Wednesday, March 21, 2018

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Featured Stories

New knees, new life

Written by  Diane York

Polly Smith has a career that many of us would envy. She is a judge at the most prestigious dog shows in the world, including the Westminster Kennel Club show in Madison Square Garden, NY. In her younger years, she showed horses. Later, she and her husband started breeding and showing Welsh Terriers, then Chow Chows.

They became so skilled and knowledgeable about dogs that they were soon asked to judge contests all over the United States, including in Hawaii and Alaska. Thanks to this, they began traveling all over the world: to Sweden, Argentina, Chile, Columbia, Australia and other countries. Contrary to what you might think, judging dogs is a physical sport that involves walking up and down with lots of bending to take a closer look and trotting with the dogs as they are shown. Then, there is the travel. All of this added up, and Polly began to experience significant problems with her knees. The stiffness, pain and swelling began to cut into her activities. She was concerned that she might have to give up judging.

Polly is one of the thousands of Americans who seek help for painful knees each year. More than 600,000 knee replacements are performed yearly in the United States.

Damage to the Knee

Injuries are the most common cause of knee problems. Sudden (acute) injuries may be caused by a direct blow to the knee or from twisting the knee, bending it, or falling on it. Also possible are tears in the rubbery cushions of the knee joint, called meniscus tears; or ligament tears such as those to the anterior cruciate ligament, commonly called ACLs. In Polly’s case, years earlier, she had experienced a blow to her left knee.

Osteoarthritis, which causes joints to wear down, is another frequent cause of knee damage. Rheumatoid arthritis (as opposed to osteoarthritis) is an autoimmune condition in which the body’s own immune system attacks its joints.

There are several treatment options that may be attempted prior to turning to surgery.

  • Corticosteroid shots, which are designed to cut inflammation and pain.
  • Stem cell therapy, in which amniotic (not embryonic) membrane stem cells are injected into the knee.
  • Platelet-Rich Plasma (PRP) therapy, popular in sports medicine, takes blood from the patient, separates out the platelets then injects the platelets near the knee.

The stem cells and platelets both travel to the site of the damage and attempt to repair it. When these treatments fail, however, there is both partial and total knee replacement surgery to consider.

Knee Replacement Surgery

During partial knee replacement surgery, one or more of the three compartments of the knee can be replaced. Using this procedure, the ligaments do not have to be cut. With a partial knee replacement, more of your own body structure remains intact.

Total knee replacement surgery (also called knee arthroplasty) is a common orthopaedic procedure that is used to replace the damaged or worn parts of the knee. Replacing these parts with an implant or "prosthesis" will relieve pain and increase mobility, allowing you to return to your normal, everyday activities. Your doctor may recommend knee replacement surgery if you have severe knee pain and/or disability from rheumatoid arthritis, osteoarthritis or traumatic injury.

No one looks forward to any kind of surgery; most people fear it, especially the post-op pain. However, new advances in knee surgery help make the process of knee replacement almost foolproof. While there is still discomfort and recovery time, new technology puts odds of complete recovery with the restoration of former abilities in the very highest range.

Polly sought help from Vic Goradia, MD of G2 Orthopedics and Sports Medicine in Richmond. Dr. Goradia is a nationally recognized, board-certified arthroscopic and sports medicine surgeon. He was one of the first surgeons in the U.S. to receive a Certificate of Added Qualifications in Sports Medicine by the American Board of Orthopaedic Surgery.

“I went to Dr. Goradia and asked about stem cell therapy,” Polly says. “While he did not think it would work in both legs, I requested it anyway. It worked in the right knee but not in the left knee, the one that had a previous injury, so we scheduled the surgery for that knee. I had some pre-surgery physical therapy and felt confident about the surgery.”

Dr. Goradia says, “Both of Polly’s knees had bothered her for years. They were badly arthritic, and she had developed a significant limp. She leads a very active life and wanted to keep it that way, so she had already tried other treatments.”

