Advanced Knee Care

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

Minimally Invasive Total Knee Replacement

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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.

Total Knee Replacement Revision

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Total Knee Replacement

Despite the success of Total Knee Replacement, it can still fail over time due to various reasons. The most common are the following: wearing out of the replacement artificial joint, dislocation, and fracture. When any of these occur, your knee may become swollen, stiff, unstable and painful. If this happens to you, you may need to undergo a Total Knee Replacement Revision.

Revision of Total Knee Replacement

Basically, Total Knee Replacement revision is a second surgery. This is recommended when the knee replacement fails for some reason. In this surgery, the doctor will remove, either totally or partially, the prosthesis or artificial joint and replace them with new ones.

In the first total knee replacement, the knee joint is replaced with an artificial one, an implant also known as prosthesis. Such is made of plastic and metal components. If these fail, they will be replaced with new ones during the revision procedure. This is so because the implant may loosen or wear out over time and due to other factors.

Different types of revision surgery are available. In some cases, the whole implant is removed and replaced; while in others, only its parts are replaced. The artificial joint or prosthesis has three main components: femoral, patellar and tibial. They come with metal pieces which serve as substitute for the missing bone. All these may be replaced with new ones or only some, depending on the patient’s individual situation and condition.

Generally, the primary and revision Total Knee Replacement have the same goal; that is, to restore and improve function and to relieve pain. However, revision surgery is a more complex procedure. It requires specialized implants, extensive planning and longer procedure. But the result is still the same or even better.

Commonly Identified Benefits of Total Knee Revision

The revision procedure generally has the same benefits as the primary Total Knee Revision. But studies show that majority of patients who have undergone revision surgery experienced long-term outcomes. Some of these benefits are the following:

  • Increased function and stability.
  • More efficient pain relief.
  • Faster recovery period.
  • Regain of previous mobility.
  • Getting back to performing normal activities.

TKR Surgery Fact: Do Both Knees End Up Being Replaced?

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total knee replacement

Not all who have knee problems need to undergo knee replacement. Most of the time, only patients with severe destruction of the knee joint or osteoarthritis end up having their knee replaced. The procedure is medically known as Total Knee Replacement surgery. In this procedure, the defective knee will be replaced with an artificial one. The diseased or injured joint will be replaced with plastic and metal parts which function normally and last long enough for the patient to enjoy doing normal activities again.

Total Knee Replacement is a popular procedure not only for osteoarthritis patients, but also to those who have devastatingly injured their knee. Despite the success and innovativeness of this procedure, some people are still wary of its effects. Some patients are still concerned about the pros and cons of Total Knee Replacement.

But it is not only this that they are worried about. There are reports that say once you have undergone TKR on your one knee, you will likely undergo another procedure on your other knee. Patients raise concern that once you have had one knee replaced, there is a high chance that your other knee will need replacement too. So the question that needs to be answered is this: do both knees end up being replaced? Is this a fact or just a myth? Let us find out if there is any truth to this.

To answer the question, let us take a look into a particular study conducted on the subject. A population study spanning 40 years was conducted. This question was addressed to the TKR candidates: if you had one knee replaced, what are the chances that the other knee will also be replaced through Total Knee Replacement surgery? Based on the data studied, the general finding is this: there is 45% chance that the other knee will be replaced within 11 years after the first knee replacement. In the study, the data of 2,000 total knee patients, spanning from 1969 to 2008, were analyzed. The results show that out of the 2,000 patients who underwent one knee replacement, 809 had their other knee replaced within 11 years after the initial knee replacement procedure. In fact, most of the patients underwent the second knee replacement surgery within 10 years.

Now going back to the question, the answer is yes, it is a TKR surgery fact that both knees could end up being replaced. But this does not mean that TKR as a procedure is not working. It just goes to show that once one knee has encountered an injury or another problem that needs surgery; there is higher chance that the other knee will also encounter the same fate. Still, this does not take away the fact that TKR is an innovative and important procedure. And if you indeed end up having your other knee replaced too with an artificial one, you can still count on the procedure just as you had during the first surgery. As long as it is done right and by the right professional, there is really nothing to worry about.

If you wish to know more facts about Total Knee Surgery or if you need to consult anything about your knee problems or injury, contact Dr. Tarlow at Advanced Knee Care. Make an appointment with us and we will help you with your knee issues.

