Presentation on theme: "Kenneth D. Kleist, M.D. HealthPartners Medical Group Regions Hospital St. Paul, MN Whats New in Knee Replacement."— Presentation transcript:
Kenneth D. Kleist, M.D. HealthPartners Medical Group Regions Hospital St. Paul, MN Whats New in Knee Replacement
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.
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
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
Better Nausea Control Much more focus –Regional Anesthesia Helps –Multimodal approach Less intravenous narcotics Scopolamine patches Odansetron Prochlorperazine Metoclopramide
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
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.
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
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
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
Other Alternative Bearings New approaches to femoral components –Ceramics –Oxidized Zirconium
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