Replacement Parts for Your 21st-Century Body

Got an achy hip? Missing tooth? Faulty heart valve? Today's doctors might have the answer for you–right off the shelf.

Charles Freeman, who has worn prosthetic legs most of his 27 years, works with Amanda Persak, a West Orange prosthetist.
Photo by Yvonne Albinowski

The first thing you notice about Charles Freeman is his smile. Framed by a thick growth of dark beard, it lifts his cheeks and brightens his eyes, communicating delight—as if he’s about to tell you something really, really funny. You notice the bandana that wraps his head, the wooden beads around his neck and wrist, and the white T-shirt hinting at a weightlifter’s build. Probably the last things you notice are his prosthetic legs, perhaps because Freeman, 27, has been wearing them, or some version of them, for most of his life.

Freeman was born five months premature—so early that his legs hadn’t fully formed. The doctor gave his mother two choices: Keep the legs and let him live his life in a wheelchair, or amputate them and, when he is ready to walk, fit him with prosthetics.

“She made the right decision,” says Freeman, “and by the grace of God, I’ve been able to have a wonderful life.” He might also thank his own zest for living and, beyond that, the remarkable technology that’s allowed him to train, run, sprint up hills and dance.

More than ever before, human beings are turning to technology to replace what aging, accidents and illness have taken away. At the beginning of the last century, a cane was your best option when the cartilage in your knees and hips wore out; bed rest was the best medicine for an ailing heart; and you had no choice but to accept failing sight if you developed cataracts. Today, some 7 million Americans are living active lives thanks to hip and knee replacements; an increasing number of heart-failure patients are extending their lives after receiving mechanical heart pumps; and replacement lenses restore vision to more than 10 million cataract sufferers annually worldwide.

If you suspect, or know for a fact, that one or more of your parts is ready for replacement, our guide to the body bionic, assembled with the help of some of the state’s best doctors and practitioners, will help you make a more informed decision and give you a sense of what to expect. The guide focuses on the most commonly performed and/or life-changing procedures, which, thanks to the marriage of medicine and technology, are becoming more common and changing more lives—like Charles Freeman’s—by the day. (The guide includes possible complications for each procedure. Note that virtually all surgical procedures carry the risks of bleeding, infection and complications from anesthesia, and all joint replacements carry the risk of implant loosening.)

Prosthetic Limbs
Not long ago, Amanda Persak, a licensed prosthetist at the Hanger Clinic in West Orange, met a man who had lived with the same prosthetic leg since the 1970s. It was made of wood, a far cry from today’s prosthetics, crafted from materials like carbon fiber, fiberglass, silicone and urethane. It struck Persak how incredibly crude the man’s wooden leg was compared to the latest smart prosthetics, like knees that recognize when the joint needs to bend and myoelectric hands that let users open carry bags and type on a keyboard.

The procedure: After recovery from amputation (generally four to six weeks) the patient is fitted with a compression sock to shape the remaining limb and squeeze out excess fluid. A prosthetist makes a mold of the limb with fiberglass or plaster, and the patient is fitted with a clear, plastic check socket that helps the prosthetist determine the size and shape of the permanent socket to which the new limb will be attached.

Who’s a candidate: Most people who have lost a limb. Physical therapy is recommended to increase strength in order to work the prosthetic, which requires significant energy.

Before surgery: Optimally, the patient meets with a prosthetist, who explains the process and offers resources for additional information. If the patient loses a limb due to sudden trauma, he or she will meet with a prosthetist later, often immediately after surgery.

Recovery: The patient is likely to be sent to a physical therapist to learn how to use the prosthetic. There are a number of follow-ups, both immediately after the final fitting and, because changes in weight can affect fit, periodically throughout the recipient’s life.

Possible complications: The most common complication, says Persak, is development of pressure sores from ill-fitting prosthetics, “which usually occurs when people don’t come regularly for their follow-ups.”

Life span of the device: For most people, five to eight years; if weight stays stable and the recipient avoids extreme physical activity, it could be indefinite.

Lens
it’s one of modern medicine’s great success stories. The ability to remove and replace a lens clouded by cataracts in a 15-minute procedure with a 99 percent or greater success rate has saved and/or restored the vision of millions worldwide. In the last 60 years, notes Dr. Harry Coniaris, an ophthalmologist in Holmdel, replacement lenses have changed dramatically, so today, “the surgery doesn’t just improve vision, but also offers the option of improving vision without glasses.”

The Procedure: Through a tiny incision in the cornea, the cataract is broken up via ultrasound and removed, and an intraocular lens is inserted. If there are cataracts in both eyes, the second is usually done a week or more later. Generally, the lens will improve distance vision and, to some degree, vision up close. Standard surgery doesn’t correct astigmatism, but that can be accomplished by another procedure, though it’s generally not covered by insurance. Special lenses can be used to significantly improve close-up and distance vision but again, insurance doesn’t usually reimburse their cost.