Sex Life after Knee Replacement

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tarlow knee sexual functionKnee problems such as osteoarthritis affect millions of Americans every year. Aside from this fact, many people are not that aware that there is a correlation between knee problem and sexual function. Based on a research presented at the annual meeting of American Academy of Orthopaedic Surgeons (AAOS), osteoarthritis of the knee limits sexual activity.

In a survey of Knee Replacement patients, several patients were observed. These patients have undergone knee replacement surgery two years prior. The results and findings of such survey were published in the Journal of Arthroplasty. Before knee replacement, 45% of the patients with knee arthritis said that before knee replacement, their sexual frequency and/or quality was limited. They cited knee pain and limited knee flexions as the major factors that make having sexual activity challenging. After they have undergone knee surgery, 72% of the patients said that they were no longer limited by the aforementioned factors. Postoperatively, patients were able to resume sexual activity at an average of 2 ½ months (ranging from 0-18 months) after the knee replacement operation.

In another study, patients under the age of 70 with a mean age of 57.7 years agreed to participate. The study required them to answer and fill out questionnaires prior their scheduled for primary total knee replacement. They were also asked again six months and then one year after surgery. Out of the 147 patients, 78 of which are women and 68 are men, 65% participated in and completed the three surveys. The result of said study contains the following findings and generalizations:

  • 67% of the patients reported physical problems and limitations regarding sexual activity prior to the surgery. The common problems include stiffness, pain, reduced libido and inability to attain proper sexual position.
  • 91% of the patients answered that they experienced psychological issues related to their knee problem or osteoarthritis. The issues include low sexual self image and diminished sense of general well-being.
  • 90% of the TKR patients reported that they experienced improved overall sexual function after the surgery. More women reported improvement more than men. 42% reported improvement in libido; 41% said that their intercourse frequency has increased; 41% also said that they have increased intercourse duration; 84% of the patients reported that their general well-being improvement; and 55% attested that their sexual self image developed. Only 16% of the patients said that the surgery did not significantly affected their sexual function, particularly due to fear that the replacement joint might get damaged.

Sexual function is also a vital part of one’s life. It is only justifiable to include sexuality and sexual activity in the evaluation of the outcome of total knee replacement and other knee surgery. Sexual experience is part of one’s overall health and lifestyle, which is why it is great to note that knee surgery has something to offer as regards one’s overall sexual function.

But there must be a balance between sexual function and taking care of the knee replacement. This is better discussed personally with your surgeon or knee professional. If you need to learn more about knee surgery or if you want to undergo the same, contact Tarlow Knee. Make an appointment with us today.

Total Knee Replacement Fact: Obesity Puts Patients at Risk

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obesity and total knee replacement

Much is said about Total Knee Replacement. While many agree that it is a perfectly safe procedure, there are those who say that the surgery can be risky. One of the most common factors that increase the risk for knee replacement is obesity. There is a circulating belief that people who are obese are not fit to undergo TKR. There is higher risk for complications for patients who are obese, they say. How true is this and if so, what are the possible serious complications? Let us find out.

Let us take a closer look into this study conducted by Mayo Clinic which was published in 2016. The study seeks to the address the following question: Is Total Knee Replacement a more risky procedure in patients with high body mass index (BMI)? Luckily, this was answered in the same study.

The study used and reviewed the data of 22,000 patients who underwent Total Knee Replacement. The average BMI of the patients is 31. Out of the 22,000 patients included in the study, 5,500 have a BMI above 35. Based on the results of the study, there was an increased rate of repeat knee surgery (including revision total knee replacement surgery) as well a striking increase of knee joint infection, a serious complications in the morbidly obese group (BMI 35-40).

Complications arose following the Total Knee Replacement among the patients belonging to this group. This answers the question as to the complications that obese patients might encounter after undergoing TKR.

However, in the same study, it has been noted that the risk for complication can be minimized by delaying surgery until obesity and other modifiable risk factors are reversed. While obese patients are at risk for complications when undergoing the procedure, the case is not totally hopeless. In fact, the case can be remedied and these patients can still continue with their treatment with less risk. The risks can be minimized through best practices. This calls for experienced and reliable professionals. If the surgeons employ best practices and proven strategies, they can maximize patient outcomes and surgical success, as well as minimize risk for serious complications among obese patients. In other words, the key to lowering or totally eliminating the risk for such patients during and following TKR is to have the procedure conducted only by trusted and proven professionals.

