Chrondroitin sulphate and glucosamine are naturally occurring substances in the body that prevent degradation of cartilage and promote formation of new cartilage. Chrondroitin sulphate and glucosamine obtained from animal sources are available as over the counter products for arthritis. Apart from these various other nutritional supplements are also available such as calcium with magnesium and vitamin D as a combination, S-Adenosyl-Methionine and Methylsulfonylmethane.

These injections of steroids are given directly into the affected joint for severe pain when use of NSAIDs does not bring much relief. Steroids are very strong anti-inflammatory drugs and if used orally cause various side effects on other body systems. Local analgesics that prevent the sensation of pain are sometimes given along with steroids in the same shot to bring relief quickly.

Anti-rhuematic drugs include nonsteroidal anti-inflammatory drugs (NSAIDs), disease modifying anti-rheumatic drugs (DMARDs) and biologic agents. NSAIDs are anti-inflammatory agents that are devoid of steroidal components but effective in relieving the pain & inflammation. They are available in the form of pills, liquids and topical creams and are recommended to relieve arthritic pain. They are available as both over the counter drugs and prescription drugs.

Disease modifying anti-rheumatic drugs (DMARDs) considered as first line of agents for arthritis and these drugs retard the progression of joint damage. Biological agents are the antibodies developed using genetic engineering technology and they destroy the inflammatory agents causing arthritis.

Makoplasty® Robotic Knee Replacement

MAKOplasty® Partial Knee Resurfacing for Knee Osteoarthritis

The Procedure

MAKOplasty® Partial Knee Resurfacing is an innovative treatment option for adults living with early to midstage osteoarthritis (OA) in either the medial (inner), patellofemoral (top), or both compartments of the knee. It is powered by the RIO® Robotic Arm Interactive Orthopedic System, which allows for consistently reproducible precision in performing partial knee resurfacing.

The RIO® System empowers surgeons and hospitals to address the needs of a large and growing, yet currently underserved patient population. Patients who desire a restoration of lifestyle, minimized surgery, reduced pain and rapid recovery may benefit from MAKOplasty®.

During the procedure, the diseased portion of the knee is resurfaced, sparing the patient’s healthy bone and surrounding tissue. An implant is then secured in the joint to allow the knee to move smoothly again. MAKOplasty® Partial Knee Resurfacing can:

As a knee arthroplasty procedure, MAKOplasty® is typically covered by most Medicare-approved and private health insurers.

Dr. Elvis Grandic performing first robotic knee surgery in Palm Beach County Florida.

Robotic Arm Interactive Orthopedic System (RIO®)

The RIO® Robotic Arm Interactive Orthopedic System features three dimensional pre-surgical planning. During surgery, the RIO® provides the surgeon with real-time visual, tactile and auditory feedback to facilitate optimal joint resurfacing and implant positioning. It is this optimal placement that can result in more natural knee motion following surgery.

RIO® Features:

A knee replacement surgery is the last resort to relieve pain and restore function in knee damaged by arthritis or an injury when non-surgical treatments do not relieve the condition. The procedure involves replacing the damaged surfaces of the articulating bones with the artificial implant. Most of these implants wear with use. Thus the risk of need for revision surgery is high in young and active people if the implant has to last the lifetime of the patient. The life of the implant can be extended by precise alignment of the implant and this can be achieved by the use of computer navigation for total knee replacement surgery.

Computer navigation provides the surgeon with the real time 3-D images of the mapped patient’s knee and the surgical instruments during surgery. The data for the images is provided by the infrared sensors fixed to the bones of the knee and the surgical instruments. Their position is tracked by an infrared camera placed above the surgical table connected to the computer. The computer than generates the real time images with the help of the appropriate software to  guide the surgeon to precisely resurface and cut the bones of the knee and fix the implant precisely & accurately according to the pre-operative surgical plan. Thus the surgery is done by the surgeon only. Computer navigation is just a tool to guide the surgeon and improve the outcome of the surgery. It cannot replace the skills of an experienced surgeon.

