John F. Irving, MD

John F. Irving, MD

Biography

Dr. Irving is a Board Certified Orthopaedic Surgeon, who specializes in Arthritis Surgery, Total Joint Replacement and all aspects of adult reconstructive surgery of the shoulder, elbow, hip and knee. His primary focus is on joint preservation and reconstruction for arthritic, degenerative and post-traumatic conditions. This includes Arthroscopy and Osteotomy, as well as Total Joint Replacement.

Dr. Irving graduated from the Tulane University School of Medicine in 1982, where he was elected to the Alpha Omega Alpha Medical Honor Society. He was awarded the Gold Scalpel Surgical Award by the Department of Surgery. In 1987, he completed a five-year residency program in Orthopaedic Surgery at the Mayo Clinic Graduate School of Medicine in Rochester, Minnesota.

Dr. Irving has been an Attending Orthopaedic Surgeon in the New Haven area since 1987. He is an Attending Surgeon at Milford Hospital, the Hospital of St. Raphael and Yale New Haven Hospital, as well as Assistant Clinical Professor of Orthopaedics and Rehabilitation at the Yale University School of Medicine.

The American Board of Orthopaedic Surgery certifies Dr. Irving. Among his professional affiliations, Dr. Irving is a Fellow of the American Academy of Orthopedic Surgeons, and has been elected to The Society of Arthritic Joint Surgeons. He is also a member of the American Association of Hip and Knee Surgeons.

Dr. Irving was designated in Orthopaedics a "Top Doc", by Connecticut Magazine in 2002, 2003, 2004, 2005 and again in 2007.

Dr. Irving was born in New Haven and raised in Milford, graduating from Milford High School. He received a BS degree in Biology cum laude from Northeastern University in Boston, where he was varsity member of the U.S. National Champion Crew in 1973 and Captain in 1975. Besides his family, his other interests include golf, scuba diving and other outdoor activities.

Dr. Irving's practice focuses on minimally invasive surgical techniques for hip and knee replacements. These tissue sparing surgical techniques combine well proven, reliable hip and knee implants with less traumatic soft tissue dissection. Less muscle and tissue damage allow for a faster and more complete recovery and provides long lasting results.

Total Hip Replacement

Dr. Irving has performed more than 3,500 hip replacements during his 20 years in practice. There are now two procedures that he uses for hip replacements, and each combines a unique surgical approach with an appropriate hip implant (prosthesis). Both of these approaches are tissue sparing, and the choice of which to use is determined by the implant the patient is best suited for. Dr. Irving selects the proper implant by carefully evaluating each patient's age, activity level, weight, and hip anatomy. He recommends the approach that will allow for the best results and fastest recovery time. The implants Dr. Irving uses are the S-ROM and the Corail implants. Both of these devices have well documented worldwide clinical success for over 20 years!

The goal of using the most reliable implants with a minimally invasive approach is to progress to using a cane by hospital discharge and to wean off of the cane by 2 – 4 weeks post operatively.

One approach that Dr. Irving uses is called the 2-incision approach. Dr. Irving pioneered the 2-incision approach himself in 2001. It is now utilized by surgeons across the U.S. and Europe . The 2-incision approach is used to accommodate the S-ROM hip implant, as well as the Corail stem. The S-ROM implant is chosen for patients with certain anatomic variations, and frequently for younger active men and women as well. It is an “off the shelf” customized implant, which means that it has thousands of variations which can fit all hips.

Dr. Irving also utilizes a MICRO HIP ® approach. The MICRO HIP® approach is used with the Corail implant only. It is a 2-3 inch front (or anterior) incision that is the most muscle sparing surgical approach . However, the nature of the implant also limits its use in some patients. The MICRO HIP® approach was developed in Switzerland and is a “user friendly” variation of the Direct Anterior Hip Approach. The Corail implant that is used with the MICRO HIP® incision is becoming the fastest growing hip stem used in the U.S. It was introduced in Europe in 1986 and has enjoyed spectacular early success and long lasting results. It was introduced into the U.S. market in 1999 and Dr. Irving began using it in 2002.

Both implants that Dr. Irving uses are uncemented and are used with all types of “bearing surfaces.” The choice of bearing surface is again made based on the patient's age, size, and activity level. Currently, Dr. Irving considers combinations of plastic, ceramic, and metal on metal. Each combination has pluses and minuses which Dr. Irving discusses with the patient before surgery. More active, younger patients generally choose a metal on metal bearing implant. For all others, metal on cross-linked polyethylene plastic or a ceramic (BIOLOX) ball on plastic is the combination of choice. The current generation of cross linked-plastic liners has had superb results in its 8 years of use and, to date, is as good as any other. Dr. Irving does not use the ceramic on ceramic combination because the FDA has not approved the best kind of ceramic material. In the U.S., only the ceramic ALUMIMNA is allowed for both the ball and hip liner. The newer ceramic “BIOLOX DELTA,” however, is the ceramic of choice internationally and will replace ALUMIMNA when it is finally approved in the U.S. around 2010.

Dr. Irving does not perform hip resurfacing . This procedure involves one type of metal on metal bearing surface. Unfortunately, the concept of the procedure still remains to be worked out. Even in the best of circumstances it will have limited use. It was tried and failed 35 years ago with different bearing surfaces.

