How long does knee cartilage transplantation last?

May 17th — admin

I’ve had the cartilage in both my knees scraped and smoothed over. It only seemed to last a couple of years. Now there’s another hole in the cartilage of my left knee. If I go for the more expensive transplantation treatment, how long does that last?

Healthy cartilage cells called chondrocytes can be harvested from a patient, grown in a lab, and transplanted back into the knee. The entire process takes about four to six weeks.

Since the patient donates his or her own chondrocytes, the procedure is called autologous chondrocyte implantation (ACI).

ACI is a fairly new procedure. Long-term studies are not available yet. Some of the earlier studies do show positive results. After having an ACI, symptoms improve. The patients report less pain and better function.

Activities of daily living are restored and quality of motion returns to normal. ACI clearly helps many patients who are in pain but do not have enough knee damage to need a total knee replacement.

At least one study followed patients for four years with good results. The main problem after ACI involves hypertrophy or overgrowth of tissue. Additional surgery may be needed after ACI to remove the excess tissue and smooth the surface over.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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How do doctors decide if a knee replacement is needed?

April 17th — admin

My mother has been having a lot of knee pain recently and difficulty walking. Her doctor is trying to convince her to have a knee replacement. On what basis do doctors decide to do a replacement?

Total knee replacements are usually done because a patient has severe osteoarthritis or rheumatoid arthritis of the knee, or has had a severe trauma or injury to the knee that is causing a lot of pain and difficulty with movement.

Your mother’s doctor may have looked at the amount of pain she is experiencing when she walks and how it may be limiting her life. If she can’t walk without a significant amount of pain, or has difficulty going up and down stairs, or getting in and out of chairs, this can be affecting her quality of life. If her pain is severe even when resting and she’s not responding to pain relievers, this can affect how she sleeps and even how she feels about herself.

It could be that other treatments, like physiotherapy, have also been tried but without much success.

Immobility and social isolation are big problems among our older citizens and it’s important for them to be able to maintain their independence as long as possible.

Of course, your mother’s doctor will also ensure that she is healthy enough to undergo such a surgery.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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What does the term “less invasive surgery” mean?

August 16th — admin

When I saw the surgeon about my knee replacement, she advised using a unicompartmental implant. She will just remove and replace the inside half of my left knee. The paperwork I was given says that this type of surgery is less invasive. What does that mean?

Improved technology and surgical equipment has made it possible for surgeons to perform some operations with smaller incisions. This is called minimally invasive surgery (MIS).

A smaller incision also means less damage to the soft tissues and muscles. In the case of knee replacement surgery, the ligaments inside the knee and the quadriceps muscle along the front of the thigh are spared during MIS.

Studies show that preserving the integrity of the soft tissues also maintains more normal knee function. Proprioception and kinematics remain normal or near normal. Proprioception refers to the joint’s sense of position. Kinematics is the actual motion of the joint.

Patients end up with a more functional knee after UKA compared with a total knee replacement (TKR) that is done with the standard, open incision approach. The UKA patients can put more weight on the leg sooner. They return to full activities faster.

Studies show these positive results are likely the result of preserving normal biomechanics and kinematics in knees after UKA implantation.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Does computer-assisted surgery increase the cost of health care?

August 14th — admin

It seems like they are using computers for everything. Now I see there is computer-assisted knee replacements. Are these really needed? Doesn’t it just drive up the cost of health care? I had a total knee replacement the old-fashioned way, and I’m doing just fine.

You are right that computer-guided joint replacement has recently been introduced. And as always with new and improved technology, the costs do go up.

But in this case, the cost of less invasive reconstructive surgery may be well worth it. First of all, improved implant alignment of total knee replacements are possible with computer-guided systems.

Accuracy is important because any imbalance can lead to uneven wear and tear on the implant. And that can mean more pain and loss of function for the patient. Decreased quality of life may add insult to injury.

Good implant alignment is now possible even when using smaller incisions. Less cutting on the knee translates into improved muscle and joint function.

Studies show that tiny receptors in the joint complex register position and movement. When these mechanoreceptors are damaged during surgery, recovery takes longer. Over time, anything that alters the normal biomechanics of the joint can lead to disability and even a second surgery. The cost of either is greater than the added expense of computer technology.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Is minimally invasive surgery something new?

August 10th — admin

I have a unicompartmental knee replacement in the left knee. The operation was done with an open incision. Now I need the same operation on the right knee. But a different surgeon is going to do it using a much smaller incision. Is this something new?

More and more surgeons are now using the minimally invasive surgery (MIS) for unicompartmental (one side) and total knee replacements (TKRs). This new technique has been made possible by advances in technology and surgical instruments.

The MIS method was actually developed for unicompartmental knee arthroplasty (UKA). It was later adapted for use with TKRs. With MIS, there is the obvious advantage of a smaller scar for the patient. But this also means less soft tissue and muscle is cut making rehab and recovery faster and easier.

Other advantages of the MIS are less blood loss, less pain, and lower costs. There are some concerns about the accuracy of implant position with a shorter incision. But improved computer navigation may offset this problem.

So far, several studies have shown no difference in the accuracy of implant alignment between these two surgical procedures. It’s likely that more and more surgeons will move from the traditional open incision method to the MIS method.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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How does one qualify for a partial knee replacement?