Knee replacements are preformed through an incision on the front of the knee. There are some different ways to handle the soft tissue and extensor mechanism of the knee which are discussed below. Each approach has advantages and disadvantages.

Knee Replacement Approach Types

Medial Parapatellar Approach
A medial parapatellar incision involves cutting the quadriceps tendon above the knee cap (patella) and around the inside (medial) of the knee cap. The tendon is then repaired at the end of the procedure. The idea behind cutting the tendon is that the tendon might heal better than cutting into the muscle belly of the VMO. The patella is typically flipped during this approach to gain access to the knee joint which may or may not affect the knee rehab in the short term.

Mid-Vastus Approach
A mid-vastus approach does not cut the quadriceps tendon but instead cuts into the VMO muscle belly and around the inside of the knee cap. The idea behind leaving a large portion of the VMO attached to the quadriceps is that the VMO muscle may help patellar tracking and knee extension strength. The muscle belly is repaired at the end of the procedure. The patella may or may not be flipped during this approach.

Sub-Vastus Approach
The sub-vastus approach elevates the VMO muscle instead of cutting into it. The incision then extends around the inside of the knee cap. The patella is typically not flipped with this approach. This approach is difficult in muscular patients with large VMO muscles and generally makes the operation a little harder. Theoretically, the patella tracking and quadriceps muscle strength may be temporarily improved with this approach in the short term, but there are no long term differences months later.

Quad-Sparing Approach
The quad-sparing approach cuts just the inside of the knee cap. This approach requires special side cutting instruments. There is definitely a steep learning curve regarding the use of these instruments and many physicians (including myself) worry about the accuracy of the bone cuts and limb alignment with these side cutting instruments. This approach has received some press, but has not caught on among orthopedic surgeons.

Lateral parapatellar Approach
The lateral parapatellar approach is a uncommon approach where the incision extends around the outside (lateral) of the knee cap. Some surgeons will use this approach for severe valgus deformities.

Good results after a total knee replacement can be achieved with any of the above approaches. Patients should allow the surgeon to perform the approach the surgeon is most comfortable with.

Knee Anatomy

The knee is made up of four bones. The femur or thighbone is the bone connecting the hip to the knee. The tibia or shinbone connects the knee to the ankle. The patella (kneecap) is the small bone in front of the knee and rides on the knee joint as the knee bends. The fibula is a shorter and thinner bone running parallel to the tibia on its outside. The joint acts like a hinge but with some rotation.

The knee is a synovial joint, which means it is lined by synovium. The synovium produces fluid lubricating and nourishing the inside of the joint. Articular cartilage is the smooth surfaces at the end of the femur and tibia. It is the damage to this surface which causes arthritis.

Why does a knee need to be revised?

Surgical procedure

It will be explained to you prior to surgery what is likely to be done but in revision surgery the unexpected can happen and good planning can prevent most potential problems. The surgery is often, but not always, more extensive than your previous surgery and the complications similar but more frequent than the first operation.

The surgery varies from a simple liner exchange to changing one or all of the components. Extra bone (cadaver bone) may need to be used to make up for any bone loss.

Risks and Complications

As with any major surgery there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery takes place. Complications can be medical (general) or local complications specific to the knee.

iTotal® Customized Knee Replacement System

The ConforMis iTotal® CR is an individualized patient specific implant for replacement of all the three compartments of the knee. It is thus most appropriate for patients with knee arthritis and knee damage requiring implant for not one or two but all the three compartments of the knee. It is designed specifically to match the natural shape of the articulating surfaces of the patient’s knee. This is done by mapping the articulating surfaces of the femur and tibia using the data from the CT scan of the patient’s knee. It also comes with disposable patient specific iJig instrumentation with built-in image guidance which simplifies the surgical procedure and improves the outcome.

