Knee Presentation - Dr Sanders for The Sanders Clinic Website


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Knee Presentation - Dr Sanders for The Sanders Clinic Website

  1. 1. Mark S. Sanders, MD FACS Special thanks to DePuy Orthopaedics, Inc.
  2. 2. Agenda <ul><li>How your knee works & why it hurts </li></ul><ul><li>Knee replacement basics </li></ul><ul><li>What patients have to say </li></ul><ul><li>Your questions </li></ul>Thigh bone (femur) Cartilage Shin bone (tibia) Kneecap (patella)
  3. 3. How your knee works <ul><li>Anatomy of the knee </li></ul><ul><ul><li>Largest joint in body </li></ul></ul><ul><ul><li>Referred to as a hinge joint because it allows the knee to flex & extend; while hinges can only bend and straighten, the knee has the ability to rotate (turn) & translate (glide) </li></ul></ul><ul><ul><li>3 bones </li></ul></ul><ul><ul><ul><li>Shin bone (tibia) </li></ul></ul></ul><ul><ul><ul><li>Thigh bone (femur) </li></ul></ul></ul><ul><ul><ul><li>Kneecap (patella) </li></ul></ul></ul>
  4. 4. What’s causing your pain? <ul><li>It’s estimated 70 million people in the U.S. have some form of arthritis. 1 O st eoarthritis is one of the most common types. </li></ul><ul><li>Osteoarthritis </li></ul><ul><ul><ul><li>Wear and tear that deteriorates the “cushion” in your joints </li></ul></ul></ul><ul><ul><ul><li>A degenerative condition—it won’t get better and may get worse </li></ul></ul></ul><ul><li>Rheumatoid arthritis </li></ul><ul><ul><ul><li>An autoimmune disease that attacks the lining of joints, causing swelling, possibly throbbing pain and deformity </li></ul></ul></ul>1. Landers, S. Another reason to exercise for those with arthritis. American Medical Association website. <>, 2005.
  5. 5. What’s causing your pain? <ul><li>Healthy knee </li></ul><ul><li>The end of each bone in the joint is covered with cartilage, acting as a cushion so the joint functions without pain </li></ul><ul><li>Diseased knee (osteoarthritis) </li></ul><ul><li>Wear and tear deteriorates natural cushion, leading to bone-on-bone contact, soreness and swelling </li></ul>
  6. 6. Assessing your pain <ul><li>Does your knee hurt one or more days per week? </li></ul><ul><li>Does the pain interfere with your sleep? </li></ul><ul><li>Is it painful for you to walk more than a block? </li></ul><ul><li>Are pain medications no longer working? </li></ul><ul><li>Is knee pain limiting your participation in activities (e.g. family vacations or other functions)? </li></ul><ul><li>Has inactivity from knee pain caused you to gain weight? </li></ul>
  7. 7. Assessing your pain <ul><ul><li>Rate your pain on a scale of 1 to 5 </li></ul></ul><ul><ul><li>For most people, the tipping point is about 4 or 5— that’s when the pain becomes too difficult and they turn to a surgeon for relief 1 </li></ul></ul>Little or no pain Excruciating, debilitating pain 1. 2007 DePuy Orthopaedics, Inc. Knee Attitudes & Usage Study.
  8. 8. Assessing your pain <ul><li>Check your mobility </li></ul><ul><li>If you have difficulty performing any of the movements below, </li></ul><ul><li>it may be time to talk to your doctor about next steps </li></ul>Walk Bend at the hips and knees Pretend to drive: push the gas/brake Pretend to golf: swing a club
  9. 9. How can your pain be treated? <ul><li>Medications </li></ul><ul><ul><li>Analgesics </li></ul></ul><ul><ul><li>Corticosteroids </li></ul></ul><ul><li>Injections </li></ul><ul><ul><li>Corticosteroids, hyaluronic acid (e.g., Orthovisc ® ) </li></ul></ul><ul><li>Water therapy </li></ul><ul><ul><li>Soaking, ice packs, hot packs </li></ul></ul><ul><li>Exercise & physical therapy </li></ul><ul><ul><li>Also good for weight loss </li></ul></ul>
  10. 10. Knee replacement <ul><li>Implants replace damaged surfaces </li></ul><ul><li>Helps relieve pain and restore mobility </li></ul><ul><li>More than 500,000 knee replacements are performed each year in the U.S. 1 </li></ul><ul><li>A recent Arthritis Foundation ® study shows knee replacement has a 90-95% rate of patient satisfaction 2 </li></ul>1. <>, 2005. 2. The Arthritis Foundation. <>, 2006.