July 19th — admin

I’ve been told that younger, active patients with arthritis can have part of the joint replaced when uneven wear causes problems. How young do you have to be? I’m 62-years-old and not quite ready for a complete knee replacement. Am I too old for this operation?

The unicompartmental knee arthroplasty (UKA) has several advantages over a total knee replacement (TKR). As you mentioned, it is an acceptable alternative to TKR when only one side of the joint needs to be replaced.

UKA is less invasive and removes less bone compared to a TKR. Improved computer-assisted surgical methods and improved implant quality have made it possible for younger patients to benefit from the UKA.

The exact definition of younger has not been statistically determined. Each patient is evaluated by the orthopedic surgeon for this type of implant. Studies report surgeons are using the UKA in adults ages 47 to 83.

Older age is not as much of a challenge as younger age. The reason for this is concern over how many years of wear and tear the implant can handle. The average TKR lasts about 15 years. Older adults who have a TKR usually die before the knee wears out. The average life of the UKA is unknown. Mid- and long-term results of UKA are slowly trickling into the published literature.

Patients with UKA report their motion and feeling with the implant are more like a normal joint. Computer analysis shows knee joint biomechanics with a UKA are closer to a normal knee compared to the biomechanics provided by a TKR. That’s because the cruciate ligaments inside the joint are not cut or removed with a UKA (but they often are with a TKR).

At age 62, you may be a good candidate for a UKA. With increasing life expectancy for many adults, the UKA may give you added years of quality knee function. Then if you need to convert to a TKR later, it may be an available option.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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My knee replacement needs repair. Am I doing something wrong?

July 13th — admin

I’m going to have a second knee surgery on my right leg. The first operation was a total knee replacement. This one is to take out the tibial insert and replace it. This part of the joint has gotten worn clear through. Am I doing something wrong that has caused this problem?

Wear and tear on the plastic tibial and uneven wear patterns are not something a patient can avoid. Sometimes imbalance in the joint or soft tissue alignment cause the uneven wear pattern.

The asymmetrical pattern can affect different parts of the implant at the same time. This could include the front, back, and/or sides of the joint surface.

There may be scratches or wear patterns all the way through the implant. It sounds like this is what has happened to yours. Once your surgeon removes the insert, an examination of the wear pattern may help show what is the problem.

Location, type, and depth of wear pattern will be observed. This kind of information is helpful for surgeons and scientists who are trying to improve TKR implant design and results.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Why is my total hip replacement incision so long?

May 15th — admin

I just had a total hip replacement last month. I was pretty dismayed when I saw how long the incision is–about 12 inches. I thought they could do this operation with a tiny opening now.

The standard opening for hip joint replacement is still between five and 10 inches. Not all surgeons use the mini-incision for this operation. Some patients are too large for the mini-approach.

Sometimes the skin is too tight and a longer incision is needed. In other cases, the surgeon needs to see more of the joint so a bigger opening is needed.

Chances are you got the standard incision if you didn’t ask for a small incision before the operation. If you ever have the other hip replaced, be sure and talk with your surgeon about this option.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Why does my total knee replacement still hurt?

May 4th — admin

I’m a 46-year old woman with a knee problem. Last year I had a total knee replacement for severe osteoarthritis of my left knee. This year, I have pain and stiffness — a very disappointing result. I thought my younger age would be to my advantage. What went wrong?

There are many, many possible reasons for a failed joint replacement. Studies show that poor motion before the operation has a strong link with poor motion afterwards. Younger women actually do have poorer results compared with other ages and gender.

Even the patient’s personality has been identified as a possible contributing factor. Patient’s who do not tolerate pain well and especially those who do not follow the rehab program have increased rates of knee stiffness after a total knee replacement (TKR).

There may even be a genetic basis for your poor results. Tissue sampling and analysis has shown chemical changes during the healing phase in patients who end up with stiff joints. The body doesn’t clear the joint of inflammatory cells. There’s a build-up of too much protein called reactive oxygen and nitrogen species (RONS).

Scientists are studying ways to prevent this build-up as well as stiffness from other causes as well. There’s still hope for you now with continued rehab. Your age is in your favor there. It may take longer and may require persistence on your part, but restoration of normal to near normal motion is possible.

If you have already done all this, then an operation to manipulate the joint and break the scar or fibrosis holding the joint may be needed. If that doesn’t work, then a second or revision operation can be done. Your surgeon will be able to advise you what treatment might work best for your situation.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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What is baja of the kneecap?

May 2nd — admin

What is baja of the kneecap? My surgeon has identified this as the main reason my total knee replacement is so stiff.

Patellar baja refers to the position of the patella or kneecap. In patellar baja, the kneecap rides down low over the femur (thigh bone).

This can just be the way you were born. More often it occurs as a result of the patellar tendon shortening after surgery or injury. Either way, a patellar tendon that is too-short can pull the patella downwards.

A recent study of stiff knees after total knee replacement (TKR) identified patellar baja as a possible cause. Women were at higher risk of patellar baja. Younger age was also a factor but age was linked with joint stiffness after TKR, not the patellar baja.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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