One of the most challenging things about knee replacement surgery is the proper alignment of the replacement knee in the patient’s leg. Most of the time, this involves a steel rod being placed in the bone in order to correct a leg deformity making the operation invasive. However, Dr. Goradia’s practice, G2 Orthopedics and Sports Medicine, is offering something that’s new, more accurate and far less invasive. OrthAlign is a small, handheld device that utilizes cell phone and missile guidance technology to map the perfect placement of the new prosthetic knee. It is compatible with all implant systems. According to the manufacturer, recent studies have shown that OrthAlign® technology improves alignment when compared to traditional mechanical guides.

Dr. Goradia says, “The OrthAlign computer allows us to make a straight line precisely from the center of the hip to the center of the ankle. If the knee tends to be on one side or other, we must try to get the mechanical axis straight. The computer can adapt and allow us to make a correct alignment with true center through the center of the knee.”

He explains how OrthAlign is different from older technology. “In the old way, we had to insert a half-inch rod into the femur thigh bone. We don’t have to do that with OrthAlign. It decreases bleeding and is less invasive, easier on the patient. This makes for a quicker, easier recovery and better results.” While OrthAlign is used regularly by Dr. Goradia, it is relatively new technology, and there are only a few of these devices available in the Richmond area. He says, “While we don’t have 10-year outcomes yet, I feel that OrthAlign is a big improvement in knee replacement surgery.”

Polly says, “I had the surgery on a Tuesday, Nov 8th. I walked on Wednesday and went home Thursday, doing physical therapy at home with a therapist. By January 14th, I was showing and judging dogs again. I flew to Arizona and judged 146 dogs in one day! Pain had been a constant part of my life. I don’t even think about it now. I am going from 8 a.m. to 6 at night. Sometimes, I will be stiff, but there’s no real pain. I did not need pain medication after December 1st. It feels like a normal knee. Dr. Goradia is a great surgeon.”

Frequently asked questions about knee replacement

How long should people wait to have knee surgery?

“When your knee problems begin to affect your daily activities,” says Dr. Goradia. You should consider having knee surgery when you cannot get out of a chair without difficulty, when you avoid walking because of pain and when you cannot bend your knee. In other words, you should consider having surgery when your knee problems are stopping you from living your life. If you have tried injections and other treatments without success, then it is time to consider knee surgery.

Should you consider having surgery on both knees at one time?

Many people consider getting both knees operated on at the same time in order to reduce their time lost from work. Some feel that it is better to experience all of the pain at once instead of during two separate operations. However, Dr. Goradia says, “There is a somewhat higher risk of blood clots and infection when both knees are done at once. The recovery is harder. To do it this way, the patient must really be up for it and be willing to work hard through the pain.”

How long do knee replacements last?

According to the American Academy of Orthopaedic Surgeons, if you’ve had a total knee replacement, you can expect it to hold up and allow you to remain active for at least 20 years and sometimes for as long as 30 years.

How long does recovery take?

Patients often start standing and walking the same afternoon of their surgeries. Hospital stays are usually no more than three days. Patients begin physical therapy in the hospital and continue it at home. Usually 6 to 12 weeks of physical therapy is required post-surgery.

How safe is it?

Total knee replacement is considered to be a relatively safe procedure. Per the American Academy of Orthopaedic Surgeons, “Serious complications such as knee joint infection occur in fewer than 2 percent of patients.”

Blood clots can be a risk, as they are with all orthopaedic procedures — but that risk is low. Using a blood thinner or other common preventative measures reduces the risk.

In terms of the side effects, stiffness is typical following the operation. This is one of the reasons that postoperative physical therapy is so important.

How can you help yourself have a successful knee replacement?

  • Be prepared mentally and physically.
  • As with any surgery, recovery isn’t easy. Expect some pain and discomfort. You may also experience some frustration over your limited ability to move around. It may help to talk with others who have had a knee replacement to get a good sense of what to expect.
  • Be in as good of physical shape as you can before the surgery.
  • Do pre-surgery physical therapy to make the post-surgical therapy easier. Strengthening the arm and shoulder muscles will help you use crutches after surgery.
  • Lose weight.

Dr. Goradia says that losing weight benefits the knees because it decreases the weight-bearing pressure on the knees. Each pound of weight loss can reduce the knee-joint load by 4 pounds. Lose just 10 pounds, and that's 40 fewer pounds per step that your knees must support. People who are overweight or take part in high-impact activities are more likely to experience problems with a knee implant.