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Surgical Treatment Options

If you have not experienced adequate results with medication and other conservative treatments, surgery may provide the pain relief you long for, in addition to allowing you to return to the lifestyle and activities you enjoy. Our doctors can tell you whether you might benefit from joint replacement and explain the reasons why it may, or may not, be right for you.

If you and your doctor decide that surgery is an option to relieve your pain, your doctor will provide the specific-to-you details of which type of artificial joint he or she will use, what you need to know to prepare for the surgery, how the surgery will be performed, and what you can expect once you are up and moving again.

The orthopedic surgeon can evaluate your condition and tell you if knee replacement would be right for you. If your family physician, an internist, or a rheumatologist is currently treating your condition, you can ask them to refer you to an orthopedic surgeon for an evaluation.

Consequences of Delaying Surgery

Surgery is a difficult decision. You should talk with your doctor to better understand the risks and complications before making the decision to undergo total knee replacement; but keep in mind that osteoarthritis is a degenerative disease, which means that the disease, and your pain, is likely to get worse over time. So why wait? Consider the fact that better outcomes have been reported in those patients who had a total joint operation earlier in their disease process.1 Two years after their operation, patients who chose surgery earlier in the disease process had improved function and reduced pain compared to those who waited.1

Arthroscopic Procedures

  • Repair or resection of torn cartilage (meniscus) from knee or shoulder
  • Reconstruction of anterior cruciate ligament in knee
  • Removal of inflamed lining (synovium) in knee, shoulder, elbow, wrist, ankle
  • Repair of torn ligaments
  • Removal of loose bone or cartilage in knee, shoulder, elbow, ankle, wrist

Partial Knee Resurfacing (PKR)

There are three compartments to the knee: the medial (inside) compartment, the lateral (outside) compartment and the patellofemoral (kneecap) compartment. Depending on where the arthritis affects your knee, partial knee resurfacing may be an option for you. PKR is a growing procedure. There are approximately 70,000 partial knee resurfacing procedures done in the U.S. each year.

Unicompartmental Knee Resurfacing is a procedure that resurfaces only the affected compartment of the arthritic femur and the tibia.

Patellofemoral Knee Resurfacing is a procedure that resurfaces the worn patella and the trochlea (the groove at the end of the thighbone).

Benefits of Partial Knee Resurfacing - Quicker Recovery

Because the PKR artificial joints are smaller than total knee implants, the surgical incision may be smaller. A smaller incision may lead to a smaller scar. Other potential benefits to PKR include a quicker operation and a shorter hospital stay compared to a total knee replacement. Rehabilitation may also be more progressive. Because less bone is removed and there is less trauma to soft tissue during surgery, your knee may feel more natural than with a total knee replacement.

Patellofemoral Knee Joint Resurfacing

Patellofemoral pain (anterior knee pain) is pain felt between the patella (kneecap) and the thighbone. Patellofemoral Knee Resurfacing is a procedure that resurfaces the worn patella and the trochlea (the groove at the end of the thighbone) to alleviate this pain.

With the Mako Patellofemoral Knee System, joint resurfacing may be an alternative to total knee replacement for patients with patellofemoral arthritis. It is designed to reproduce the natural patellofemoral joint throughout movement and facilitate sliding of the patella along the end of the thighbone. It is also designed to produce a natural feeling knee with comfortable and reliable function.

Following a patellofemoral knee resurfacing, you may be able to get up and walk on the first post-operative day and start an active range of knee movement. All knee implants (including total knee implants) have a limited life expectancy. Based on your age, weight, and activity level, a PKR implant may relieve pain and last for a number of years.

MAKOplasty® Partial Knee Resurfacing

MAKOplasty® Partial Knee Resurfacing is an innovative treatment option for adults living with early to midstage osteoarthritis (OA) in either the medial (inner), patellofemoral (top), or both compartments of the knee. It is powered by the RIO® Robotic Arm Interactive Orthopedic System, which allows for consistently reproducible precision in performing partial knee resurfacing.

The RIO® System empowers surgeons and hospitals to address the needs of a large and growing, yet currently underserved patient population. Patients who desire a restoration of lifestyle, minimized surgery, reduced pain and rapid recovery may benefit from MAKOplasty®.

During the procedure, the diseased portion of the knee is resurfaced, sparing the patient’s healthy bone and surrounding tissue. An implant is then secured in the joint to allow the knee to move smoothly again. MAKOplasty® Partial Knee Resurfacing can:

  • Facilitate optimal implant positioning to result in a more natural feeling knee following surgery
  • Result in a more rapid recovery and shorter hospital stay than traditional knee replacement surgery
  • Be performed on an outpatient basis
  • Promote a rapid relief from pain and return to daily activities
  • As a knee arthroplasty procedure, MAKOplasty® is typically covered by most Medicare-approved and private health insurers.

Knee Replacement

What Is Total Knee Replacement Surgery?

