Knee Replacement
Computer Knee Navigation
Jan,25,2010 12:17 Filed in: Knee
Replacement
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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Knee Resufacing Update
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
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 Filed in: Knee | Knee
Replacement
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.
Advertising
Mar,15,2008 08:43 Filed in: Advertising
I have
been very concerned about advertising on both TV and
radio being done by many surgeons and orthopaedic
companies. Much of the information is misleading or
downright wrong. One of the surgeons in our area is
advertising a procedure he's only done a few of, and
some others are promoting older technology as if it
were invented yesterday. Of course, it's important
for patients to discuss the type of prosthesis they
may be getting, but I think the advertising can
interfere with that process.
Gender Specific Knees
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.
Deuce Knee Implant
May,15,2008 08:39 Filed in: Knee | Knee
Replacement
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.