The Joint Preservation, Resurfacing & Replacement service is comprised of faculty members with special interests and training in total joint arthroplasty and joint preserving operations of the lower extremity, including hip resurfacing.

The service encompasses surgeries performed at Barnes-Jewish Hospital and the John Cochran Veterans Administration Hospital.

The service's faculty members include:
Robert Barrack, MD (chief of service)
John Clohisy, MD
Ryan Nunley, MD

Primary joint replacement surgeries of the hip and knee are performed for osteoarthritis, inflammatory arthritis, osteonecrosis, post-traumatic arthritis and various other disorders. Revision total joint replacements are performed for failed implants and implants associated with fractures. Arthrodesis is performed for end stage degenerative disease in the young adult.

The second major emphasis of the service is joint preserving operations of the lower extremity. A variety of disorders in the young adult including hip dysplasia, osteonecrosis of the femoral head, post-traumatic nonunion and malunion of the proximal femur, early osteoarthritis, old slipped capital femoral epiphyses and other developmental deformities of the hip and knee are evaluated and considered for joint preserving operations. John C. Clohisy, MD serves as head of the Young Adult Hip Program.  Surgical techniques employed to treat these conditions include pelvic osteotomies, proximal femoral osteotomies, core decompression and bone grafting techniques and osteotomies about the knee. Additionally, hip and knee arthroscopy is utilized to treat a variety of disorders. There is an emphasis on hip arthroscopy techniques for various diagnoses, most commonly labral tears. Over 650 reconstructive and joint preserving operations of the hip are performed each year.

Clinical research efforts on the service include involvement in randomized, prospective, multi-center clinical trials evaluating cemented femoral component surface finish, low wear polyethylene implants and the medical management of periprosthetic osteolysis. A broad variety of other clinical research interests are being pursued. These include prospective and retrospective studies on hip and knee implant survivorship and the surgical management of osteonecrosis of the hip. Initial clinical studies are being performed to better define the techniques of diagnosis and patient selection in young adults being considered for hip osteotomies and hip arthroscopy. The efficacy of these surgical techniques is also being followed prospectively.

Basic science investigation is an important aspect of the service and there are two major basic science efforts that are directly related to adult reconstructive surgery. One area of basic research is investigating the in vitro development of cartilage implants and the use of these implants to repair focal cartilage defects in joint preserving surgery. The second major effort is focused on implant-associated particulate debris-induced osteolysis. The cellular, molecular and signaling pathways mediating this process are being studied with an emphasis on developing pharmacological strategies to inhibit implant-associated osteolysis.

Resident education and surgical training is incorporated into all aspects of the service. The resident team includes a PGY-2, PGY-4 and and PGY-5 or senior level resident. While the service is based primarily at Barnes-Jewish Hospital's downtown campus, trainees also see patients in the outpatient clinic at the new Chesterfield facility.

The residents have a broad exposure to the activities of the service while participating in care at the John Cochran Veteran's Administration Medical Center. The formal aspect of the education includes monthly lectures and interactive case conferences. The service has weekly preoperative planning and templating conferences. During these, all cases are reviewed and more complex cases are discussed in depth. The diagnosis, treatment options, surgical techniques, and potential complications of the cases are emphasized in this interactive conference. In the operating room the residents are exposed to a large surgical volume with exposure to a broad variety of cases and surgical techniques. This surgical experience is balanced with an involvement in the preoperative evaluation and postoperative care of the patients. Involvement in the research efforts of the service is available to interested residents.

The service is a dynamic service that provides comprehensive clinical and surgical care for disorders of the lower extremity. The service is integrated with the clinical and basic science research efforts as well as the resident education program.