Advances in knee replacement 2015.pptx

www.g2orthopedics.com

Potential Causes and Treatment Options for Knee Pain

Vic Goradia, MDOrthopedic Surgeon

G2 Orthopedics and Sports Medicine

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About My Practice

❑Expertise❑Personalized Care❑Convenience


My Background

❑Board Certified w/ CAQ in Sports Med❑Fellowship- Union Memorial Sports Med Clinic, Baltimore❑In practice since 1999❑Chair - Online CME for Arthroscopy Assoc. of N. Am❑Past Associate Editor for Journal of Arthroscopy❑Regularly teach advanced knee and shoulder surgery

courses to orthopedists around the U.S.


Your Knee Joint

❑Femur – thigh bone❑Patella – knee cap❑Tibia – shin bone❑Cartilage ▪ tissue between bones that

provides cushioning❑Synovium ▪ tissue that provides

lubricating fluid to joint❑Ligament ▪ flexible tissue that holds knee

joint together

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What Causes Knee Joint Pain?

❑Ligament injury❑Torn Cartilage❑Sprains/strains❑Overuse❑Arthritis


Ligaments Sprains

❑Ligaments ▪tough, non-stretchable fibers ▪Hold bones together

❑ACL Ligament ▪connects the thighbone (the femur) to the shinbone (the tibia) ▪helps stabilize the knee joint.


ACL Tear

❑One of the most common sport-related injuries

▪ Typically happens by sudden twisting movements, slowing down from running, or landing from a jump

▪ You may hear a popping sound at the time of injury. Your knee may give way and begin to swell and hurt.

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ACL Repair

❑Without surgery▪Brace▪therapy

❑Surgery▪Reconstruct ligament

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Meniscus

❑Shock-absorber ▪cushions

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Meniscal Tear

❑Pain, swelling, and catching❑Anti-inflammatory pills❑Cortisone❑MRI❑Tears don’t heal❑Arthroscopic surgery


ARTICULAR CARTILAGE

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Down to Bone—Grade IV

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Cartilage Damage→ Osteoarthritis


What is Arthroscopy?

❑Small incisions ❑Pencil-sized instruments

inserted that ❑Small lens and lighting

system ❑Magnify and illuminate the

structures inside the joint.


Arthroscopy

❑Rotator cuff repair❑Repair or remove torn cartilage (meniscus) ❑Reconstruct knee or shoulder ligaments❑Removal of loose bone or cartilage in knee, shoulder,

elbow, ankle, wrist.


Activities Most Affected by Arthritis & Joint Pain2

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Arthritis

❑ Osteoarthritis: • degenerative arthritis• “wearing out” • breakdown of cartilage

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Types of Arthritis❑ Rheumatoid:

• Involves joint lining – synovium • It swells• invades surrounding tissues• produces chemicals that attack

the joint surface

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Osteoarthritis Symptoms❑ May develop suddenly or very slowly❑ Pain and stiffness❑ Swelling❑ Simple tasks may be difficult to do

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Nonsurgical Options❑ Diet and Exercise❑ Physical Therapy❑ Medications❑ Glucosamine❑ Visco-supplementation❑ Cortisone injections❑ Bracing

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Knee Replacement


Myths and Truths about

Joint Replacement Surgery

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www.g2orthopedics.comMyth

Knee replacement implants are only good for about 10 years.

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Currently, more than 90% of modern total knee replacements are still functioning with a high level of satisfaction after 15 years. (1)

Truth 24


I’ll have to stay in the hospital a long time after joint replacement surgery

Myth 25


Today, patients put weight on their new hip or knee hours after their surgery and many go home after 2-3 days. (4)

Truth 26


You can't really exercise or participate in sports activities after joint replacement surgery

Myth 27


Actually being active is encouraged after joint replacement surgery. Your doctor will advise you on what is appropriate (5)

Truth 28


3 compartments of the knee

Medial Compartment

Lateral Compartment


Normal Knee X-ray Arthritic Knee X-ray

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Total Knee Replacement❑ End surface of thigh

bone replaced with metal

❑ End surface of leg bone replaced with metal

❑ Plastic liner is inserted between them

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Replaced Knee X-rayFront View Side View

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The GetAroundKnee is

❑ designed to work much like a healthy knee

❑ designed to replace the knee’s naturally circular motion.3,4,9

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Potentially improves fit for women

❑ Narrower implants accommodate the female bone structure

❑ Wide range of sizing options to more closely match the male and female anatomy8

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Computer Navigation

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Stryker Knee Navigation

❑ Navigation helps the surgeon with more accurate placement of the artificial knee


How it Works

❑Similar to GPS▪ Infrared sensors act like satellites

❑Information supplies the surgeon with the measurements of your unique anatomy.


Benefits to Your Surgeon

❑ Allows adjustments within a fraction of a degree▪ helping to ensure optimal fit and improved

performance of your implant


Potential Benefits to Patient

❑Reduced bleeding immediately after surgery

❑Easier to regain knee motion


Total Knee Replacement


• Considered the Gold Standard for Advanced Knee OA

• Best for late-stage OA➢Removes healthy bone, cartilage, and

tissue

Total Knee Arthroplasty (TKA) Isn’t Always The Solution


Partial Knee Resurfacing

▪If arthritis affects only one compartment of your knee, PKR may be an option for you.

