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Archive for the ‘Surgery’ Category

meniscus1

The Journal of Bone and Joint Surgery (JBJS) published findings that most patients with a torn or damaged meniscus (under 50 years old) experienced less knee pain and an increase in knee function following meniscal transplant surgery. Although, many patients required additional surgery within 10 years.

The meniscus acts as a cushion between the femur and tibial plateau. It can be damaged in an injury or slowly as the body ages.  A meniscus transplant can be performed in younger patients (under 50) to stabilize the knee joint, decrease knee pain, increase function, and maintain a cushion between the two bones.  The surgery is performed arthroscopically.

38 meniscal transplant patients under 50 years old were followed for about 11 years.  Outcomes were based on radiographic, subjective, and clinical measures.

10 years in to the research Sixty-three percent of meniscal transplants were still good.  11 percent of patients had pain when engaging in daily activities after the transplant. Also, nearly seventy-five percent of patients were able to participate in low-impact sports like swimming.  In patients requiring additional surgery, the meniscal transplants made it about  7 to 8 years after the surgery depending which knee compartment was being transplanted.

“This data provides surgeons with reasonable percentages that encourage delaying additional major knee surgeries related to a damaged meniscus,” Frank R. Noyes, MD, said.  Dr. Noyes is the lead author of the study and founder of the Noyes Knee Institute at the Cincinnati Sports Medicine & Orthopaedic Center.

“However, the longer-term function of meniscus transplants remains questionable because the survivorship rate of the transplants decreases to between 40 and 15 percent at 15 years,” Dr. Noyes commented. “Patients should be advised that this procedure is not curative in the long-term and additional surgery will most likely be necessary.”

 



Prosthetics like the preservation implant protect more healthy bone.  Not all procedures are equally invasive, and surgeries like the MAKOplasty may improve function and accelerate recovery.

The most severe cases of knee osteoarthritis are treated with a total knee replacement.  This highly invasive surgery involves removing large portions of bone in order to attach metallic prosthetic substitutes.  The surgery is highly traumatic and requires a lengthy recovery.  This makes a total knee replacement a difficult option for older or infirm patients because slow healing may make full recovery difficult or impossible.  Total knee replacements are also problematic for very young and very healthy people because the implants typically last only 5-10 years.  When the original prosthetic implant is replaced, even more bone must be removed to anchor the new, larger implant.  This means that a 50 year old man with severe knee osteoarthritis who has a total knee replacement can expect more highly traumatic surgeries every 5-10 years for the rest of his life.   As he ages and his healing slows down, the recoveries for each surgery will be longer as well.

Fortunately, a total knee replacement is not the only surgical option, even for the most severe patients.  Osteoarthritis affecting only one side of the knee has been effectively treated with partial knee replacements for many years.  Robotic technology has vast surgical applications, and has recently been employed in a new procedure called a MAKOplasty.  The MAKOplasty uses robotic arms to trim away only the damaged bone, and to create and implant a unique prosthetic that complements the healthy tissue.  This means that healthy, well vascularized bone is not removed, and so there is much less trauma and a faster recovery.

This procedure may not be appropriate for everyone but the MAKOplasty and other partial replacements could be a more conservative surgical treatment.  If your doctor recommends joint replacement surgery, ask about your options.  You may not need a total joint replacement to get the best results.



The KineSpring system unloads the medial compartment throughout a broad range of motion.

Moximed’s KineSpring system was developed as a surgical intervention for osteoarthritis of the knee that is not as severe as a joint replacement.  If the medial compartment of the knee is under abnormal stresses, it can lead to extreme knee pain.  This pain, and the osteoarthritis that causes it, is often treated with anti-inflammatories, rest, diet, exercise, and ultimately a partial or total knee replacement.  This final stage of treatment, the joint replacement surgery, is highly traumatic.  Joint replacements involve the removal of entire sections of bone to be replaced by metallic prosthetics.

Instead of removing damaged bone, the KineSpring system offers an implantable spring that could let the injured tissue heal.  The spring unloads the medial compartment of the knee throughout a broad range of knee motion, allowing high user function while promoting tissue repair.  This is especially important because knee motion is crucial to bone and cartilage growth.  If you are considering a medial compartment knee joint replacement, the KineSpring may be a less severe and similarly effective alternative.

But do not mistake this post as an endorsement of the KineSpring system for osteoarthritis of the medial compartment.  The KineSpring is a surgical replication of an orthotic solution.  In other words, a knee brace for osteoarthritis offers all of the benefits of the KineSpring system without the needless risk of undergoing surgery.  So if you suffer from osteoarthritis of the knee, ask your doctor about orthotic solutions before you move on to surgical ones.  Braces are safer, less expensive, and far more easily removed than surgical implantations.



Total knee replacements are invasive surgeries that leave long scars accross the knee. They involve removing damaged bone and replacing it with a prosthetic.

Osteoarthritis of the knee is very common in people age 65 and older.  As the US population ages, more and more people are diagnosed with osteoarthritis.   Since it can produce extreme knee pain that worsens over time, many people are desperate for a miracle treatment.  While there are many medications, braces, and therapies for osteoarthritis of the knee, many people are turning to surgery for help.

According to a recent New York Times article, total knee replacement surgery rose more than 800 percent from 1979 to 2002.  With improving technology, this is  a wonderful treatment for many people.  But some people are not so lucky.  For as much as 30 percent of the population, knee pain is not reduced after surgery.  So almost 1 in 3 people may be undergoing knee surgery with no benefit.  Considering that all surgeries are potentially life-threatening, this is a terrifying statistic.

