, so I appreciate how important people like Doug are. We need to keep people working, finding meaning in their lives, and contributing to their families and communities. In addition, think of what it means for those kids first thing in the morning to have a happy bus driver! 

Bonus: Click here to read Doug's story, 'After Hip Replacement, Patient Calls Surgeon a 'Miracle Worker!’