Advanced Knee Care

Knee Surgeon and Specialist Stefan D. Tarlow, M.D.

Cementless Mako Total Knee

By

Porous Coating allows for cementless fixation

Stryker’s Joint Replacement division today announced that its cementless Mako Total Knee with Triathlon Tritanium has received  market clearance by the U.S. Food and Drug Administration for Q4 2017.

Triathlon Tritanium combines Triathlon knee implant with the latest in highly porous biologic fixation technology for a knee system that holds the promise of improved fixation and longevity in younger and obese total knee replacement patients.  The innovation of Tritanium’s tibial baseplate and metal-backed patella components allow the components to be implanted without bone cement.  Bone cement loosening is one of the mechanisms of failure of artificial knees.  The though is that if one eliminates the bone cement the implant can potentially last longer.

Cementless procedures rising in popularity and becoming a fast-growing trend, especially in the under 50 year old patient.  Coupling robotics and cementless fixation solution allows orthopaedic surgeons to be more precise in the bone preparation which could increase the success of cementless total knee replacement.

If you are under 50 or have a high BMI this cementless Mako Total Knee is a procedure you should give serious consideration.  The combination of robotic surgery and ingrowth fixation is the latest advancement of total knee replacement technology.

How To Achieve The Perfect Total Knee Replacement

By

The perfect total knee is known as “the forgotten knee”.  Patients with a forgotten artificial knee state that the artificial knee always feel normal in daily activities.  This occurs approximately 66 % of the time, according to French surgeons.

Gender, age, body mass index, and preoperative pain were not predictive of outcome.

Inability to fully straighten the replaced knee, preoperative anterior or popliteal knee pain, patellar maltracking, and the diagnosis of psychological depression are associated with an abnormally feeling total knee replacement.

Better or improved knee flexion (bend) is predictive of a naturally feeling knee.

Both the patient and the surgeon have some influence on surgical outcome.  The ability to straighten the knee is often dependent on strict adherence to a post operative rehabilitation protocol (patient controlled factor).  Better pre-operative knee flexion is associated with more post operative knee bend (surgeon selection of patient for surgical treatment).

Return to Sport and Reinjury After ACL Reconstruction in Young Athletes

By

ACL surgery is common in high school and adolescent athletes.  Many return to sport at an average of 10 months after surgery.

The most common grafts used in this age group are hamstring and patellar tendon autografts (from the patient-not cadaver).

91 % of athletes returned to sports at an average of 10 months.  The 9 % that did not return were physically able to return but made a decision not to risk reinjury to either knee.

19 % of the patients re-tore the ACL in the same knee and 13 % of patients re-tore the ACL in the opposite knee.  The prevalence of a second ACL tear was 32 %.  The data in this study showed an earlier return to sport in this age group increased the likelihood of ACL re-tear (either knee).

We still have a lot to learn about young athletes and ACL tear.  Two things are certain.  The re-tear rate for each knee is high and early return to sport is a risk factor for repeat ACL tear.

Opioids and Total Knee Replacement – Preoperative Use Detrimental

By

Most patients with advanced arthritis of the knee do not use strong pain pills in the year prior to knee replacement surgery.  America has an opioid epidemic with many accidental deaths and social problems linked to use of this class of drug.  Most of this use can be traced to the abuse of doctor prescribed hydrocodone and oxycodone.

A report published in the Journal of Bone and Joint Surgery calls to our attention an orthopedic concern in people using opioids in the 2 year period prior to Total Knee Replacement surgery. Specifically, the chronic opioid group obtain less pain relief from the joint replacement surgery.  This group of patients had lower satisfaction scores and a greater number of patients in the opioid group had additional knee surgeries for pain and stiffness.

In summary, patients that are on opioids for an extended period of time prior to their joint replacement are at a greater likelihood of having a surgical failure.

Patient Satisfaction Quite High for Unicompartmental Knee Replacement (Makoplasty)

By

An article published in the Journal of Arthroplasty compares patient satisfaction rates at 2 years after surgery for both Total Knee Replacement and Unicompartmental Knee Replacement (also termed Makoplasty or partial knee replacement).

