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New knee technique puts the patient back on his feet sooner


Knee replacement surgery is infamous for being painful, requiring a long, involved recovery period and leaving a big scar.

But a new surgical technique cuts out a lot of that bad news. It leaves a smaller scar, has patients leaving the hospital in two days, skipping the rehabilitation facility and walking without a cane in about three weeks.

Brian Panush, an Olympia contractor, is a cheerleader for the procedure. He had a knee replaced in April 2005 and was walking without cane or crutches eight days later. Four weeks after surgery, he played golf, although he admits he used a cart on the course.

Panush was 52 when he opted for surgery. "The knee was keeping me up at night. It bothered me so much I didn't want to get out of my truck when I got to a job site," he said. "My rehab was phenomenal."

A physical therapist visited him in his home the week after surgery, then he had outpatient therapy for five weeks. That was it. Week seven he was dancing at a business convention. "People were astounded, " he said.

Panush credits a surgical technique that leaves the quadriceps (the long muscle on the front of the leg) intact. Traditionally, it was split to allow for installation of a new knee.

Dr. Seth Leopold, associate professor in the department of orthopedics and sports medicine at the University of Washington, was Panush's surgeon.

Although knee replacement has been mainstream since the early 1970s, "The surgical approach to the knee has changed dramatically in the last few years -- to what they're calling minimally invasive knee replacement or quadriceps-sparing knee replacement," Leopold said.

Materials -- polyethylene, cobalt chrome (a steel alloy) and titanium -- have remained basically the same with subtle changes in shapes and contours that improve performance.


"I come underneath it from the side," Leopold said. "We no longer have to dislocate the joint nor the kneecap. Two different surgeons came up with this method a few years ago -- others were working on it."

Leopold calls it "technically challenging" surgery. He learned from those who developed the procedure and designed the instruments, then honed his skills on cadavers in an anatomy lab before using the techniques on patients that now number more than 400.

Although the American Academy of Orthopedic Surgeons claims that more than 300,000 people undergo the procedure each year, usually because of arthritis, records on the percentage of those that are done with the minimally invasive techniques are not available. About 10,000 knee replacements are done in Washington, but data don't indicate which surgical method is used.

Leopold said the new technique is not yet widely accepted because published data about results are just becoming available, it's not easy to learn and it's technically challenging.

Monday morning, Leopold and his assistant, Dan Stamper, were leading a team of five through the surgery at UW Medical Center. Leopold and Stamper learned the procedure together. "It's like a dance. Both (of us) have to know the steps," Leopold said.

He made the incision at 9:27 a.m. Minutes of chipping away bone spurs, sawing and drilling followed. A metal bar was attached to the leg to act as a plumb line. "This is the equivalent of hanging a door," Leopold quipped as he checked knee/bone alignments.

They inserted trial parts, bent the knee up and down, side to side before unpacking the four permanent pieces that replace the knee. A glue-filled tool that looked like an ordinary caulking gun squirted mint-green cement onto the replacement parts.

A gleaming chrome cap was hammered over the femur. Other pieces were screwed and glued into place, and minutes later Leopold was stitching the wound. It all took less than an hour.

Leopold says this may be called "minimally invasive," but he considers the term misleading. "It's major surgery by anyone's definition."

Nancy Smith, 73, of Kirkland, had her right knee replaced with a traditional method in 1995, and her second knee replaced with the new procedure in May 2006.

"I think they've made a lot of really good improvements. This time the incision was shorter, getting the bend back to my knee faster," Smith said.

Her physician, Dr. Craig McAllister, an orthopedic surgeon in Kirkland, said he changed his technique in 2003. Before focusing on the new procedure, however, he did 100 traditional replacements and 100 minimally invasive surgeries and compared the results. He said the latter had less post-op pain, an earlier return of motion and required less aggressive physical therapy.

"The real value of these new techniques is improved function. We don't put a lot of emphasis on having a small incision. We want good results with reduced complications," McAllister said.


Traditional knee replacement

Incision: 8-10 inches

Quadriceps: split

Hospital stay: 3-4 days

Rehab facility: 3-4 days

Crutches or walker: 3-4 weeks

Cane: 2 weeks

Physical therapy: 2-3 months

Minimally invasive treatment

Incision: 4-6 inches

Quadriceps: left intact

Hospital stay: 2-3 days

Rehab facility: rarely needed

Crutches/walker: 1 week

Cane: 1-2 weeks

Physical therapy: 6 weeks

For more information, go to orthoinfo.org; www.orthop.washington.edu/quadsparing; www.jointcure.org

Last Updated ( Aug 19, 2006 at 08:57 PM )