Knee replacement surgery may be considered when arthritis limits your everyday activities such as walking and bending, when pain continues while resting, or stiffness in your knee limits your ability to move or lift your leg. Knee replacement may be recommended only after careful diagnosis of your joint problem. It is time to consider surgery if you have little pain relief from anti-inflammatory drugs or other treatments, such as physical therapy, do not relieve knee pain.

Knee replacement is a surgical procedure — performed in the US since the 1960s — in which a diseased or damaged joint is replaced with an artificial joint called a prosthesis. Made of metal alloys and high grade plastics (to mimic the function of bone and cartilage, respectively), the prosthesis is designed to move just like a healthy human joint. Over the years, knee replacement techniques and instrumentation have undergone countless improvements. Today, knee replacement is one of the safest and most successful types of major surgery; in over 90% of cases it is complication-free and results in significant pain relief and restoration of mobility.

Benefits of Total Knee Replacement Surgery?

Knee Replacement surgery helps more than 500,000 Americans each year to relieve their knee pain,2 and get back to enjoying normal, everyday activities.

Success Rates

For the vast majority of patients, joint replacement can be successful in providing relief from pain and improved mobility for many years. According to the American Academy of Orthopedic Surgeons, knee replacement procedures have been found to result in significant restoration of function and reduction of pain in 90% to 95% of patients.2

Quadriceps-Sparing Total Knee Replacement

Minimally-invasive quadriceps-sparing total knee replacement is a new surgical technique that allows surgeons to insert the same time-tested, reliable knee replacement implants through a shorter incision using a surgical approach that avoids trauma to the quadriceps muscle, which is the most important muscle group around the knee. This new technique, which is sometimes called quadriceps-sparing knee replacement, uses an incision that is typically only 3-4” in length, and the recovery time is much quicker – often permitting patients to walk with a cane within a couple of weeks of surgery or even earlier. The less-traumatic nature of the surgical approach also may decrease post-operative pain and diminish the need for rehab and therapy compared to more traditional approaches.

Benefits of Quadriceps-Sparing Total Knee Replacement

The main potential benefits of this new technique include:

More rapid return of knee function. Patients who undergo this procedure seem to get muscle strength and control back more quickly than patients who have had traditional total knee replacement. This is because the quadriceps muscle and tendon are not divided in the course of the surgical exposure like in traditional knee replacement, and the kneecap is not everted (flipped out of the way) as it is in traditional total knee replacement.

Smaller incision. While this procedure would not be worth performing for cosmetic benefits, many patients do prefer the shorter incision. Traditional knee replacement incisions often measure 8” or longer; minimally-invasive quadriceps-sparing knee replacement incisions are about 4” in length for most patients.

Decreased post-operative pain. This may be a function of the smaller incision and the fact that the incision stays out of the important quadriceps muscle/tendon group.

Same reliable surgical implants as Traditional Knee Replacement. Much has been learned about implant design in the nearly 40-year history of contemporary knee replacement. Minimally-invasive quadriceps-sparing total knee replacement is an evolution of surgical technique, which permits the use of time-tested implant designs. This gives some reassurance that while the surgical approach is new, the implants themselves have a good proven track record.

Computer-Assisted Surgery

Reasons orthopedic surgeons may choose computer-assisted technology:

  • Provides your surgeon with comprehensive data about your anatomy which may result in more exact placement of your joint replacement
  • Allows the surgeon to more accurately plan for your surgery with a partial 3-dimensional model of your hip or knee3
  • Provides the surgeon with more control, feedback and the ability to correct potential errors during the surgery4
  • Allows for better visualization of anatomy, which is particularly important when minimally-invasive techniques are used

Tremendous advances have been made in joint replacement that make it a viable option for a greater number of people than ever before. Over the past four decades joint replacement has been proven to relieve severe joint pain and restored joint function in over 90% of patients undergoing the procedure.9

During a joint replacement procedure, your surgeon will strive to ensure that everything is aligned properly. Accurate alignment of the hip or knee components is critical to the overall function of your new joint,4,5 and it also plays a role in helping your joint feel healthy again, and helping the joint replacement to potentially last longer. Computer-assisted technology has made it possible for your orthopedic specialist to navigate joint replacement procedures with a level of accuracy so precise it may improve the results of your surgery.4

Benefits of Computer-Assisted Surgery

There are several potential benefits for those who have computer-assisted surgery with their total joint replacement, including:

  • May increase the life of your replacement4
  • Reduces the risk of dislocation and revision surgery4
  • Results in greater stability and range of motion5,6
  • Helps improve the overall function of your joint replacement6

Computer-assisted surgery may allow for less-invasive surgical techniques, which have several other potential advantages, including:

  • Reduced blood loss during surgery, which lessens the need for a blood transfusion10
  • Faster recovery9
  • Reduced length of your hospital stay8
  • Shorter post-operative physical rehabilitation9
  • Less scarring7,9

How Does Computer-Assisted Surgery Work?

