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What’s New in Knee Replacement

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Presentation on theme: "What’s New in Knee Replacement"— Presentation transcript:

1 What’s New in Knee Replacement
Kenneth D. Kleist, M.D. HealthPartners Medical Group Regions Hospital St. Paul, MN Introduce yourself and the plan or plans available to the members. Let members know that you are happy to answer their questions.

2 Goals of Knee Replacement
Improve the quality of life by improving pain and function while maintaining range of motion and avoiding complications. 85% of Knee replacement patients say they would have the surgery again.

3 Trends In case anyone asks,
US News – HP commercial plans are rated 62 in the nation (Blue Plus is 126, Medica is 146) We’re top plan in the state. The magazine only lists the top 50 plans – the Web site lists more. Consumer Reports – Scored highest among local plans NCQA – one of our regions top 5 plans – only MN plan in the top five

4 What is a joint replacement?

5 What is a partial knee replacement?

6 Minimally Invasive Surgery
No good consensus on what this means Less skin incision Less tendon/muscle splitting and damage ??? More rapid recovery Certainly there are benefits Cosmetic, psychological, blood loss, recovery Bottom Line Need to have pieces put in right! Long-term survival of the joint is most important

7 Approach Medial Parapatellar Mini-Medial Parapatellar Mid Vastus
Sub Vastus Quad Sparing

8 Pain Control and Rehabilitation Protocols
Regional Anesthesia increasing Spinal or Epidural Anesthesia Femoral Nerve Blocks Pre-op Medicines Pain Catheters, continuous or on demand Local anesthetic intra-operatively Cryocuff for icing Long-Acting Narcotics Less Intravenous narcotics Pain as a vital sign

9 Better Nausea Control Much more focus Regional Anesthesia Helps
Multimodal approach Less intravenous narcotics Scopolamine patches Odansetron Prochlorperazine Metoclopramide

10 Post-operative Physical Therapy
Early mobility is helpful Continuous Passive Motion (CPM) the night of surgery Start at high flexion right away Set goals for range of motion Up on your feet the first post-operative day Discharge on the third post-operative day Transition from walker to cane to nothing

11 How much flex is enough? High flexion implants
Theoretically allow higher range of motion Traditional Implants 125, maybe 135 degrees Some now up to 155 Degrees Caution: High flexion does not mean you definitely will get better motion. Setting Expectations is Important Best predictor is pre-op motion Knee will not be normal. Can make the surgery slightly easier by removing extra bone Can provide additional implant options.

12 Gender Specific 3 anatomical shape differences Females are narrower
They have a different angle the knee cap glides through They have thinner area at the front of the bone Most companies now address this in some way Shape change Sizing

13 Mobile Bearing TKA Rotating Platform
Plastic liner rotates in the metal May decrease wear May improve motion May allow fudge factor However may also increase wear. More difficult to insert plastic

14 Highly Crosslinked Polyethylene
Relatively New Not as accepted as in the hip Goal is to reduce wear Still long-term questions about mechanica strength to fracture resistance and delamination Not common used by most surgeons yet except in limited cases Very young patient

15 Other Alternative Bearings
New approaches to femoral components Ceramics Oxidized Zirconium

16 Computer Navigation Still Controversial May improve overall alignment
May improve the accuracy of sizing Possible it may improve long term outcome Increases time “Garbage In, Garbage out” May place you at a minimal risk for fracture Awaiting long-term data

17 Direct to Consumer Marketing

18 Current State of Patient’s Decision Making in Today’s Market!
The best advice is to have a discussion with your surgeon. Balancing Act Patients needs/desires Surgeon training, experience, and skill

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