Total Knee Replacement

Dr. Irving also specializes in total knee replacement, and has performed over 5,000 total knee replacements during his career. Dr. Irving utilizes only the most minimally invasive total knee surgeries that spare muscle and tissue. Similar to hips, there are choices for knee implants and surgical approaches. Each patient is matched with the appropriate implant and approach based on age, activity level, size, and knee structure.

Most total knee replacements are done using the “ SUBVASTUS ” surgical approach which eliminates cutting, scarring, and dysfunction of the quadriceps tendon. The SUBVASTUS approach, by sparing this muscle, has been shown to permit a much faster and less painful recovery than more traditional surgical techniques. In some cases, a “ Mid-Vastus ” approach is used. Again, this approach is less invasive than traditional techniques and avoids cutting into the quadriceps tendon above the knee.

In younger and more active men and women, Dr. Irving prefers to use the Mobile Bearing, Rotating Platform (DePuy Orthopaedics) implant. This implant has been in clinical use for over 20 years and is designed to last for an exceptionally long time. It may minimize the wearing down of the implant's plastic and more closely duplicates normal knee motion. Dr. Irving also uses well proven non-mobile bearing implants when appropriate. These “fixed-bearing” implants have an astounding success rate of 90-95% after 15-20 years of implantation.

Dr. Irving does not currently use computer guidance . This is still a technique in development and the benefit and certainly the necessity of using this technology has not been proven. This is especially true when compared to the results Total knee replacement with traditional instruments by an experienced total knee surgeon.

The ultimate results and the longevity of total knee are related to not only proper implantation of the implants but the patients own healing response, the activity level of the patient and the design of the implant. Currently there are no results that show any functional, longevity, or revision rate improvement over traditional total knee done by an experienced knee surgeon. Dr. Irving has had to revise or re-do only 1%-2% of the 5000 total knees he has performed in 20 years.

Dr. Irving recommends reading this timely article detailing the true recovery time after Total Knee Replacement.

Maintaining your total hip and knee

Why should a hip or knee need to be redone?

This is a common question and is understandable, given the history of joint replacement failures a generation ago. Yet, 50% of TOTAL HIPS done 30 years ago did not need to be replaced – even with old implants, poor plastic, and radical surgical techniques! The current generation of implant and bearing surfaces should give excellent results in over 90% of patients for 25 years and more!

TOTAL KNEES have had even better results and continue to do well.

The common lay-person impression is that total joints only “last” 10 years; this is totally and completely wrong!

Two important changes have been made in hip and knee replacement surgery:

1. Standardized implants with improved materials.

2. MANDATORY follow-up appointments for life!

Dr Irving considers a total joint to be a chronic condition. He likens it to a patient with high blood pressure or diabetes requiring regular maintenance. Total joints are mechanical devices in a biological environment – they have demonstrated a remarkable endurance. However, changes can occur in all implants and bearing surfaces. Most of the time, wearing down of the bearing surface (a precursor to loosening) has no symptoms until after a major problem has occurred. With regularly scheduled x-rays, a minor problem can be identified and corrected with, at worst, a minor operation; versus a major problem requiring a major operation. If a plastic bearing wears out after 15 years or more, this is not a failure of the operation and means that the patient had a successful operation that permitted them to function at a normal high level for years! As described above, however, if the plastic wears out, left unchecked, the implant pieces fixed to bone can come loose. This situation needs to be avoided and prevented!

A typical post-op course involves exam and x-rays at 6 weeks, 3 months, and 1 year from the date of surgery. Then, follow-up exams are yearly for the first 5 years and every 2 years thereafter.

Dr. Irving's Joint Team

Jaclyn Burns, PA-C has been part of Dr Irving's team for over 13 years. She has been his surgical assistant for 10 years. Additionally, Ms. Burns has her own office schedule for pre- and post-op care, as well as for injections and evaluations.

Dr. Irving's team also includes Karen Strouse, R.N., who sees patients in the hospital with Dr. Irving, does wound care and dressings, and is the liaison for pre and post-op surgical care questions. Ms. Strouse also manages the post-op anti-coagulation.

Sema Webb and Candace Harrison are the talented administrative assistants for the clinical team. They schedule surgery, coordinate appointments with primary care and specialist physicians, and answer many questions related to hip and knee surgery.

Joint Center

Dr. Irving performs 90% of hip and knee surgeries at the Connecticut Joint Center at Milford Hospital. The post-op care at Milford Hospital is in a private wing, where all patients recover in private specially designed rooms. The most important aspect of the post-op care, however, is the highly professional services of the exclusive and dedicated nurses, aids, physical therapists, and housekeepers. This team is very proud of the excellent care they give to patients (there were over 500 in 2006) in a clean environment conducive to rapid post-op rehabilitation. The other 10% of cases are done at Yale New Haven Hospital.

Health Education Information:

Profile of John F. Irving, M.D., from TOG Community Magazine

Dr. Irving Talks about Hip Replacement on WTNH-TV

Minimally Invasive Two-Incision Total Hip Replacement