Computer-assisted technology uses special tracking devices, providing your surgeon a comprehensive understanding of your joint mechanics in the operating room (OR). Armed with this information, your surgeon can make adjustments within a fraction of a degree, helping to ensure your new joint has the stability and range of motion needed for a successful replacement. Specifically, the technology uses the latest advancements in science and computer engineering to make the procedure more accurate than joint surgery without it.4 As the surgeon moves an instrument within your joint, special infrared trackers calculate its position and wireless instruments instantaneously transfer the data to a computer in the OR. This information is then displayed on a monitor as an interactive model of the anatomy or “blueprint” that supplies the surgeon with all the angles, lines and measurements of your unique anatomy. The surgeon will then replace the diseased bone with new, artificial joint components often called prostheses or implants. Joint implants are engineered to replicate a normal, healthy joint. With certain techniques, your surgeon may use pins that hold trackers around the incision site of your joint. These temporary placeholders give the computer key information and may make the surgery even more exact. Emerging technologies and alternative techniques may reduce the number of incisions and therefore reduce scarring.

Follow-Up Appointments

Follow-up visits with your surgeon after joint replacement surgery are important. Many of our patients travel great distances to have their procedure performed at our institute. Regardless of the distance, our location, post-operative follow-up with us is necessary. It is typical to have two to three routine follow-up visits post-surgery, but additional appointments may be required.

Understand the Potential Risks and Complications

The complication rate following joint replacement surgery is very low. Serious complications, such as joint infection, occur in less than 2% of patients.11 Nevertheless, as with any major surgical procedure, patients who undergo total joint replacement are at risk for certain complications — many of which can be successfully avoided and/or treated. Possible complications include:

Infection

Infection may occur in the wound or within the area around the new joint. It can occur in the hospital, after the patient returns home, or years later. Following surgery, joint replacement patients receive antibiotics to help prevent infection. Joint replacement patients may also need to take antibiotics before undergoing any medical procedures to reduce the chance of infection spreading to the artificial joint.

Treating a Joint Replacement Infection

People who develop infections within the first few months of joint replacement surgery are often treated successfully with intravenous antibiotics and a surgical technique that washes the infected implant. People who develop infections months or years after joint replacement appear to face more challenging treatment. Often these infections require surgical removal of the infected implant, use of a spacer impregnated with antibiotics to stabilize and treat the joint space, and longer-term intravenous antibiotics. Careful blood monitoring helps to determine when the infection is thoroughly cleared. A new joint replacement may be considered at that time.

Blood Clots

Blood clots can result from several factors, including the patient’s decreased mobility following surgery, which slows the movement of the blood. There are a number of ways to reduce the possibility of blood clots, including:

 

  • Blood thinning medications (anticoagulants)
  • Elastic support stockings that improve blood circulation in the legs
  • Plastic boots that inflate with air to promote blood flow in the legs
  • Elevating the feet and legs to keep blood from pooling
  • Walking hourly

Lung Congestion

Pneumonia is always a risk following major surgery. To help keep the lungs clear of congestion, patients are assigned a series of deep breathing exercises.

 

1 Arthritis Foundation website, http://www.arthritis.org/faqs-taking-control-of-oa.php, accessed Oct. 2008.

2 American Academy of Orthopaedic Surgeons website, http://orthoinfo.aaos.org/topic.cfm?topic=A00389.

3 Noble PC, Sugano N, Johnston JD, Thompson MT, Conditt MA, Engh CA Sr, Mathis KB. Computer Simulation: How can it help the surgeon optimize implant position? CORR. 2003 Dec; (417):242-52.

4 Sikorski JM, Chauhan S. Computer- Assisted Orthopaedic Surgery: Do we need CAOS? J Bone Joint Surg 2003; 85-B:319-23.

5 Widmer KH, Grutzner PA. Joint replacement-total hip replacement with CT-based navigation. Injury. 2004 Jun; 35 Suppl. 1:S-A84-9.

6 Klein GR, Parvizi J, Venkat RR, Mathew AS, HozackWJ. Evaluation of in vivo knee kinematics by a computerized navigation system during total knee arthroplasty. J Arthroplasty. 2004 Dec; Vol. 19:986-91.

7 Keggi, Kristaps. Total hip arthroplasty through a minimally invasive anterior surgical approach, JBJS, Vol. 85-A.

8 Tria AJ, Minimal Incision Total Knee Arthroplasty, CORR 2003, Vol 416.

9 Zanasi, Stefano. Minimally Invasive Computer-assisted Total Knee Arthroplasty through a Subvastus Approach, October 2006. Article from: Orthosupersite.com.

10 Kalairajah, et al. Blood Loss after total knee replacement, JBJS, Vol. 87-B, No. 11, Nov. 2005.

11 Hanssen, A.D., et al., “Evaluation and Treatment of Infection at the Site of Total Hip or Knee Arthroplasty,” JBJS, Volume. 80-A, No. 6, June 1998, pp. 910-922.

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The Coon Joint Replacement Institute values your privacy and handles your personal information with care. Your email address and information is secure, confidential and will not be sold to any third party sources.

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