Knee
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
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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.
Pain Control After Surgery
Apr,15,2008 08:41
Controlling
pain is one of the most important areas of
postoperative care. It is usually the aspect of
surgery that scares patients the most and is most
ignored by doctors. We have tried to take a more
comprehensive approach. The most important principle
is to treat the pain with different modalities so
that we have to use the least amount of narcotics.
Narcotics are the drugs that make patients sleepy,
constipated and unable to cooperate well with their
physical therapy.
We use local blocks, spinal anesthesia and injections around the incision to help control pain. By combining these methods with nonsedating drugs, we are able to keep patients very comfortable and use very little sedation after surgery. The nurses who take care of our patients after surgery have seen a dramatic difference in the amount of pain that patients report to them after surgery. I see this as one of the most important aspects of our care and does more to ensure rapid recovery than any other method we employ. If you have any specific questions about the exact methods we use, please email me any time.
We use local blocks, spinal anesthesia and injections around the incision to help control pain. By combining these methods with nonsedating drugs, we are able to keep patients very comfortable and use very little sedation after surgery. The nurses who take care of our patients after surgery have seen a dramatic difference in the amount of pain that patients report to them after surgery. I see this as one of the most important aspects of our care and does more to ensure rapid recovery than any other method we employ. If you have any specific questions about the exact methods we use, please email me any time.
Knee Implants
Apr,15,2008 08:40