This does not mean that knee surgery is bad or ineffective, but it may not be right for everyone.  Before looking for a surgical solution, try non-invasive arthritic knee treatments first.  Why take the risk if you don’t have to?



 

A recent study shows that smokers have a harder time with knee replacement surgery than non-smokers.  That’s not a surprise.  But what is surprising is that the research said there was no difference between current smokers and patients that had quit.

Dr. Michael Mont, director of the Center for Joint Preservation and Replacement said, “It could be that the damage was already done.  When you smoke and stop, you improve your health, but you still have build-up in your system. That may be why we didn’t see a difference.”

The study, which was presented at the annual Academy of Orthopedic Surgeons in San Francisco, examined 600 knee replacements in 60 – 65 year old patients.  About 20% of the patients were smokers.  Problems related to surgery like failing kidneys, blood clots, and abnormal heart rhythms affected 21% of the smokers compared to 12% of the non-smokers.  Smokers were ten times more likely to have a revision surgery to fix things that went wrong than non-smokers.

One of the last treatment options for osteoarthritis of the knee is knee replacement surgery.

 



2012 Pac Rim Meeting - A Pacific Forum for Physical Rehab

 

The United States Chapter of the International Society of Prosthetics and Orthotics held its bi-annual meeting in Honolulu this week.  Dr. Frank Gottschalk presented a half hour lecture titled, “Amputation Following Failed Infected Knee Arthroplasty”.  Dr. Gottschalk stressed the fact that total knee arthroplasty is a safe and common procedure, and explained that only less than 1% of patients succumb to infections.  However he believes that this problem could become more prevalent by 2030.

Dr. Gottschalk quoted statistics that there are approximately 500,000 knee replacements performed in the United States each year.  That number will swell to 3.5 million annual surgeries by 2030.  His research indicates that there are specific risk factors that lead to infections post surgery.  Diabetes, morbid obesity, smoking, rheumatoid arthritis, steroids, and revision surgeries are the primary culprits. Knee replacement surgeries for these osteoarthritis patients are usually a last resort.

The infections are of the staph, MRSA, and Gram Negative varieties.  Approximately 90% of the patients who succumb to infection post knee replacement surgery are treated successfully, but some conditions will deteriorate to the point where a limb will have to be amputated.  Dr. Gottschalk informed the audience of prosthetists about what types of patients will be successful candidates for prosthetic restoration.  He stressed that when a patient is motivated they can have the potential to accomplish anything.

His statistics show that younger patients who lose limbs following an infected knee replacement will have a good chance of becoming active community ambulators.  Dr. Gottschalk explained that elderly and morbidly obese patients will often times not be candidates for artificial legs and will most likely be confined to wheelchairs.  He concluded by saying that the more surgery a patient is exposed to, the more scar tissue will develop.  Scar tissue decreases functionality.  So it is in the patient’s best interest to keep the revisions to a minimum.

Frank Gottschalk, M.D. is a professor at the Department of Orthopaedic Surgery at the University of Texas Southwestern Medical Center at Dallas.  Dr. Gottschalk serves on the Board of United States Member Society, International Society of Prosthetics & Orthotics.

 



Knee Replacement

Knee Replacement

Black patients are more likely than white patients to have their knees replaced in hospitals with high risks of post-operative complications or mortality; reports a new study published in the journal of Clinical Orthopedics and Related Research.

Total Joint Replacements are performed in patients with knee osteoarthritis of all races.  Earlier science has suggested that black patients are more likely to get their knees replaced in medical centers or hospitals that perform a low number of joint replacement surgeries as compared to white patients who tend to have their joints replaced in hospitals that perform significantly more of these types of surgeries.

The study examined the records of Medicare patients who had their knees replaced between July 1st, 2002 and June 30th, 2005.  The study concluded that, “Among elderly Medicare beneficiaries undergoing TKA, African American patients were more likely than Caucasian patients to be admitted to hospitals with higher risk-adjusted postoperative rates of complications or mortality”.



Total Knee Rehab

Total Knee Rehab

The rehabilitation process following knee replacement will vary.  Expect to stay in the hospital from one to seven days following your surgery.  The length of stay will depend on your strength and your at-home support.

Protected weight-bearing with a walker or crutches is required until the quadriceps has healed and recovered.  Continuous Passive Motion machines are often prescribed to enhance range of motion.  Daily physical therapy will be required to restore motion, function, and strength.

It will take about six weeks for you to walk with a cane, and full recovery should be expected after three months.  Many patients kick themselves for waiting so long to have their knees replaced.  After years of suffering with osteoarthritis it is a pleasure to be able to walk without pain.



uni-knee

uni-knee

Partial knee replacement or unicompartmental arthroplasty (UKA) is intended for patients who have significant wear and tear to only one of the three compartments comprising their knees; unicompartmental osteoarthritis.  The advantages of a partial knee replacement as compared to a total knee replacement is that the incision is smaller, the post-surgery rehabilitation is easier, better range-of-motion after surgery, the hospital stay is shorter, less blood is lost during the procedure, lower risk of infection, lower risk of blood clots, and revisions are easier if surgical complications present.



knee-replacement

knee-replacement

Knee arthroplasty or knee replacement surgery replaces the anatomy of an osteoarthritic knee with prosthetic components.  Generally the weight-beaing surfaces of the joint are replaced to relieve pain and improve function.

Knee replacements can be partial or total.  The surgeries are major, requiring intense physical rehabilitation and considerable post-operative pain.  Recovery time can take weeks and the use of a cane or crutches is usually required.

The results are usually impressive.  A person who suffers for years with osteoarthritis in many instances will be able to walk pain-free and enjoy a full range-of-motion.