Knee Replacement
Computer Knee Navigation
Jan,25,2010 12:17
I’ve
always been very skeptical of computer navigation in
total knee replacement. While it makes sense that
computers in the OR could help us place the parts
more accurately, in practice, these systems have been
cumbersome, time consuming, and haven’t been shown to
produce any improvement in outcomes. The extra
equipment is very expensive and required additional
pins to be put into patients bones to guide the
computer.
I’ve recently started using a system that produces custom molds made from an MRI scan of the knee. The molds are made before the surgery and guide the placement of the knee replacement. The molds are extremely accurate, require less time than a standard total knee and also allow us to place less instruments in the knee - not more. While the MRI and the molds are expensive, we do see some cost savings in less time in the OR and less instruments that need to be sterilized. The benefit to the patient is a custom fitted knee and less time in the OR. Not every patient is a candidate, and some insurers are resisting paying for the molds, I think this new procedure is going to be very helpful.
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German Surgeon Visit
Oct,27,2009 20:42
We often
have visitiors from around the world at the Rubin
Institure. Recently, I had a group visit from Germany
to observe hip and knee replacement. They were very
interested in minimally invasive surgery and pain
management techniques. They also got to see a
minimally invasive hip replacement, revision knee
replacement and a hip resurfacing. I always have a
great time showing off what we are able to accomplish
at the Rubin Institure, but I also get to learn a lot
myself. Out visitors never fail to teach me some
technique I wasn't aware of or propose some
improvement we can make. it's this kind of
interaction that forces me to always try to stay
ahead of our very knowledgable and experienced
visitors.
Progressive Knee Replacement
Jul,16,2009 10:05
Now that
we have so many options for treatment of knee
arthritis, I’ve been trying to formalize an algorithm
for progressive replacement of the knee. I recently
gave grand rounds at Howard University on this idea.
While total knee replacement is a wonderful operation
that works very well, it does take a long time to
recover from. A great many patients can benefit from
replacing just the part of the knee that is worn out
and not the whole thing. These patients have a faster
recovery, less pain, and more natural feeling knees.
While this concept has been working very well for my patients, it’s extremely important to pick the right operation for the right patients, otherwise, they may continue to have pain. This algorithm helps to insure that treatment is as optimal as possible for each person no matter what their age, race or gender may be.
While this concept has been working very well for my patients, it’s extremely important to pick the right operation for the right patients, otherwise, they may continue to have pain. This algorithm helps to insure that treatment is as optimal as possible for each person no matter what their age, race or gender may be.
Parital Knee Replacement Around the World
Jul,16,2009 09:39
I recently had the opportunity to give lectures in
Fukuoka Japan, and Vienna Austria on partial and
full knee replacements. It was a wonderful
experience to go to prestigious international
meetings on almost opposite sides of the world. I
found it most interesting that the attitudes toward
partial knee replacement are very different in
these very different countries. In Japan, surgeons
tend to be fairly conservative. They favor
osteotomies or realignment of the bones in younger
patients who have partially arthritic knees. In
Europe, surgeons are much more in favor of partial
knee replacement, because of the quicker and more
predictable recovery.My talk on partial knees was
very well received in Vienna, while it took much
more explaining and convincing in Japan. I think
it’s very healthy for surgeons to have different
opinions and attitudes about implants and
operations. It encourages us to constantly examine
what we are doing and make sure we know exactly why
we are recommending different treatments for
different patients. I always try to customize each
patient’s treatment and not just recommend the same
total knee replacement for every patient with
arthritis. It’s nice to know that there are so many
surgeons around the world who have the same
attitude.
Trip to Japan
Jan,21,2009 10:11
Knee Resufacing Update
Nov,07,2008 10:55
I think
this procedure will be a major improvement for a
number of our patients. It can be done
athroscopically with a small incision for the femoral
(thing bone) component which allows most patients to
go home the same day. Pain is much less than with a
total knee replacement and the physical therapy is
much easier. The parts are so small that, if a
patient needs a total knee replacement someday, they
will not interfere. Not everyone is a candidate, but
I think this procedure will spare a lot of people
from a premature knee replacement
Arthrosurface
Sep,03,2008 11:44
I very
excited about a new technology that we now have
access too. Called Arthrosurface, it’s an innovative
new approach to knee arthritis. Using an
arthroscopicly assisted technique, we can resurface
small parts of the knee that are worn our for
arthritis. This is a much smaller operation than a
knee replacement, and patients can go home the same
day and walk on the knee immediately. Physical
therapy is much easier and the time investment is
much less. Not everyone is a good candidate for this
new procedure, but I think it will save many patients
from a much larger operation. We don’t know the long
term outcomes yet, but I’m very optimistic about this
technique’s future.