So if you are obese and you have knee problems, don’t consider yourself as a hopeless cause. You can still have your knee issue fixed without having to worry about serious complications following the knee replacement. As already said, it’s just a matter of employing best practices With the right preparation and right measures before, during a and after the procedure, you will have a successful TKR operation. To reiterate, the key to a successful surgery is a reliable, trustworthy and experienced surgeon.

If you are obese and are having doubts whether to continue with the procedure or not, give us a call. You do not have to look further to find the right surgeon who can ensure a successful, risk-free procedure. We know exactly what needs to be done and what’s appropriate for you and your condition. Our surgeon has the right experience, expertise, knowledge, practices and passion for this kind of procedure to work. Make an appointment with us today for a consultation.

Total Knee Replacement Myth Busters 2017

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Total knee myths photo

There are various reasons why patients opt for total knee replacement. The most common reason is that, to them, knee replacement shows a lot of promise in achieving a better lifestyle and better movement. They undergo this surgery in hopes of gaining a more active life. However, many of these patients go into surgery believing in “myths” regarding what awaits them after. Some patients look at knee replacement as the ultimate solution, while others see it as something to be avoided, if at all possible. In the eyes of the patients, there is a fine line between what’s true and what’s not.

Here is a list of several myths about total knee replacement:

  1. Exercise alone, without knee replacement, minimizes pain and maximize function.

This is a myth. In patients with end stage knee arthritis, exercise and therapy alone do not minimize knee pain nor maximize function. Exercise, therapy and optimized personal fitness must be combined with Total Knee Replacement surgery to achieve the highest functional improvement and maximum pain relief.

  1. New technologies improve patient-perceived surgery outcomes.

The fact is in the contrary. The truth is, new technologies like minimally invasive surgery incisions do not improve patient-perceived surgery outcomes.

  1. Advanced implant designs improve patient results.

This is another myth. Advanced implant designs include mobile bearing knees, single radius knees or high flex knees. There is no evidence that these will improve patient results.

  1. Cemented fixation of the implant is not reliable.

Another myth. Cemented fixation provides reliable and durable fixation. You can also opt for cement-less knee design. However, there is no sufficient data comparing cemented and cement-less fixation. But you can count on the durability and reliability of cemented fixation.

  1. TKR is painful.

With the help of modern-day technology and pain management, Total Knee Replacement is not painful. There are now innovative and effective measures to ensure that the patient does not feel pain during or after the surgery.

  1. TKR affects an active life negatively.

It does not. In fact, it helps promote a better lifestyle. Certain activities such as driving and walking will be much easier and comfortable after the surgery. However, you must still observe proper care and avoid contact sports.

  1. Knee replacement patients take a long time to recover.

Again, this is a myth. Full recovery can be expected just within six weeks. In fact, the patient can already do toilet activities independently in just 24-48 hours after the surgery. In three weeks’ time, the patient can already participate normally in basic outdoor activities.

  1. Knee replacement does not last very long.

Some say that it only lasts 10 years or even less. But this is another myth about TKR. Knee replacement can last a long time, even longer than 20 years. With recent advancements in technology, knee replacements now last longer and work more effectively than they used to twenty years ago.

  1. The newest technologies are nearly perfect.

Technologic advances in surgical technique are available. The benefits of computer assisted surgery, including computer navigation, robotics and patient specific instruments, remain uncertain at this time. These technologies improve prosthesis position but positive impact on pain and function remains undemonstrated.

If you wish to know the truth about Total Knee Replacement, the surest way is to talk to a reliable and experienced professional. Make an appointment with the only best orthopedic knee surgeon in Arizona.

 

Total Knee Replacements: An Overview

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Younger Patients Driving Increase in Total Knee Replacement Surgery

From 1997 to 2007, the number of total knee arthroplasty (TKA) procedures performed annually in the United States doubled, with much of the increase taking place in younger patients, according to a study presented at the 2011 AAOS Annual Meeting.  Data has shown that younger and healthier patients have better post-TKA outcomes, the indications for performing surgery have been expanded to include these patients.  Keep in mind that more surgery in younger patients drives up the cost of US Healthcare, but better outcomes in young people justify the increase in costs.  Treating severe knee disability increases the productivity of these working aged people and improves quality of life for 20-30 years.

During the study period, the overall U.S. adult population grew slightly (1.13-fold and the prevalence of obesity grew 1.12-fold). But the number of TKAs performed more than doubled—from 264,311 in 1997 to 549,707 in 2007. When researchers examined population growth, obesity rates, and number of TKAs performed by age group, they found the greatest growth in TKAs among those younger than age 65.