Who’s a candidate: For the most part, anyone for whom cataracts are making it difficult to drive, read, watch television or participate in other daily activities can be helped by cataract surgery. The lenses can also be used to improve uncorrected vision in people without cataracts, but that surgery isn’t widely performed.

Before surgery: Patients with certain retinal or other ocular diseases may have to have them treated prior to cataract surgery.

Recovery: Most patients experience blurriness for a day or more. On the day of surgery, and for a few days after, patients must refrain from driving. They should avoid bending over, and picking up heavy objects, for about one week. They may need to sleep with eye shields for a short time.

Possible complications: Retinal detachment can occur, as can infection and bleeding. “Fortunately,” says Coniaris, “it’s very rare and, in most instances, can be successfully treated.”

Life span of the device: The vast majority never require replacement.

Teeth
In wide use since the 1980s, titanium dental implants have revolutionized the treatment of missing or failing teeth, allowing dentists to implant a replacement root impervious to decay, with a natural-looking replacement tooth connected to it. Today, notes Barnegat dentist Dr. Kathy Banks, certain procedures—like extracting a tooth and inserting an implant, or putting an implant in place and topping it with a temporary or final crown—that once required several steps performed weeks or months apart can, for some patients, be done the same day. Most insurers do not cover implants.

The procedure: A hole is drilled into the jawbone, and the implant, similar to a small screw, is placed in the hole. A restoration—usually a porcelain crown—is connected to the screw, sometimes on the same day as the surgery, sometimes later. (Implants are also used to anchor dental bridges.)

Who’s a candidate: Most adults are good candidates, with the possible exception of those on certain anti-cancer and osteoporosis medications, which can impede healing of the jawbone.

Before surgery: The dentist takes X-rays and/or a 3-D CT scan to help with placement of the implant. (Banks, an oral/maxillofacial surgeon, recommends the scan because it can better identify areas where the implant shouldn’t encroach, like the nasal or sinus floor.) If there’s bone loss or the bone is of poor quality, the dentist may perform a bone graft several months before surgery.

Recovery: Depending on the number of implants, the patient is asked to avoid strenuous activity for one to five days.

Possible complications: “Operator error”—poor surgical technique—can result in failure of the implant to stay in place or cause it to protrude into the sinus or nasal cavity, “when an implant is lost,” says Banks, “it’s usually the result of improper professional hygiene maintenance.”

Post recovery: With individual implants, a patient should be able to chew, speak and floss normally.

Life span of the device: With proper hygiene, an implant could last a lifetime.

Shoulder
“I never knew that a shoulder could be replaced.” It’s a comment Dr. Stephen Ducey, an orthopedic surgeon in Nutley, hears from many patients. In fact, surgeons have been replacing diseased shoulders since the 1950s—and, says Ducey, “it’s become more mainstream in the last 20 or 30 years, and the implants have become smaller.”

The procedure (shoulder arthroplasty): In total shoulder-replacement surgery, the ball at the top of the humerus is replaced with a metal ball, attached to the bone or within the canal, and the socket is resurfaced with plastic. In a partial replacement, only the ball is replaced. A procedure called reverse replacement, in which the ball is attached to the shoulder bones and an artificial socket is implanted at the top of the arm, is performed when the rotator cuff is irreparable or there is a complex fracture.

Who’s a candidate: If you have pain in daily activities like dressing, bathing or reaching upward, or moderate pain at rest or sleeping, and if conservative measures like medication and physical therapy haven’t helped, you may benefit from replacement surgery. Ducey tends to see two subsets of patients: arthritis sufferers in their 70s or older, and manual laborers or serious weight-lifters, who are younger. Patients may also be candidates if they’ve had a serious accident involving the shoulder (like a broken bone) or a torn rotator cuff or have an inflammatory disorder or failed prior surgeries.

Before surgery: The patient may be asked to do exercises to strengthen the rotator cuff (unless it is badly damaged).

Recovery: Most patients go home the day after surgery, wear a sling for two to four weeks, and are prescribed an at-home exercise regimen. The majority, says Ducey, are close to fully recovered in one to two months.

Possible complications: Nerve injuries can occur, so it’s important to choose a surgeon who is highly experienced in the procedure. The most common complication is a loosening of a part of the replacement known as the glenoid.

Life span of the device: 10–25 years.

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  1. John Smith

    Thanks for this very informative article.

  2. G. Lawler

    Its amazing what the new world of prosthetics is doing ! Just for an FYI, medical clearance is generally routine for any of these surgeries. Plus many hospitals and surgeons implement a preadmission infection screening and prevention routine.

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