This study confirmed that Unicompartmental Knee Replacement patients have higher satisfaction scores (86 % vs 71 %) than Total Knee Replacement patients.  The reasons for this include better range of motion, more natural feeling knee, less stiffness, and less serious complications for patients receiving a Unicompartmental Knee Replacement.  Additionally, Total Knee Replacement is a more invasive surgery with longer healing times.

For many patients there can be a choice between which type of knee replacement you can have.  Make a thoughtful decision based on your specific clinical information and discuss the options with your surgeon.  Choose wisely.

Minimally Invasive Total Knee Replacement

By

minimally invasive TKR

One of the most common orthopedic procedures is total knee replacement. This minimally invasive procedure is also known as arthroplasty. It is used to replace worn or damaged surfaces of the knees. Basically, an implant is placed as a replacement for the knee surfaces to increase mobility, relieve pain and help the patient return to his/her normal everyday activities.

Minimally Invasive vs. Traditional Approach

The main goal of total knee replacement procedure is to relieve the pain, restore the health and function of the, and to eventually help the patient return to daily activities. In this procedure, the damaged bone and cartilage are removed from the surface of the knee and replaced with artificial ones.

The traditional approach involves full surgery. It takes longer and leaves a long vertical incision in the center of the operated. Now minimally invasive knee replacement is gaining more popularity over the traditional approach. This is because, as the term suggests, the technique is less-invasive and faster. I also uses a shorter incision; hence, speeding recovery and reducing postoperative complications.

While both traditional and minimally invasive total knee replacement have more or less the same results; minimally invasive promises a faster recovery and lesser risk for complications. The only problem is that unlike traditional approach, minimally invasive procedure is not for everyone. You need to discuss with your surgeon first if you are a good candidate for the said procedure.

Minimally Invasive Knee Replacement

In minimally invasive TKR, the artificial implants used are the same as the ones used in traditional approach. However, the surgical instruments used for the removal of the damaged cartilage and bones and for the placement of the implants are different and more specialized. This is because in minimally invasive procedure, the incision is shorter, about 4 to 6 inches only, compared to the 10-inch incision in traditional surgery. This means less tissue disturbance and faster recovery. Additionally, the technique used in opening the knee is also less invasive, avoiding trauma and reducing risk for infection and other complications.

Among the benefits of minimally invasive knee replacement procedure are quicker and less painful recovery, rapid return to normal daily activities and lesser damage to soft tissues. It also means less stay at the hospital.

As already mentioned, not all people are a good candidate to undergo minimally invasive total knee replacement. If you wish to know if you are a candidate or not, and if you wish to know more about minimally invasive knee replacement; contact an orthopedic surgeon. Make an appointment with Dr. Tarlow today.

Kneecap Replacement Surgery Recovery Time

By

Kneecap Replacement Surgery Recovery Time

The recovery time of kneecap replacement surgery depends on what type of procedure was performed, the quality of the knee surgeon and on the health and age of the individual having the surgery. However, to speed up your recovery, it is important that you follow the advice of your surgeon after the surgery. Much depends on how you take care of yourself with regards to how soon you will be able to be up and running.

How Soon Will You Be Able to Be Up and About?

If you have undergone a minimally invasive kneecap replacement surgery, you will be able to stand up and walk on the very same day of your operation. The staff or nurse will help you stand and assist you in walking within the first 12 to 24 hours after the operation. During this time, it is highly encouraged that you use crutches or a frame when walking. In most cases, people will be able to walk independently, supported by a stick or cane, after just about a week.

While you are still staying in the hospital, you will be taught certain exercises that help strengthen your knee. You can begin doing these minimal and safe exercises the day after the operation. It is important that you only follow the advice of the medical professional.

It is normal to feel and experience discomfort when walking and exercising during the first few days. Other people also experience swelling in their feet and legs. If there is swelling, it is advised that you raise your legs to improve circulation. You may also be put on a motion machine while you are in bend to restore movement in your knee and legs.

Recovery At Home

You will only stay in the hospital, generally, for three to five days. This depends on how you progress and the type of kneecap replacement you underwent, whether it was traditional surgery or minimally invasive. Half-knee replacement and minimally invasive procedures usually require shorter hospital stay. Others even get discharged within the first three days after the operation, of course, upon the advice of your doctor.