What is driving the increase?

Obesity and population size accounted for 22.6 percent of the approximately 100 percent increase in the number of TKAs performed,” said author Elena Losina, PhD, director of the Orthopaedic and Arthritis Center for Outcomes Research at Brigham and Women’s Hospital in Boston.

The rapid expansion of TKA utilization can not be fully explained by increases in population and obesity prevalence.

Other factors that may be driving the increase in TKA include an increasingly active population and expanded indications for surgery among a younger patient population.
Previous studies have linked sport-related knee injuries and increased physical activity in younger people to an increase in early-onset osteoarthritis. Therefore, active lifestyle increases may help explain why rising numbers of younger patients are receiving TKAs.

4 Million Total Knees Walking Around the U.S.

From March, 2013 Journal of Bone and Joint Surgery

In the last decade, the number of total knee replacements performed by Knee Surgeons annually in the United States has doubled, with disproportionate increases among younger adults. While total knee replacement is a highly effective treatment for end-stage knee osteoarthritis, total knee replacement recipients can experience persistent pain and severe complications. We are aware of no current estimates of the prevalence of total knee replacement among adults in the U.S.

We estimated that 4.0 million  adults in the U.S. currently live with a total knee replacement, representing 4.2% of the population fifty years of age or older. The prevalence was higher among females (4.8%) than among males (3.4%) and increased with age.

Among older adults in the U.S., total knee replacement is nearly as prevalent as congestive heart failure. Nearly 1.5 million of those with a primary total knee replacement are fifty to sixty-nine years old, indicating that a large population is at risk for costly revision surgery as well as possible long-term complications of total knee replacement.

These prevalence estimates will be useful in planning health services specific to the population living with total knee replacement.

No Benefit Found For Continuous Passive Motion (CPM) After Total Knee Replacement

Advanced Knee Care, experts in knee replacement surgery,  is not able to recommend for the use of CPM after Total or Partial Knee Replacement surgery.  Unfortunately, some things that we do in medicine, we do because we’ve always done it, not because there are good data to support that practice.  Patients have come to expect the CPM — they hear previous patients talking about how it helped them recover, and they think they need it.  Here’s the thing — current data does not support it. Over the past 10 years, hospitals that specialize in total joint replacement have studied the use of CPM versus moving a patient rapidly into active therapy, and found that CPM is no better for a patient than introducing physical therapy shortly after the surgery. Evidence based treatment decisions show that  CPM had no significant advantage in terms of improving function or range of movement, and that its use increased blood loss and pain medication requirements. Another study concluded Continuous passive motion (CPM) gives no benefit in immediate functional recovery post-total knee arthroplasty (TKA), and the postoperative knee swelling persisted longer.  A third study concluded CPM did not lead to improved knee range of motion after Knee Replacement Surgery.

Dr.Tarlow says:  “It is time that we as surgeons only prescribe treatments in which costs are justified because of improved patient outcomes after knee surgery.  CPM machines do not satisfy this criteria.  It’s time to break the bad habit of prescribing things that do not aid in patient recovery”.

High-Impact Sports After Total Knee Arthroplasty

Patient reported activities often reveal non compliant behaviors after total knee
replacement (TKR). Although surgeons generally recommend avoiding heavy manual labor and high impact sports, there has been few medical studies to guide these traditional recommendations.

Mont et. al.reported on thirty one patients with knee replacements that participated in high impact sports including jogging, singles tennis, racquetball, squash and basketball on average 4 times per week. After an average four year followup, thirty two of the thirty three knees had successful clinical and x-ray outcomes. These results indicate that some patients will participate in high-impact sports and enjoy excellent clinical outcomes at a minimum 4 years after surgery. Clearly, patients with TKR participate in activities considered risky by surgeons.

At least in the short term, doing so does not appear to detract from the success of the procedure.

Total Knee Patient Experience Survey for Dr. Tarlow

The quality department at an inpatient surgical facility has provided the following survey summary.

1.  88 % of patients found the preop phone call from the hospital nurse helpful, and none of the patients would have preferred to come to the facility for an in person information session.  In 2016 the need for face to face communication for certain tasks is not desirable.
2.  3 months after Total Knee Replacement 37 % of patients rated their pain as worse than expected.  The average Total Knee patient needs 9-12 months of healing time so this survey result is expected.
3.  One year after Total Knee Replacement 90 % of people believe the surgery met their expectation and 10 % have not had their expectations met.  This is better than most scientific studies that report 80 % of patients had expectations met.