  11. 11. What is knee replacement? <ul><li>A surgical procedure that removes and replaces diseased joint surfaces with implants </li></ul>Femoral component Tibial component
  12. 12. How does it work? <ul><li>Diseased areas at top of shin bone (tibia) and bottom of thigh bone (femur) are removed and reshaped </li></ul><ul><li>Femoral component covers the thigh bone (femur) </li></ul><ul><li>Tibial component covers the shin bone (tibia) </li></ul><ul><li>Polyethylene insert placed between femoral and tibial components </li></ul><ul><li>Patellar component replaces the kneecap (patella) </li></ul>Femoral component Tibial component Patellar component Polyethylene insert
  13. 13. How does it work? Healthy knee Knee replacement
  14. 14. DePuy Sigma ® Knees <ul><li>Sigma Knees come in a wide range of shapes, sizes and materials </li></ul><ul><li>Your surgeon may be able to fit you with a Sigma Knee designed to provide a more natural feel and movement </li></ul><ul><li>Sigma Knees can be implanted using minimally invasive surgery </li></ul><ul><li>The Sigma Knee is a great example of a proven design that continues to evolve to meet the demands of today’s patients </li></ul>
  15. 15. Sigma ® Fixed-Bearing Knees <ul><li>Most widely used type of knee replacement in the U.S. today 1 </li></ul><ul><li>Designed to enhance stability of the joint </li></ul><ul><li>New designs and advanced materials - Helps reduce wear </li></ul>1. IMS Health
  16. 16. Sigma ® Fixed-Bearing Knees
  17. 17. Sigma ® Rotating Platform Knees <ul><li>Rotating Platform Knee </li></ul><ul><li>Designed to rotate as it bends, imitating your natural knee movement </li></ul><ul><ul><ul><li>The surfaces of the knee joint roll and glide against each other as you bend. In other words, your knee naturally rotates as it bends </li></ul></ul></ul><ul><ul><ul><li>Designed for patients who want to remain active since it minimizes implant wear, compared to traditional knee replacements 1 </li></ul></ul></ul><ul><ul><ul><li>A multi-center DePuy Orthopaedics study shows 97% patient satisfaction at 5 years after surgery 2 </li></ul></ul></ul>1. McNulty, D. et al. “In Vitro Wear Rates of Fixed-bearing and Rotating Platform Knees (Rev. 2).” 2003. 2. DePuy Multi-Center Study. 2006.
  18. 18. Should you wait to replace your knee? <ul><ul><li>Assess your pain and ability to function </li></ul></ul><ul><ul><ul><ul><li>Do you feel severe pain in your knee? </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Has the pain and loss of function affected your quality of life? </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Do you have difficulty sleeping or performing basic functions (walking, driving, climbing stairs)? </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Does medication no longer provide relief? </li></ul></ul></ul></ul><ul><ul><li>Consult your physician </li></ul></ul><ul><ul><li>Early diagnosis and treatment are important 1 </li></ul></ul><ul><ul><ul><ul><li>Delaying may lower your quality of life 2 </li></ul></ul></ul></ul><ul><ul><li>Osteoarthritis is degenerative—it won’t get better and may get worse </li></ul></ul>1. Fortin PR, et al. Outcomes of Total Hip and Knee Replacement. Arthritis & Rheumatism. 1999;42:1722-1728. 2. Fortin PR, et al. Timing of Total Joint Replacement Affects Clinical Outcomes Among Patients With Osteoarthritis of the Hip or Knee. Arthritis & Rheumatism. 2002;46:3327-3330.
