New Knee Surgery
Offers Speedy Recovery
Just nine hours after Grover Thomas had his knee replaced, he hobbled
home from the hospital. Five days later, he was walking unassisted,
no crutch or cane in sight.
Thousands have total knee replacements
every year, and many might be green with envy upon reading this:
The operation usually requires several days in the hospital and
weeks on crutches, not counting arduous physical therapy.
Now, a small but growing number of
surgeons are implanting the manmade joint with less of that
through a mere 3-inch incision and without cutting a muscle and
tendon that are crucial for knee flexing. The changes promise less
pain and faster recovery.
At least one, Dr. Richard Berger,
even offers it as outpatient surgery, so far sending Thomas and
22 other patients home within hours of the operation.
It's "a little like building a ship
in a bottle," says Berger, of Chicago's Rush University Medical
Center. "It takes a little bit of practice and a little bit of skill."
Patients recover three times faster
than with standard surgery, says Dr. Alfred Tria of New Jersey's
Robert Wood Johnson Medical School, who pioneered the new method
and has used it on 140 patients.
It's not suitable for everyone, Tria
cautions: People who are obese, over age 80, have had other nonarthroscopic
knee surgery or are very knock-kneed or bowlegged don't qualify.
But Tria predicts that within five
years, the minimally invasive method will account for about 40 percent
of total knee replacements.
"Other patients that are in (physical)
therapy at the same time I am are eight weeks out and still on crutches,"
says Thomas, 59, an insurance company chief executive in Lake Forest,
Ill., who wore out his natural knee running marathons.
In contrast, Thomas went on a half-hour
outdoor bike ride just three weeks after his Feb. 3 surgery.
He's not completely recovered
the knee still is tender, and he's still in physical therapy. But
"no one that sees me can believe it" is a brand-new knee, Thomas
People undergo total knee replacement
when arthritis or injury erodes the joint's natural cushioning to
the point where it's hard to walk even short distances without severe
pain. A recent analysis commissioned by the National Institutes
of Health said the treatment gives tremendous relief and a much-improved
quality of life.
Still, the operation and recovery
can be grueling.
Traditionally, surgeons make a 12-inch
incision in the front of the knee, peel back the kneecap, and cut
through the quadriceps muscle and a tendon that attaches it. That
allows open access to the thigh and shin bones, which are cut to
fit the metal-and-plastic joint implant.
It is healing of the muscle and tendon
that causes much of the pain during recovery, as patients must stretch
those injured parts to regain knee motion.
With the new procedure, doctors make
a 3-inch incision slightly to the kneecap's side, and harmlessly
slide under the muscle and tendon to get to the bones that need
cutting. Then the same artificial joint is squeezed into place.
Key was creating specialized surgical
instruments that could allow bone-cutting in such tiny quarters.
Tria and Dr. Thomas Coon of Redding, Calif., developed the method
and asked joint manufacturer Zimmer Inc. to make the instruments.
"We get essentially the same bone
cuts as you used to get with the knee wide open," says Tria. "The
principles of the operation have to remain exactly the same."
The cost of knee replacement varies
around the country, from $22,000 to $39,000, usually covered
by insurance. The new method's shorter hospital stays could cut
the bill by 30 percent, Tria says.
He hospitalizes patients for two
days instead of the standard operation's four, saying the stay "probably
is a little bit of emotionalism on our part and a little bit of
safety the patients like." Other surgeons keep patients only overnight.
Chicago's Berger, best known for developing minimally invasive hip
replacement, is believed the first to offer the outpatient option.
Surgeons have been inching toward
less invasive knee replacement, and this method "is reasonable,"
but there aren't yet studies proving that knees implanted this way
are as durable, cautions Dr. Clifford Colwell, president of the
American Association for Hip and Knee Surgeons. Interested patients
should question surgeons carefully about their experience.
The less-invasive operation is more
difficult for surgeons, who train on cadavers, and takes about 30
minutes longer to complete, says Tria, who will teach the technique
at this week's meeting of the American Academy of Orthopaedic Surgeons.
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