Gender Knee Update
Jun,16,2008 07:50
I still
get quite a few women asking about gender specific
knees. Most of them have seen television ads or a web
site promoted by an implant manufacturer. I think one
of the issues that has gotten lost amid all the hype
is the wide variarions that occur normally in human
knees. Knees vary not just by gender, but by age,
race, height, weight and the type of arthritis that
the patient is suffering from. Sometimes a “male”
knee is better for a woman or vice versa depending on
the size of the patients knee.
The most imporatant thing to focus on is the number of sizes available and picking the right knee for each patient. I try to pick the knee that is most appropriate for a specific problem, and then use the wide variety of differnent sized to get a perfect fit. In my experience, focusing on just the patient’s gender is too much of an oversimplification.
The most imporatant thing to focus on is the number of sizes available and picking the right knee for each patient. I try to pick the knee that is most appropriate for a specific problem, and then use the wide variety of differnent sized to get a perfect fit. In my experience, focusing on just the patient’s gender is too much of an oversimplification.
Deuce Knee Implant
May,15,2008 08:39
We have a
new knee implant available for patients with
arthritis of the knee. It's called the Deuce because
it replaces the inside of the knee and knee cap
only.
The
implant can be put in with a minimally invasive
technique and retains all the knee ligaments, which
isn't possible with traditional total knee
replacements. The thigh bone side of the implant is
made of a ceramic, called Oxinium which may not wear
out as fast as standard metal implants. I think it
may be a good choice for younger patients who want to
remain active. We can determine if this is an
appropriate choice by examining x-rays and the
arthritic knee.
Knee Tourniquet
Apr,23,2008 22:03
When a
patient undergoes a knee replacement surgeons almost
always use a tourniquet around the thigh to cut down
on blood loss and make it easier to see during the
surgery. The tourniquet is inflated to a
pressure of 250 to 350 mmHG, which cuts off all blood
flow to the leg and foot. As you can imagine, this
puts tremendous pressure on the thigh muscles.
I've long suspected that a lot of the pain and
swelling after surgery is related to the use of a
tourniquet. So, over the last year, we have been
conducting a formal study of patients who undergo
knee replacement without a
tourniquet.
What I have found is that when a tourniquet is not used, patients have less pain, less blood loss, better range of motion and less swelling. The really dramatic difference is when patients return to the office, six weeks after the surgery, they are much more comfortable and much less swollen. It is now our standard form of treatment for both primary and revision surgery due to it's success.
There have been many studies published by The Journal of Bone and Joint Surgery that agree with these findings and I think a lot of surgeons haven't changed just because they are comfortable with the tourniquet. I plan to publish the findings formally fairly soon.
****Just to clarify, a tourniquet is placed on all knee replacement patients, it is just not inflated when there is adequate blood control.
What I have found is that when a tourniquet is not used, patients have less pain, less blood loss, better range of motion and less swelling. The really dramatic difference is when patients return to the office, six weeks after the surgery, they are much more comfortable and much less swollen. It is now our standard form of treatment for both primary and revision surgery due to it's success.
There have been many studies published by The Journal of Bone and Joint Surgery that agree with these findings and I think a lot of surgeons haven't changed just because they are comfortable with the tourniquet. I plan to publish the findings formally fairly soon.
****Just to clarify, a tourniquet is placed on all knee replacement patients, it is just not inflated when there is adequate blood control.
Gender Specific Knees
Apr,15,2008 08:42
I've had
some questions recently about Zimmer's gender
specific knee, which is targeted at female patients.
I am actually pretty upset about what is a blatant
attempt to market unproven designs directly to
patients. It is true that femaie knees are generally
smaller and have a slightly different groove for the
knee cap than men do. However, most implants already
take this into account and have for years. There is
no reason to label a knee "specific to women" other
than to steer them to a Zimmer implant. I believe
that my patients are smarter than that and will see
through what is basically marketing hype.
Unfortunately, we often spend a lot of time talking
about non-issues like gender specifics rather than
important things, like getting through the surgery in
the safest and smoothest fashion possible.
Knee Implants
Apr,15,2008 08:40
3D Knee
Mar,15,2008 08:42
We are
currently conducting a study of the 3D Knee. It's an
interesting concept that should work well for younger
patients who need a total knee replacement. By
changing the shape of the surface that the patient
walks on, the implant can compensate for the ACL,
which has to be removed during total knee surgery.
This should provide better stability and a more
natural knee for very active patients.