Dr. Steven Fisher of Fort Wayne Orthopaedics considers himself a wellrounded individual. He enjoys spending time with his family, he supports the local art scene, and he is an avid golfer and tennis player. There is, however, one subject that the amiable Fisher admits gives him a bit of tunnel vision: joint replacement. In Fisher's case, joint replacement of the hip and knee.

The Indiana University School of Medicine graduate was three years into medical school when he noticed an increasing interest in the professional literature being written about advancements in hip and knee joint replacement. He decided that this field of medicine would become his specialty, and he has not regretted the decision for a moment.

"I honestly was drawn to this area of medicine because I saw how truly lifetransforming joint replacement surgery can be for someone who is being significantly affected by arthritis disease in these areas of the body," Fisher recalls.

Upon completion of his residency in orthopaedic surgery at IU in 1991, Fisher performed a one-year fellowship in joint implant surgery and adult reconstruction through Ohio State University in Columbus, Ohio. After completing his fellowship, Fisher, a native of Marion, Indiana wanted to return to his home state to begin his practice. He knew that Fort Wayne had a reputable orthopaedic medicine community and was thrilled to join the staff of Fort Wayne Orthopaedics in 1992.

"Fort Wayne has had a long-standing, progressive relationship with the orthopaedic technology and manufacturing industry based in Warsaw," notes Fisher. "I wanted to be as close to that as possible."

With the variety of companies based in nearby Warsaw, Fisher has witnessed first-hand the remarkable improvements made in joint replacement technology over the past 16 years. Improvements that he is quick to point out have touched all facets of the field: rehabilitation and pain management, materials and technique. The result, Fisher says with a smile, is that total hip and knee joint replacements are not options just for the elderly any more. They also can benefit patients who are well under retirement age and are still raising families.

One of the more recent advancements in prosthetic technology is the increasing use of alternative bearings, including metal on metal and ceramic on ceramic ball and sockets for hip replacements. Unlike metal and plastic, these newer designs have the potential to last two to three times longer even under more stressful use. According to Fisher, "This means we can confidently offer hip replacements to younger patients with more active lifestyles with a lower risk of them wearing out."

When it comes to knee replacement, Fisher is a firm believer in mobile bearings. "This technology has actually been around for over 30 years," says Fisher, "but only recently has the orthopaedic community become aware of its usefulness through long-term research studies."

Unlike a fixed-bearing prosthetic, mobile bearing knees, or MBK's, decrease the contact stress on the polyethylene, or plastic, liner of the knee replacement. This potentially allows longer use and greater function without restricting the range of motion.

"Many people mistake the knee joint as a kind of simple hinge on which your lower leg swings," Fisher says. "In reality, the knee joint is more complex, involving not only bending motion, but side-to-side movement as well."

Fisher recently used the MBK replacement with several patients who were still in their 40's, including a nurse who was back on the job within four weeks and a factory worker who returned to a demanding assembly line within eight weeks; both with great success. In addition, critical follow-up studies of total knee joint replacements using the MBK have shown an impressive 90 percent-plus survivorship rate of the device itself at 20 years.

Fisher is also an expert in partial knee replacements using mobile bearings. At least 40% of patients who develop arthritis in the knee have the disease isolated to the medial compartment or inner aspect of the knee. In these cases, Fisher is able to offer a partial or unicompartmental knee replacement. It is truly a minimally invasive procedure that involves less discomfort and risk and a shorter recovery time. Furthermore, because it preserves all of the normal ligaments in the knee, it feels more natural and has greater range of motion and function. "The mobile bearing knee has transformed my treatment of patients with arthritic knees of all ages," says Fisher.

"The message I try to get across whenever I'm talking about joint replacement is that patients experiencing pain have options available to them that are not only high quality but are conducive to their lifestyle," observes Fisher. "They don't have to just live with the pain any more."