What is New in Total Knee Replacement

A summary appeared in the January, 2016 JBJS and here are the highlights.

Risk stratification is predictable and accurate for Knee Replacement patients.  Patients at higher risk for complications should postpone (if risk factors are modified) or avoid knee replacement surgery.  These risks are uncontrolled diabetes (higher risk of deep infection, blood clot, periprosthetic fracture, aseptic loosening, and poorer Knee Society function score.  Morbid obesity (BMI > 40)  is a patient factor associated with increased medical costs and complications including medical complication (heart attack, pneumonia, etc), postop knee infection, return to the operating room for a second procedure and longer hospitalization.  Morbidly obese patients have a higher risk of in hospital death after knee replacement surgery.

There is no evidence to support a particular design, brand, or material impact range of motion, clinical scores or quality of life.

The value of computer assisted TKR surgery remains undefined.  One study showed an insignificant improvement of leg alignment but no better rotation of tibial or femoral components compared to standard non navigated surgery.

Patient specific custom cutting blocks showed no improved clinical, operative or radiographic results.

 

Improving Your Knee Replacement Results

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How to Improve Total Knee Replacement (TKR) Results

Here are five “fun facts” about Total Knee Replacement.

1.  Have the same surgical team for every case (Surgeon, Assistant Surgeon, Circulating Nurse, Scrub Tech, Second assistant, and anesthesia).  30 day readmission rates due to complications are lower when consistent teams are used.

2.  Use Saphenous Nerve blocks (adductor canal blocks).  This provides better post op pain relief and shorter hospital stays or allows for same day Total Knee surgery.

3.  Emphasize the importance of post op rehabilitation.  Stronger quadriceps muscles are correlated with increased patient satisfaction after TKR.

4.  Unexplained knee pain 6 months after TKR surgery predicts a poor functional outcome at 2 years post op.

5.  Total Joint clinics see a higher percentage of obese people than are present in the total population.  Obesity is a modifiable risk factor for hip and knee osteoarthritis.

Research suggests spinal and epidural anesthesia, peripheral nerve blocks safe to use

Released: 2/14/2014 4:00 PM EST
Source Newsroom: American Society of Anesthesiologists (ASA
Citations Anesthesiology
Newswise — Two types of regional anesthesia do not make patients more prone to falls in the first days after having knee replacement surgery as some have previously suggested, according to a study based on nearly 200,000 patient records in the March issue of Anesthesiology.
Regional forms of anesthesia – spinal or epidural (neuraxial) anesthesia and peripheral nerve blocks (PNB) – which only numb the area of the body that requires surgery, provide better pain control and faster rehabilitation and fewer complications than general anesthesia, research shows. But some surgeons avoid using them due to concerns regional anesthesia may cause motor weakness, making patients more likely to fall when they are walking in the first days after knee replacement surgery.
“We found that not only do these types of anesthesia not increase the risk of falls, but also spinal or epidural anesthesia may even decrease the risk compared to general anesthesia,” said Stavros G. Memtsoudis, M.D., Ph.D., professor of anesthesiology and public health and director of critical care services, Hospital for Special Surgery, New York, and lead author. “This work suggests that fear of in-hospital falls is not a reason to avoid regional anesthesia for orthopedic surgery.”
Researchers analyzed the types of anesthesia used in 191,570 knee replacement surgeries in the Premier Perspective database: 76.2 percent of patients had general anesthesia, 10.9 percent had spinal or epidural anesthesia, and 12.9 percent had a combination of neuraxial and general anesthesia. In addition, 12.1 percent of all patients had PNB. Researchers then analyzed the type of anesthesia used for those who suffered a fall in the hospital. Of patients who had general anesthesia, 1.62 percent fell, compared to 1.3 percent of those who had neuraxial anesthesia and 1.5 percent who had general and neuraxial anesthesia. Patients who also received a PNB had a fall rate of 1.58 percent.
When patients fall during recovery, they are more likely to have worse outcomes, including more heart and lung problems and higher rates of death within 30 days of surgery. Spinal or epidural anesthesia and PNB are used far less often than general anesthesia because of concern that regional forms of anesthesia – particularly PNB – may increase muscle weakness and make patients more prone to falls. However, there has never been a large study based on real-world practices to determine if that is true.
“In this study using data from a wide range of hospital settings we found this concern seems unfounded, especially because hospitals and physicians performing these procedures use fall-prevention programs and are able to reduce the impact of other factors shown to increase fall risk, such as higher narcotic use,” said Dr. Memtsoudis.

