Advances in knee replacement 2015.pptx

Potential Causes and Treatment
Options for Knee Pain
Vic Goradia, MD
Orthopedic Surgeon
G2 Orthopedics and Sports Medicine
www.g2orthopedics.com 1

About My Practice
❑Expertise
❑Personalized Care
❑Convenience
www.g2orthopedics.com

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

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.

ACL Repair
❑Without surgery
▪Brace
▪therapy
❑Surgery
▪Reconstruct ligament

Meniscus
❑Shock-absorber
▪cushions

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

ARTICULAR CARTILAGE

Down to Bone—Grade IV

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

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

Types of Arthritis
❑ Rheumatoid:
• Involves joint lining – synovium
• It swells
• invades surrounding tissues
• produces chemicals that attack
the joint surface

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

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

Knee Replacement

Myths and Truths
about
Joint Replacement
Surgery

Myth
Knee replacement
implants are only good
for about 10 years.

Currently, more than 90% of
modern total knee
replacements are still
functioning with a high level of
satisfaction after 15 years. (1)
Truth www.g2orthopedics.com 24

I’ll have to stay in the
hospital a long time
after joint replacement
surgery
Myth www.g2orthopedics.com 25

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

You can't really
exercise or participate
in sports activities after
joint replacement
surgery
Myth www.g2orthopedics.com 27

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

3 compartments of the knee
Medial Compartment
Lateral Compartment

Normal Knee X-ray Arthritic Knee X-ray

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

Replaced Knee X-ray
Front View Side View

The GetAroundKnee is
❑ designed to work much
like a healthy knee
❑ designed to replace the
knee’s naturally circular
motion.3,4,9

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

Computer Navigation

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

Total vs. Partial

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

MAKOplasty® Fills A Gap For Patients With Mid-Stage
Osteoarthritis
Early-Stage Knee Pain Mid-Stage OA Late-Stage OA
MAKOplasty Partial Knee Arthroplasty Options
Total 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 knee
Bicomp 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

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=0.0
06

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: 804-678-9000
www.G2orthopedics.com

Advances in knee replacement 2015.pptx

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