The several advantages of this patient specific or iTotal customized total knee replacement implants over the regular traditional implants are:

Indications For Use

The iTotal CR implant require the use of bone cement for fixation.

Although iTotal Customized total knee replacement systems are recommended in various conditions, they are not appropriate in patients with:

 

 

(Unicondylar) knee replacement simply means that only a part of the knee joint is replaced (i.e. Partial Knee) through a smaller incision than would normally be used for a total knee replacement. Unicondylar knee replacements have been performed since the early 1970's with mixed success. Over the last 25 years implant design, instrumentation and surgical techniques have improved markedly making it a very successful procedure for unicompartmental arthritis. Recent advances allow us to perform this through smaller incisions and therefore the procedure is not as traumatic to the knee making recovery quicker.

Advantages & Disadvantages of Partial Knee Surgery

Conservative Treatment Prior To Surgery

Prior to surgery you will usually have tried some conservative treatments such as simple analgesics, weight loss, anti-inflammatory medications, modification of your activities, canes or physical therapy.

Advantages

Disadvantages

Candidates For Partial Knee Replacement

Who Is Suitable?

Who Is Not?

Pre-Operative Checklist

Below is a list of items that will be completed before surgery.

Day of Surgery

The list below is an outline of your day of surgery and things that will occur on that day.

Surgical Procedure

Post-Operation Care

Risks And Complications

As with any major surgery, there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages.

It is important that you are informed of these risks before the surgery takes place.

Complications can be medical (general) or local complications specific to the Knee.

Summary

Surgery is not a pleasant prospect for anyone, but for some people with arthritis, it could mean the difference between leading a normal life or putting up with a debilitating condition. Surgery can be regarded as part of your treatment plan it may help to restore function to your damaged joints as well as relieve pain.

Surgery is only offered once non-operative treatment has failed. It is an important decision to make and ultimately it is an informed decision between you, your surgeon, family and medical practitioner.

Although most people are extremely happy with their new knee, complications can occur and you must be aware of these prior to making a decision. If you are undecided, it is best to wait until you are sure this is the procedure for you.

Introduction

A Total Knee Replacement (TKR) or Total Knee Arthroplasty is a surgery that replaces an arthritic knee joint with artificial metal or plastic replacement parts called the ‘prostheses'. The procedure is usually recommended for older patients who suffer from pain and loss of function from arthritis and have failed results from other conservative methods of therapy. The typical knee replacement replaces the ends of the femur (thigh bone) and tibia (shin bone) with plastic inserted between them and usually the patella (knee cap).

Causes or Reasons for a Total Knee Replacement

In an Arthritic Knee

The combinations of these factors make the arthritic knee stiff and limit activities due to pain or fatigue.

The diagnosis of osteoarthritis is made on history, physical examination; X-rays. There is no blood test to diagnose Osteoarthritis (wear; tear arthritis).

Benefits of Total Knee Replacement 

The decision to proceed with TKR surgery is a cooperative one between you, your surgeon, family and your local doctor.

The benefits following surgery are relief of symptoms of arthritis. These include:

Conservative Treatment Before Surgery

Prior to surgery you will usually have tried some conservative treatments such as simple analgesics, weight loss, anti-inflammatory medications, modification of your activities, canes, or physical therapy. Once these have failed it is time to consider surgery. Most patients who have TKR are between 60 to 80 years, but each patient is assessed individually and patients as young as 20 or old as 90 are occasionally operated on with good results.

Pre-Operative

The below items will be completed before surgery.

Check out our full Pre-operative instructions here.

Day of your surgery

Below is a list of what to expect on the day of surgery.

Surgical Procedure

Each knee is individual and knee replacements take this into account by having different sizes for your knee. If there is more than the usual amount of bone loss, sometimes extra pieces of metal or bone are added.

Surgery is performed under sterile conditions in the operating room under spinal or general anesthesia. You will be on your back and a tourniquet applied to your upper thigh to reduce blood loss. Surgery takes approximately two hours.

