Many of my patients have been asking about concerns related to metal on metal hip implants. While we have had tremendous success with metal on metal, but the feature that I feel is the most beneficial is the large ball and socket that make dislocations less likely. Metal on metal also has less wear than traditional plastic. However, during the last ten years, plastic technology has caught up in many respects. We are now able to use cross linking techniques to make the plastic stronger and use vitamin E to prevent the plastic from getting brittle while it is cross linked. I am happy to report that we have ePoly available for both hip and knee replacement . It should provide us all the benefits of metal on metal without the worry about metal ion generation. While we can never promise, I think we are getting closer to lifetime joint replacements with each new innovation.

Tags: Total knee, Total hip

Conformis has been working on a CT guided, custom knee replacement for a number of years now, using the same technology we are using for their uni knee replacement. Unlike other systems, this is a true custom knee unique to each patient. it should allow a more accurate knee without giving up the benefits of a total knee replacement. We should be able to start our first cases in the fall. I’m really looking forward to offering this to our knee arthritis patients.

Tags: Knee, Total knee, conforis, iTotal

Dr Waldman discusses custom knee replacement.


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The anterior approach can have advantages for early recovery. Many patients are able to go home in one to two days. However, it often requires a complex table or forceful manipulation of the leg during surgery. The Corin Minihip allows us to preserve bone and perform anterior surgery much more easily due to it’s shape and small size. it has been an excellent alternative to resurfacing in patients who want to preserve bone, have a mini incision, and have a full active lifestyle.

It’s a very exciting time to be an arthroplasty surgeon. As computer technology improves, we’ve been able to get a lot of the cumbersome planning and navigating steps out of the OR and into our preoperative planning. The more we can do a head of time, the less time the surgery takes which should lead to fewer complications and more accurate surgery. Below is the plan for an upcoming uni knee replacement. A preoperative CT allows us to make custom cutting blocks and custom implants that come in a small, sterile package, all ready to go. Each implant is made specially for each patient and perfectly matches their anatomy.

I get a lot of questions about bilateral, or both at the same time, knee replacement. Doctors have really struggled with this concept because doing both at the same time can result in a much more difficult operation. It obviously takes twice as long, can result in more blood loss, more stress on the heart and lungs, and a longer anesthetic. Doing both knees together takes some surgeons three to four hours and can get very tiring. Because of these added complications, many surgeons severely limit the number of bilateral knee replacements they will do - if they will do any at all.

At the Rubin Institute, we have been able to minimize these problems by combining several techniques. The first is the computer navigation I discussed in an earlier post. By doing all the calculations using custom molds before the surgery, we can speed up the measuring process for both knees. Combining this with some innovative, uncemented knee technology, we can eliminate cementing, which can take 15 - 30 minutes per side. These techniques, I believe, have resulted in better alignment and a much quicker procedure. We are able to do both knees in about 90 minutes with a spinal anesthesia, which is generally safer for the patient.

Our early data show better results, in less time, with fewer complications. It’s allowed me to open up this procedure to far more patients than in the past because of the reduction in risk. While doing both knees at the same time does result in more time in the hospital, many patients recover just as quickly from two knees as one. I always caution that this is still major surgery, and can certainly have complications, but it is a much more reasonable option than it was in the past and can benefit a lot of patients.

Tags: Bilateral, Knee, Replacement