Total knee replacement (TKR) is utilized for end-stage knee osteoarthritis, which often leads to excellent long-term outcomes with greater than 95 percent survival at 20 years. Yet it has been shown that 20 percent or more of these patients can be dissatisfied with the procedure.
At Cleveland Clinic, we perform over 3,000 knee replacements annually, and have been making patient-focused efforts to improve short- and long-term outcomes. These clinically based projects cover all phases of care: pre-, intra- and postoperative.
In this article, we review several of these innovative efforts:
- Robotic total knee replacement
- Press-fit implant technology
- Customized 3-D implant printing
- Wound closure technology
- Neuromuscular electrical stimulation
- Innovative pain technologies
Each of these technological advancements individually has the potential to change the field of knee replacement surgery. Together, they can revolutionize TKR procedures to the point that patients will have minimal pain and can almost guarantee optimal short- and long-term results in the future.
Robotic total knee replacement
Robots have been used in various surgical fields, but have only recently been utilized clinically in orthopaedics. They are purported to improve accuracy, precision and outcomes for all types of surgeries. In knee replacements, we have performed studies that show improvements in placement of the implant, which should also translate into better patient outcomes.
Michael A. Mont, MD, helped a team complete a cadaver study that assessed knee alignment and component position using robotic and non-robotic methods. Robotic surgery achieved more accurate component position and alignment than the manual (non-robotic) technique.
Additionally, Cleveland Clinic is one of four sites involved in a multicenter clinical trial comparing robotic techniques with standard total knee replacements. Investigators are optimistic that this technology will improve outcomes in knee replacement.
Press-fit implant technology
Traditionally during TKR, implants are placed into the knee using cement to allow for initial implant stability and adherence to bone. However, cement may not permit optimal bone-implant integration, which may compromise long-term results.
To circumvent this issue, Cleveland Clinic researchers and others have developed “press-fit” implant designs. These implants do not require cement and, therefore, bone grows into the implant surfaces. This theoretically could provide better long-term implant longevity, especially in younger patients in whom these prostheses may need to last for 20 or more years.
- Preoperative standing anteroposterior and lateral radiographs of an arthritic knee.
- Postoperative standing anteroposterior and lateral radiographs after cementless total knee arthroplasty.
Customized 3-D implant printing
Knee implants traditionally have a standard design and come in various sizes to allow the surgeon to choose the best fit for each patient. However, individual patient anatomy can vary markedly.
To address the need for individualization, we have worked with a company that develops customized 3-D printed prostheses with additive technology. Theoretically, this will allow for a knee replacement that more closely matches the patient’s native anatomy, thereby potentially improving patient function and satisfaction.
By Michael A. Mont, MD; Viktor E. Krebs, MD; and Morad Chughtai, MD | Cleveland Clinic
Image Credit: Cleveland Clinic