The surgeon cuts down to the bone to expose the bones of the knee joint.

The damaged portions of the femur and tibia are then cut at the appropriate angles using specialized jigs. Trial components are then inserted to check the accuracy of these cuts and determine the thickness of plastic required to place in between these two components. The patella (knee cap) may be replaced depending on a number of factors and depending on the surgeon's choice.

The real components are then inserted with or without cement and the knee is again checked to make sure things are working properly. The knee is then carefully closed and drains usually inserted, and the knee dressed and bandaged.

Post-Operation

When you wake, you will be in the recovery room with intravenous drips in your arm, a tube (catheter) in your bladder and a number of other monitors to check your vital observations. You will usually have a button to press for pain medication through a machine called a PCA machine (Patient Controlled Analgesia).Once stable, you will be taken to the ward. The post-op protocol is surgeon dependant, but in general your drain will come out at 24 hours and you will sit out of bed and start moving you knee and walking on it within a day or two of surgery. The dressing will be reduced usually on the 2nd post op day to make movement easier. Your rehabilitation and mobilization will be supervised by a physical therapist.

To avoid lung congestion, it is important to breathe deeply and cough up any phlegm you may have.

Your Orthopaedic Surgeon will use one or more measures to minimize blood clots in your legs, such as inflatable leg coverings, stockings and injections into your abdomen to thin the blood clots or DVT's, which will be discussed in detail in the complications section.

A lot of the long term results of knee replacements depend on how much work you put into it following your operation.

Usually, you will remain in the hospital for 5-7 days. Then, depending on your needs, either return home or proceed to a rehabilitation facility. You will need physical therapy on your knee following surgery.

You will be discharged on a walker or crutches and usually progress to a cane at six weeks.

Your sutures are sometimes dissolvable but if not, are removed at approximately 10 days.

Bending your knee is variable, but by 6 weeks should bend to 90 degrees. The goal is to obtain 110-115 degrees of movement.

Once the wound is healed, you may shower. You can drive at about 6 weeks, once you have regained control of your leg. You should be walking reasonably comfortably by 6 weeks.

More physical activities, such as sports previously discussed, may take 3 months to do comfortably.

When you go home you need to take special precautions around the house to make sure it is safe. You may need rails in your bathroom or to modify your sleeping arrangements, especially if they are up a lot of stairs.

You will usually have a 6 week check up with your surgeon who will assess your progress. You should continue to see your surgeon for the rest of your life to check your knee and take X-rays. This is important as sometimes your knee can feel excellent but there can be a problem only recognized on X-ray.

You are always at risk of infections especially with any dental work or other surgical procedures where germs (Bacteria) can get into the blood stream and find their way to your knee.

If you ever have any unexplained pain, swelling or redness or if you feel generally poor, you should see your doctor as soon as possible.

Risks and Complications

As with any major surgery, there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages.

It is important that you are informed of these risks before the surgery takes place.

Complications can be medical (general) or local complications specific to the Knee.

For more information about the Risks and Complications with Knee surgery click here

Summary

Surgery is not a pleasant prospect for anyone, but for some people with arthritis, it could mean the difference between leading a normal life or putting up with a debilitating condition. Surgery can be regarded as part of your treatment plan—it may help to restore function to your damaged joints as well as relieve pain.TKR is one of the most successful operations available today. It is an excellent procedure to improve the quality of life, take away pain and improve function. In general 90-95% of knee replacements survive 15 years, depending on age and activity level.

Surgery is only offered once non-operative treatment has failed. It is an important decision to make and ultimately it is an informed decision between you, your surgeon, family and medical practitioner.

Although most people are extremely happy with their new knee, complications can occur and you must be aware of these prior to making a decision. If you are undecided, it is best to wait until you are sure this is the procedure for you.

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Whether it’s post-injury help or consultation about your first symptoms, our orthopedic doctors provide total management of patient care. Contact us find out more about OSA, our doctors, and our facilities, or to get started as a patient.

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