Key to Better Knee Replacement Outcomes: An Experienced Surgeon

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Experienced Knee Replacement Surgeon

Optimal Delivery of Total Knee Replacement Surgery – Surgeon Experience Improves Outcomes

High volume Total Knee surgeons working at high volume facilities deliver the best outcomes for patients undergoing total knee replacement surgery.

The Hospital for Special Surgery in New York published data on meaningful surgeon and hospital volume thresholds in the October, 2016 Journal of Bone and Joint Surgery.
Here are the key numbers.
Surgeon volume of 60 or more cases per year had the best 90 day complication and 2 year revision rates. Choose a surgeon that performs 5 or more knee joint replacement surgeries per month.
Facility volume of 236 cases per year had lower 90 complication rates.  Mortality rates were lowest for facilities performing more than 645 cases per year.

Higher Hospital and Orthopedic Surgeon Volume Linked to Improved Patient Outcomes

An analysis of 182,146 patients undergoing primary total hip and knee replacement concludes higher surgeon volume was associated with lower rates of readmission and reoperation, shorter length of hospital stay and higher likelihood of being discharged to home (JBJS November 17, 2010). Higher hospital volume was associated with lower risk of mortality and readmission and higher likelihood of being discharged home.

The process of standardization- adhering to evidence based processes of care resulted in improved clinical outcomes and shorter length of hospital stay, independent of surgeon or hospital volume. Annual surgeon volume high to low in quartiles is 278, 127, 62 and 24 cases per year. Annual hospital volume high to low in quartiles is 1007, 604,361 and 181 cases per year.

Dr. Tarlow’s surgical volume is in the highest Quartile (above 278 cases per year)

3 Frequently Asked Questions About Knee Replacement

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Knee of a runner

  1. How Successful Are Total Knee Replacements in the First Three Years?

    A frequently asked question about knee replacement centers on the success rates of the surgery. A British Study looked in the National Registry to determine revision surgery rates of 80,697 primary Total Knee Replacements between 2003 and 2006. This was an observational study and a revision for any reason (infection, loosening, instability, fracture) was the defined end point of the study. Observational studies have many limitations, but the numbers in this study still have some validity and some interest.

    The overall primary knee replacement revision rate was 1.4% for cemented total prosthesis, 1.5 % for cement less total prosthesis, and 2.8% for uni compartmental prosthesis at three years. Patients younger than 55 years at the time of the primary TKR had the highest revision rate and those older than 75 years at the time of primary TKR had the lowest rates. Overall, this reports shows that revision rates in the first 3 years after knee replacements carried out in the NHS in England since April 2003 were low.

  2. Does Sports Participation Adversely Affect Total Knee Durability?

    The American Academy of Orthopedic Surgeons annual meeting was held in New Orleans last week. Paper 507 by surgeons from Mayo Clinic Rochester (including well respected Mark Pagnano, MD and Daniel J. Berry, MD) reviewed results of knee replacement patients that did not follow doctors orders and participated in heavy labor or high impact sports such as aerobics, football, soccer, baseball, basketball, jogging and power lifting.

    Contrary to accepted doctrine, at an average 7 1/2 year followup the high activity group actually did BETTER than the restricted activity patient group, with higher knee rating scores and better knee function scores.

    The authors were surprised by these findings. “We hypothesized that high-impact activities would not increase the risk of implant failure, but we did not foresee that such activities might actually improve clinical results”.

    These finding are accompanied by, you guessed it, a disclaimer; The industry is not ready or able to revise activity recommendations after knee replacement, but that possibility may exist in the not too distant future. In the meantime, surgeons and patients should continue to follow all industry recommendations relating to recovery following joint replacement surgery.

  3. Does Outpatient Physical Therapy Improve Functional Outcome After Total Knee Replacement?

    One frequently asked question about total knee replacement seems to have been answered in a recent study. Quality of life and functional outcomes after total knee replacement are of great importance to both patients and surgeons. Mockford et al. studied 150 patients after knee replacement to determine the effect on range of motion and functional outcome. Patients in one group received NO physical therapy and the study group received 6 weeks of outpatient PT.

    At one year followup there was no difference in knee function or range of motion.

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