When you are at home, take time to rest. It is normal to experience discomfort and tiredness. That is a normal aftermath of a surgery. Just follow the advice of your surgical team and other medical professionals that had a hand in your surgery. To speed up your recovery at home, avoid the things that the professionals asked you to avoid and continue exercising. It is better if you have someone who will assist you in your recovery at home for your safety. Just eat healthy and take care of yourself and you’ll recover quickly.

How Long Till You Feel Normal

You can do away with the crutches, frame or stick after six weeks. By this time, you can now resume your normal leisure activities. However, in some instances, the swelling continues up to three months. But this will generally not affect your movement and daily activities. Just avoid extreme sports and strenuous movements until you have fully recovered.

If you wish to know more about kneecap replacement surgery or if you are planning to undergo such procedure, make sure that you only contact a knees-only orthopedic surgeon like Dr. Tarlow. Contact us today to schedule your appointment.

Knee Cartilage Damage Exercises

By

knee cartilage damage exercises

Your knee cartilage plays a vital role to the knee and other joints. It serves a natural cushion so that the joints won’t rub together. However, knee cartilage can get damaged due to injury or caused by certain medical conditions. The most common knee cartilage issue is torn meniscus. Another common cause of cartilage damage is osteoarthritis. Fortunately, there are now medical treatments for knee cartilage injuries.

Knee exercises also play an important role in treating cartilage damage. Such exercises help in restoring the strength and motion of the knees. Of course, follow the exercise under the supervision and advice of your knee physician or professional. The following are some of the simple but effective exercises you can do at home or at the gym:

  • Flex and Extend

The common effect of cartilage damage is swelling around the knee joint. Flex and extend exercises help reduce the swelling and alleviate the symptom associated with it. Such exercises also help you restore the full mobility of your joint once the swelling has subsided. To do this exercise, you need to sit down on a chair and make sure that your feet don’t touch the ground. Then start bending your knees gently and slowly extend them to their fullest. Repeat this motion for 10 to 20 times a day. Adjust the repetition and ease up the movement if you feel pain.

  • Heel Slide

This type of exercise strengthens the thigh muscles and the knee. To perform this, you need to lie down with your knee bent, your feet touching the floor. Slowly slide your heel towards your buttocks and gradually slide it back to its original position. However, it is important not to overdo this exercise especially during the healing period of your injury. You just have to increase the repetition gradually as you slowly regain your strength and mobility.

  • Immobile Extension

It is painful to straighten out your legs completely if you have torn knee cartilage. This helps address such issue. The first thing to do is to sit on a chair with a small low stool placed adjacent to it. Rest your heel comfortably on this stool while you sit on the chair. Place a rolled-up towel underneath the heel and straighten your leg as far as you can. Make sure that you don’t push it too hard. Only straighten it as you can tolerate. Do this for a few minutes and slowly increase the minutes up to 15 when it is no longer that painful.

  • Calf Stretches

You can also try calf stretches. This exercise aids in the rehabilitation of the knee by strengthening the calves and the hamstrings, which support the knee. In this exercise, you will have to stand facing the wall, keeping a distance. Bend one leg on the front straighten the other at the back. Hold this position for around 30 seconds and do it the other way.

Remember that exercises are not treatment in themselves. They merely help with the whole treatment process. It is important that you get medical attendance for your knee cartilage damage. Approach a knee specialist to get your problem treated. Contact Dr. Tarlow today to schedule an appointment.

SaveSave

Warning Signs That You May Need Knee Replacement Surgery

By

Signs You Need Knee Surgery

This past year, there have been more than 600,000 total knee replacements performed by surgeons in the United States alone. And this number is expected to continually rise for the years to come. This says that despite the long rehabilitation and recovery process of the procedure, more and more people trust the effectiveness and benefit of the knee replacement surgery. But when do you know that you may already need to undergo knee replacement surgery? The answer is both personal and practical.

Sometimes, people wait for things to become unbearable and too much before they decide to get knee replacement surgery. Well, this is more or less a normal response because surgery is a big deal to most people. People prefer minimally invasive and other non-surgical options to treat their knee problem. But there are cases where the only and best option left is to undergo total or partial knee replacement. And there are warning signs for this.