▪Approximately 70,000 Partial Knee Resurfacing procedures are done each year in the US*

*2008 Projection, Millennium Research Group, 2005.


Stryker Implant Technology

Triathlon® PKR Knee System

Avon® Patellofemoral Knee System

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Total vs. Partial


MAKOplasty®

Patient-specific Partial Knee Resurfacing Using Surgeon-controlled Robotic Arm Technology

Partial Knee Replacement

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MAKOplasty® Fills A Gap For Patients With Mid-Stage Osteoarthritis

Early-Stage Knee Pain Mid-Stage OA Late-Stage OA

MAKOplasty Partial Knee Arthroplasty OptionsTotal Knee ReplacementArthroscopy



Prevalence of Partial Knee Osteoarthritis

• Unicondylar Disease− ≈ 43% of TKA patients may only have one area of

arthritis

• Patellofemoral Disease− 24% of patients may only have arthritis in kneecap

• Bicompartmental Disease− 40-65% of patients have arthritis in only 2 of the 3 parts of

the kneeBicomp disease

TKA Patients

Partial disease

Kneecap disease

OA Patients

OA Patients


Before surgery a 3-D plan is created from a CAT scan of your knee

The MAKOplasty® Advantage


• Patient-specific pre-operative 3-D plan enables accurate implant sizing and positioning consistently and reproducibly

• 3-D view improves surgeon visualization

• Proper implant alignment is assessed BEFORE procedure begins

• Optimal soft tissue balancing through entire range of knee motion is enabled

The MAKOplasty® Advantage


MAKOplasty® PKU Overview

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MAKOplasty® PKR Surgery Overview


• Offers The Following Potential Benefits:− Improved surgical outcomes− Less implant wear and loosening− Bone-sparing and soft-tissue preserving− ACL and PCL preservation

• Feels More Natural When Compared to Total Knee Replacement1

MAKOplasty® Clinical Value to Patients

(PKR= partial knee replacement)


MAKOplasty® Provides More Accurate And Reproducible Implant Placement Than Conventional

Partial Knee Techniques

• Robotic arm assisted PKA leads to:− 2-3 times more accurate implant

placement than manual UKA1,2,3,4,5

− At least 3 times more reproducible implant placement than manual UKA1,2,3,4,5

− Fewer outliers than manual UKA6

Conclusion: MAKOplasty Patients Had Significantly Less Pain than Oxford Patients Day 1 To Week 8

MAKOplasty® Demonstrates Less Post-Operative Pain Versus Manual PKR (Oxford® )1

Early Post-operative Pain

1. Jones B, Blyth M, MacLean A, Anthony I, Rowe P. Accuracy of UKA implant positioning and early clinical outcomes in a RCT comparing robotic assisted and manual surgery. CAOS International Conference, June 13-15, 2013, Orlando, Florida.

Oxford® is a registered trademark of Biomet, Inc.


Conclusion: MAKOplasty patients showed improved function at 3 month follow-up based on AKSS

MAKOplasty® Demonstrates Improved Function Versus Manual PKR (Oxford® )1

1. Jones B, Blyth M, MacLean A, Anthony I, Rowe P. Accuracy of UKA implant positioning and early clinical outcomes in a RCT comparing robotic assisted and manual surgery. CAOS International Conference, June 13-15, 2013, Orlando, Florida.

Oxford® is a registered trademark of Biomet, Inc.

p=0.006


Who Are Good Candidates For A MAKOplasty® Procedure?

Typical MAKOplasty Patients Share the Following Characteristics: • Knee pain with activity, on the inner knee, under the knee cap or the outer knee

• Start up knee pain or stiffness when activities are initiated from a sitting position

• Failure to respond to non-surgical treatment such as rest, weight loss, physical therapy and non-steroidal anti-inflammatory medication

• Best treatment option for each patient will be determined individually

BICOMPARTMENTAL PATELLOFEMORALUNICONDYLAR LATERAL



Partial Knee Resurfacing

❑Suitable if only one half of the knee is diseased

❑Surfaces are replaced only on one side of knee

❑Implants are anatomically shaped


Total Knee vs. Partial Knee


Benefits of Partial Knee Resurfacing (PKR)

❑Recovery period may be shorter than total knee replacement*

❑Post-operative pain may be reduced*❑Smaller implants mean the surgical incision may

be smaller

* Newman, John H., Unicompartmental Knee Replacement, The Knee, 7 (2000), pp. 63-70.

A Giant Step Forward in Joint Replacement

❑Computer-Assisted Surgery


What are the potential risks?

❑Risks which are normally encountered in conventional TKA remain

❑Individual results and post-op activity levels vary


Knee Implants

❑Longevity of knee implants is affected by many factors including: ▪Patient weight▪Activity level▪Bearing surface


Knee Rehabilitation

❑Performing rehabilitative exercises may gradually return full flexibility and stability to your knee

❑Building strength in your thigh and calf muscles to support the reconstructed knee is a primary goal of rehabilitation


Conclusion

❑I start with non-operative options❑When pain and activity limitations effect the

patient then a replacement is discussed❑The use of technology permits me to more

accurately and reproducibly perform the surgery


❑I like to offer the least invasive procedure that will provide the desired outcomes

❑Robotic technology permits accurate and reproducible outcomes

❑Future

Conclusion


Thank You

Vic Goradia, MD

Office: 804-678-9000www.G2orthopedics.com

Health & Medicine

Advances in knee replacement 2015.pptx