Knee Surgery Improvements Discussed

March 27th, 2006 · No Comments

The benefits of less-invasive knee replacement surgery may not be as dramatic as some direct-to-consumer advertising may claim, but the procedure has resulted in less scarring,
diminished pain and faster recoveries for select patients.

At a panel briefing of the American Academy of Orthopaedic Surgeons’ 73rd Annual Meeting,
experts discussed the pros and cons of the increasingly popular procedure, how
orthopaedic surgeons are attempting to meet patients’ growing demand for
shorter incisions, and whether the less-invasive approach will ever totally
take the place of traditional knee replacement surgery.
    “Minimally invasive surgery (MIS) is no longer just about making smaller
incisions,” said Robert E. Booth, Jr., MD, chief of orthopaedic surgery at
Pennsylvania Hospital in Philadelphia. “The procedure now includes a range of
precise techniques to control pain, get people back on their feet and back to
work more quickly.”
    Less-invasive knee replacement surgery involves an incision of three to
four inches as opposed to the eight- to 10-inch incision required for
traditional surgery. Surgeons attempt to reach the knee without cutting into
tendons, muscles and other tissues around the knee.
    Minimizing pain in the days and weeks after surgery is a primary goal of
the procedure. Patients are given anti-inflammatory medicine and local
anesthesia before surgery, and pain medications after the operation. Patients
also receive counseling about what to expect from the surgery, the length of
the recovery process and how much pain they may experience.
    “Often times if you tell patients beforehand that taking medication will
reduce their discomfort, they will, indeed, feel less pain,” Dr. Booth
explained.
    Like the traditional surgery, the less-invasive approach has many of the
same risks like infection and blood clots. But smaller incisions mean surgeons
have to operate in a more compact area with a reduced field of vision.
    “Any time surgery is performed with a smaller incision, the surgeon has
fewer visual clues to guide them on techniques, such as the appropriate
placement of the implant,” said Mark W. Pagnano, MD, associate professor of
orthopedics at the Mayo Clinic College of Medicine in Rochester, Minn.
“Particular care must be taken during surgery not to damage tissue around the
knee.”
    Computer-assisted navigation systems make the procedure safer when
visibility is compromised. The length of the incision, however, is the least
important factor in the successful outcome of the procedure. Smaller
incisions necessitate more force on the tissues that may inhibit wound
healing.
    The other major risk is that less-invasive surgeries can take two- to
three-times longer to perform than traditional operations. The protracted
surgery may increase the risk of infections, blood clots and other
complications.   Thus far these additional risks have not been a problem,
according to Dr. Booth, though he emphasized the need for more evidence-based
data on the efficacy of less-invasive surgery to determine if the procedure
has long-term benefits for patients.
    While medical device companies are fueling the demand for the procedure by
advertising directly to patients, both experts agreed that smaller is not
always better across the board. “Not every patient is right for the
procedure,” stressed Dr. Pagnano. “Patients who are obese, have a very stiff
knee or a high degree of knee damage are not candidates for less-invasive knee
replacement.”
    However Dr. Booth mentioned one positive outcome of the direct-to-consumer
advertising is that patients are coming in earlier to get surgery; this can
translate into a more successful operation. The experts concluded that while
the less-invasive approach has many advantages, it may never completely
replace the traditional method.
    “Certainly not in the foreseeable future, as long as you have people who
are overweight or who have already undergone multiple operations on their
knee,” said Dr. Pagnano. “But as techniques improve and evolve, we hope to
make this type of surgery available to a wider range of patients.”
    “Regardless of whether you call it less invasive or minimally invasive,
almost every surgeon these days is making smaller incisions,” concluded Dr.
Booth. “The art of knee surgery has been significantly advanced because MIS is
out there.”
    While no current estimates exist, Dr. Booth predicted that within the next
decade, “I think about half of all patients will be getting MIS operations on
their knees.”
    An orthopaedic surgeon is a physician with extensive training in the
diagnosis and non-surgical as well as surgical treatment of the
musculoskeletal system, including bones, joints, ligaments, tendons, muscles
and nerves.
    With more than 29,000 members, the American Academy of Orthopaedic
Surgeons ( http://www.aaos.org ) or ( http://www.orthoinfo.org ) is the
premier not-for-profit organization that provides education programs for
orthopaedic surgeons and allied health professionals, champions the interests
of patients and advances the highest quality musculoskeletal health.
Orthopaedic surgeons and the Academy are the authoritative sources of
information for patients and the general public on musculoskeletal conditions,
treatments and related issues. An advocate for improved patient care, the
Academy is participating in the Bone and Joint Decade ( http://www.usbjd.org )
– the global initiative in the years 2002-2011 - to raise awareness of
musculoskeletal health, stimulate research and improve people’s quality of
life. The Academy’s Annual Meeting is being held March 22-26, 2006 in Chicago