Duke Health brings the latest joint replacement advancements to patients, including robotic surgery, minimally invasive approaches, and outpatient procedures. “Our fellowship-trained surgeons are thought leaders in joint replacement,” says Michael P. Bolognesi, MD, division chief of adult reconstruction at Duke Orthopaedics. “We are continually evaluating new exposures and technologies to confirm that they improve outcomes.”

Bolognesi recommends referral after radiographic confirmation of arthritis and after conservative treatment has failed. “These operations offer predictable success in improving patients’ function and pain, so delaying treatment significantly affects patients’ quality of life,” he says.

Below, Duke orthopaedic surgeons share insights on advancing technologies and techniques.

Amanda W. Hayes, MD: Our research has shown that patients who go home the same day experience a more comfortable and faster recovery. It allows the patient to get back to their normal routines sooner and is associated with decreased risk of developing a surgical site infection.

Total Hip Arthroplasty (THA)

Adam Brekke, MD: Our surgeons have adopted many of the technologies used to assist with hip and knee replacement, and we pay particular attention to how these tools align with the principles of surgery and contribute to long-term success in a cost-effective way. Duke is committed to patient-centered care and leading the way in surgical technique and innovation.

Samuel S. Wellman, MD: AR allows for both a higher level of preoperative planning and an efficient, accurate intraoperative tool to carry out the plan. This technology has been proven to be very accurate as well as more efficient than competitive technologies.

Sean P. Ryan, MD: AR improves the accuracy of component placement for hip replacements in primary and revision settings. It allows for opportunities to optimize fixation strategies when there is bone loss and may help reduce dislocation risk and leg length differences.

Andrew Schwartz, MD: The direct anterior approach for total hip arthroplasty allows patients to realize the benefits of their surgery sooner and regain their quality of life. Minimally invasive, muscle-sparing techniques can increase the difficulty of a procedure, but at Duke, we feel strongly that these extra efforts are well worth it to make patients’ postoperative recovery smoother and less painful, allowing them to realize the benefits of their surgery sooner, and regain their quality of life.

Total Knee Arthroplasty (TKA)

Thorsten M. Seyler, MD, PhD: Custom 3D-printed implants represent the next frontier in reconstructive arthroplasty, particularly for patients with severe bone loss, failed prior surgeries, or anatomical deformities that off-the-shelf implants cannot address. Using advanced imaging and additive manufacturing, we design an implant that precisely matches the patient’s residual bone geometry. In revision and reconstruction cases, I have seen dramatic improvements.

Schwartz: This new paradigm in knee implant alignment utilizes each patient’s individual anatomy to optimally position their implants. This aims to make their recovery less difficult while giving them a more natural-feeling knee for all of their activities that drove them to consider knee replacement in the first place.

Seyler: Robotic-assisted surgery has shifted us from a one-size-fits-most philosophy to true patient-specific execution. Intraoperatively, the robotic platform allows us to optimize implant positioning with submillimeter accuracy. The data increasingly support that this precision translates into improved early functional outcomes and greater patient satisfaction. Robotics amplifies surgical judgment and surgical ability.

Bolognesi: Subvastus is an anatomic-preserving exposure for total or partial knee replacement. Rather than cutting the quadriceps tendon, you push the vastus medialis to the side. We’ve done this for many years, and it merits continued evaluation to demonstrate that the proposed benefits truly exist.