  19. 19. Information specific to Dr. Sanders’ approach
  20. 20. Preoperative Planning <ul><li>Long Standing X-rays (Orthoradiograms) </li></ul><ul><li>Medical, Vascular, and Cardiac clearance </li></ul><ul><li>Patient Education </li></ul>
  21. 21. Decreasing Postoperative Pain <ul><li>Spinal Anesthesia decreases post op pain and thromboembolic disease </li></ul><ul><li>Minimally Traumatic Surgery </li></ul><ul><li>Minimal Use of the tourniquet averages 20 minutes </li></ul><ul><li>Ranawat cocktail locally injected for post op pain relief </li></ul><ul><li>Rapid Surgery (averages one hour) </li></ul><ul><li>Epidural catheter for pain relief x 2 days </li></ul><ul><li>Oral analgesics </li></ul><ul><li>Cryocuff for cold therapy </li></ul>
  22. 22. Decreasing the Incidence of Thromboembolism <ul><li>Immediate Active Motion without CPM machine (average patient’s motion 0-120 degrees by day one) </li></ul><ul><li>Foot pumps placed before surgery to decrease thromboembolic disease </li></ul><ul><li>Ambulation with PT that afternoon TED antiembolism stockings worn for two weeks </li></ul><ul><li>Medications given to prevent clotting </li></ul><ul><li>Most patients receive only Aspirin </li></ul>
  23. 23. Decreasing the Infection Rate in the OR <ul><li>Preoperative intravenous antibiotics </li></ul><ul><li>Antibiotics impregnated in bone cement </li></ul><ul><li>Special “Space Suits” worn by all scrubbed OR personnel </li></ul>
  24. 24. Post Operative Rehabilitation <ul><li>Immediate active motion (no CPM machine) averages 0-120 º within 24 hours </li></ul><ul><li>Ambulation with PT that same day </li></ul><ul><li>Average hospital stay from Tuesday to Friday </li></ul><ul><li>Most patients <70 go home </li></ul><ul><li>Most patients >80 go to rehab hospital </li></ul><ul><li>Average length of time with crutches/walker 10 days </li></ul><ul><li>Average time in PT ranges from 4-6 weeks </li></ul>
  25. 25. Wound Management/Infection Prevention <ul><li>Patients shower daily with ® Hibiclens starting at 24 hours post surgery </li></ul><ul><li>Compression stockings worn for two weeks </li></ul><ul><li>No skin staples </li></ul><ul><li>® Dermabond (medical grade ® Krazyglue ) lasts for ten days </li></ul><ul><li>Intracuticular sutures ( ® Quill ) dissolves on its own without need for suture removal </li></ul>
  26. 26. Important safety information. . . <ul><li>As with any medical treatment, individual results may vary </li></ul><ul><li>The performance of joint replacements depends on your age, weight, activity level and other factors </li></ul><ul><li>There are potential risks, and recovery takes time </li></ul><ul><li>People with conditions limiting rehabilitation should not have this surgery </li></ul><ul><li>Only an Orthopaedic surgeon can tell if knee replacement is right for you </li></ul>
  27. 27. Summary <ul><li>The leading cause of knee pain is osteoarthritis </li></ul><ul><li>Osteoarthritis is degenerative – it won’t get better and may get worse </li></ul><ul><li>Early diagnosis and treatment for total knee replacement are important 1 </li></ul><ul><li>A recent Arthritis Foundation ® study shows knee replacement has a 90-95% rate of patient satisfaction 2 </li></ul><ul><li>Sigma Knees come in a wide range of shapes, sizes and materials, so your surgeon may be able to fit you with a knee designed to provide a more natural feel and movement </li></ul>1. Fortin, Paul R., et al. Outcomes of Total Hip and Knee Replacement. Arthritis & Rheumatism 42 (1999): 1722-1728 2. The Arthritis Foundation. <>, 2006.
  28. 28. And Never Forget: <ul><li>Inform every doctor or dentist you have a knee replacement to receive antibiotics before invasive procedures </li></ul>
  29. 29. Thank you! <ul><li>To find out more about knee pain and the treatment options available, visit: </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li>© DePuy Orthopaedics, Inc., 2010. </li></ul><ul><li>The third party trademarks used herein are trademarks </li></ul><ul><li>of their respective owners. </li></ul>