Dr. Matthew T. Hummel of Commonwealth Orthopaedic Centers performed the first total knee replacement surgery using new robotic-arm assisted technology at St. Elizabeth Healthcare — technology available at only a handful of medical centers in the nation.
Today’s successful surgery was performed using a device called the Mako Robotic-Arm Assisted Surgery System. The surgeon’s use of the robotic-arm system brings exceptional accuracy to the surgery — which can mean the patient has a much better result, with more natural movement and less pain after the surgery.
Together with highly detailed computerized scans of the knee before surgery, the robotic arm-assisted device ensures incredibly accurate cuts for the surgery, along with precise alignment and placement of the knee implant. The device allows for accuracy within a single millimeter, or the thickness of a thread.
“I think our ability to use this advanced technology can really change the world for our patients who need this type of surgery,” Hummel said. “With our surgical expertise and with this equipment, this surgery can now be performed with exceptional accuracy, providing better results for patients.”
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Anxiety and depression make handling everyday life more difficult, but it seems these conditions also make healing from surgery considerably harder. That’s according to a large study of individuals undergoing four types of surgeries, experiencing a range of depression and anxiety symptoms.
The study included just under 177,000 patients having hip replacement, knee replacement, hernia and varicose vein surgeries over a two-year period. The researchers were careful to account for factors that typically influence surgery outcomes, including other health conditions, demographics, complexity of the procedure and when it was performed.
The results show that after taking into account all of those factors, patients with moderate anxiety or depression were more likely to have wound complications and to be readmitted to the hospital, and on average had longer hospital stays. Those with more severe anxiety and depression tended to have worse complications.
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A new study finds that inpatient rehabilitation seems to offer no overall benefit when compared with a monitored home-based regimen for patients recovering from standard knee replacement surgery, more formally known as “total knee arthroplasty.”
The results of the study were published online earlier this week in JAMA.
The researchers studied 165 adults (older than 40) undergoing single-knee total knee replacement for osteoarthritis. They divided the two groups: one that received 10 days of inpatient rehabilitation followed by an eight-week monitored home program, and the second group that underwent only the home program.
Both approaches for rehabilitation centered upon exercises that incorporated aerobic, muscle-specific and range-of-motion exercises. The researchers also enrolled an additional 87 patients who declined randomization in the home program as an observation group.
The researchers evaluated the two programs by measuring the distance participants could walk on a six-minute test, 26 weeks after surgery. They ultimately found that there was no significant difference in the distance walked between the 2 groups. Postoperative pain and “quality of life” were not significantly different between the groups studied. In addition, the number of complications was greater in the inpatient vs the home group (12 vs. 9).
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Ian McDermott is a Consultant Orthopaedic Surgeon and Founder of London Sports Orthopaedics. Ian was the youngest Elected Council Member and Trustee in the history of The Royal College of Surgeons and he currently holds an Honorary Professorship at Brunel University, London, in the School of Sport & Education. Ian specializes exclusively in knee surgery, and he is a designated ‘Center of Excellence’ for meniscal transplantation and also for the use of biological glues in cartilage replacement. Ian also specializes in high-performance partial and total knee replacement surgery, and in 2012 he was the first surgeon in the U.K. to implant a ConforMIS G2 patient-specific knee prosthesis. Ian has completed over 100 ConforMIS cases to-date, and he is now part of the ConforMIS Surgical Visitation Program, teaching other surgeons how to implant patient-specific knee prostheses.
Image Credit: ConforMIS
It has recently been reported that financial pressures within the NHS in the UK are leading some CCGs (Clinical Commissioning Groups) to consider limiting joint replacement procedures in the hospitals within their areas by 12% for hip and 19% for knee arthroplasties respectively. They will do this by treating only cases where the “patient’s pain and disability should be sufficiently severe that it interferes with the patient’s daily life and/or ability to sleep”, using the patient’s Oxford Hip Score as a determining factor.
There has been criticism of the proposal from orthopaedic surgeons, both from a financial as well as a clinical perspective. Grant Shaw, Consultant Orthopaedic Surgeon at the Alexandra Hospital in Portsmouth, UK acknowledges that “joint replacement surgery is an expensive and complex, invasive operation with significant risks” but he is adamant that these are far outweighed by “the huge potential benefits for the patient.” He says “In order to realise these benefits the surgery has to be done at the right time and for the right reasons for each individual patient.”
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If you have severe knee pain or chronic knee inflammation and swelling which cannot be improved by minor surgery or physical therapy, a doctor may recommend that you have total knee replacement surgery. For many people, after years of agony, this operation is a godsend. The procedure relieves pain and greatly enhances their quality of life, allowing them to return to work and resume activities that they have not been able to enjoy in years.
But artificial knee replacements are not a perfect solution. Studies have shown that up to 50% of recipients still have some pain after the procedure. Surgeons are reluctant to perform knee replacements on younger people because the parts don’t last. Subsequent replacements are more complex and wear out even faster.
Many of the arthritic patients I see are under 70 years old and have years of playing sports and being active ahead of them. Therefore I like to do everything possible to rebuild their knee joint with biologic tissues rather than artificial materials to help delay the time in which an artificial joint replacement is necessary.
This regenerative approach to healing is the new frontier in modern medicine as researchers all over the world look for ways to rebuild and regenerate tissues and organs, harnessing the body’s natural ability to heal itself. In many cases these solutions are a long way off, but in orthopedics, we have been practicing them for years.
A BioKnee is an alternative to an artificial knee replacement. It combines three key procedures that rebuild, regenerate or biologically replace the damaged parts of the knee.
By Kevin R. Stone, M.D. | Linkedin
Five years ago, Dr. Ira Kirschenbaum, an orthopedic surgeon in the Bronx who replaces more than 200 knees each year, would have considered it crazy to send a patient home the same day as a knee replacement operation.
And yet there he was this year, as the patient, home after a few hours. A physician friend pierced his skin at 8 a.m. at a Seattle-area surgery center. By lunch, Kirschenbaum was resting at his friend’s home, with no pain and a new knee.
“I’m amazed at how well I’m doing,” Kirschenbaum, 59, said recently in a phone interview, nine weeks after the operation.
What felt to Kirschenbaum like a bold experiment may soon become far more standard. Medicare, which spends several billions of dollars a year on knee replacements for its beneficiaries — generally Americans 65 and over — is contemplating whether it will help pay for knee replacement surgeries outside the hospital, either in free-standing surgery centers or outpatient facilities.