Signs You Need Knee Surgery

  • Severe pain in the knee and the surrounding area, which already affects your daily activities.
  • Knee pain is still present even when you are resting, feeling moderate to severe pain day or night.
  • Knee swelling and inflammation that no longer respond to medications.
  • Knee stiffness.
  • Bowing out of the leg.
  • Taking NSAIDs no longer provide relief for the pain.

If you feel and experience these warning signs, immediately go to the surgeon and ask for an advice. Chances are, it is high time that you undergo knee replacement surgery before things get from bad to worse.

These are serious signs. These signify that you must not delay because things are surely starting to get worse. The best warning that you must really heed is when the surgeon himself has advised you to undergo surgery as soon as possible. If you don’t heed such warning signs, you may suffer from any of these repercussions.

  • Weakened muscles and ligaments in the knee.
  • Deformities of the area outside the knee joints.
  • Limited mobility due to loss of functionality and chronic pain.
  • Continued degeneration of the knee joints which leads to various complications.
  • Reduced success rate of surgery in the future.

There is no hard and fast rule as t when you should need knee replacement surgery. The best advice is that coming from a reliable, experienced surgeon. Factors like medical conditions, age, weight and lifestyle also play a vital role on whether you should undergo knee replacement or not, or when.

Contact a Surgeon

But if you already suffer from any of the mentioned warning signs, the best thing to do is not to delay. Immediately seek help from a qualified professional. If you decide to get a Makoplasty knee replacement surgery, don’t hesitate to come straight to TarlowKnee. We provide advanced knee care in Arizona.

Contact us to schedule an appointment.

ACL Surgery Technique Determines Successful Return to Activity

By

​

Anterior Cruciate Ligament Surgery Technique Determines Success in ​Return to Activity for Athletes

Performing the surgery in a Technically correct manner gives my patients the best chance for a well functioning knee after ACL injury.   The transition from Transtibial to Anatomic Femoral tunnel drilling started approximately 2008 and by 2013 most surgeons had evolved.  Patients that had ACL reconstruction prior to 2008 may be candidates for revision ACL surgery.   In 2017 most, but not all ACL surgeons are proficient in the Anatomic Tunnel technique.   Outcomes after ACL reconstruction are highly dependent on precisely how the surgery is performed.  This blog post is a bit more technical than my average post.  This is intended for the lay person who wants to learn about the technical nuances of acl reconstruction of the knee.​

The surgical technique used during ACL reconstruction varies widely not only from country to country but even within departments of the same hospital. Surgeons choose from arthroscopic vs open surgery, intra vs extra-articular reconstruction, graft choice, single vs double bundle method and graft fixation.  However, all these issue are of secondary importance to FEMORAL TUNNEL and TIBIAL TUNNEL location.  An anatomic Femoral Tunnel location created by drilling through an accessory medial arthroscopic portal creates the femoral tunnel in the ideal location.  The success of your ACL surgery is most dependent on this tunnel placement.  Tibial tunnel placement is also important and should not be placed too far posterior.  ACL tunnels that vary outside of these known landmarks result in limited knee motion (tight knee), graft failure by rupture, and graft failure by recurrent instability (even when graft appears “intact” on post op MRI).  The explanation for this failure is that the anatomical approach brings the tunnel layouts to a more horizontal position, which is biomechanically better  (studies have shown it provides better stability to both anterior-posterior and the internal rotational).
 
 Anatomic ACL reconstruction will increase result in better outcomes of  in short and the long term for injured athletes.
 
Femoral tunnels created by a transtibial approach will cause the ACL graft to spread outside of the natural adhesion areas and lead to abnormal knee kinematics Anatomic tunnel surgery technique provides better relocation of the graft in terms of kinematics of the knee. Therefore, this technique combined with good rehabilitation has better activity outcomes in terms of sport and regular life compared to the transtibial technique.
A clinical study concluded that the use of the anatomic replacement of the ACL resulted in greater knee stability and range of motion values and an earlier return to running compared to the transtibial technique.

© 2024   |   ALL RIGHTS RESERVED. ADVANCED KNEE CARE, STEFAN D. TARLOW, M.D.