Presentation on theme: "What’s New in Knee Replacement"— Presentation transcript:
1What’s New in Knee Replacement Kenneth D. Kleist, M.D.HealthPartners Medical GroupRegions HospitalSt. Paul, MNIntroduce yourself and the plan or plans available to the members. Let members know that you are happy to answer their questions.
2Goals 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.
3Trends 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 plansNCQA – one of our regions top 5 plans – only MN plan in the top five
6Minimally Invasive Surgery No good consensus on what this meansLess skin incisionLess tendon/muscle splitting and damage??? More rapid recoveryCertainly there are benefitsCosmetic, psychological, blood loss, recoveryBottom LineNeed to have pieces put in right!Long-term survival of the joint is most important
7Approach Medial Parapatellar Mini-Medial Parapatellar Mid Vastus Sub VastusQuad Sparing
8Pain Control and Rehabilitation Protocols Regional Anesthesia increasingSpinal or Epidural AnesthesiaFemoral Nerve BlocksPre-op MedicinesPain Catheters, continuous or on demandLocal anesthetic intra-operativelyCryocuff for icingLong-Acting NarcoticsLess Intravenous narcoticsPain as a vital sign
9Better Nausea Control Much more focus Regional Anesthesia Helps Multimodal approachLess intravenous narcoticsScopolamine patchesOdansetronProchlorperazineMetoclopramide
10Post-operative Physical Therapy Early mobility is helpfulContinuous Passive Motion (CPM) the night of surgeryStart at high flexion right awaySet goals for range of motionUp on your feet the first post-operative dayDischarge on the third post-operative dayTransition from walker to cane to nothing
11How much flex is enough? High flexion implants Theoretically allow higher range of motionTraditional Implants 125, maybe 135 degreesSome now up to 155 DegreesCaution: High flexion does not mean you definitely will get better motion.Setting Expectations is ImportantBest predictor is pre-op motionKnee will not be normal.Can make the surgery slightly easier by removing extra boneCan provide additional implant options.
12Gender Specific 3 anatomical shape differences Females are narrower They have a different angle the knee cap glides throughThey have thinner area at the front of the boneMost companies now address this in some wayShape changeSizing
13Mobile Bearing TKA Rotating Platform Plastic liner rotates in the metalMay decrease wearMay improve motionMay allow fudge factorHowever may also increase wear.More difficult to insert plastic
14Highly Crosslinked Polyethylene Relatively NewNot as accepted as in the hipGoal is to reduce wearStill long-term questions about mechanica strength to fracture resistance and delaminationNot common used by most surgeons yet except in limited casesVery young patient
15Other Alternative Bearings New approaches to femoral componentsCeramicsOxidized Zirconium
16Computer Navigation Still Controversial May improve overall alignment May improve the accuracy of sizingPossible it may improve long term outcomeIncreases time“Garbage In, Garbage out”May place you at a minimal risk for fractureAwaiting long-term data