1 / 21

Hip and Knee Arthroplasty

INVASIVE. Minimally. Hip and Knee Arthroplasty. Presented by: Nicole M. Boyko, PT, MS. Overview. Basics of Total Joint Surgery What is MIS? Benefits of MIS Application of MIS to Hip Replacement Application of MIS to Knee Replacement Conclusion/Implication to PT. Introduction.

Download Presentation

Hip and Knee Arthroplasty

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. INVASIVE Minimally Hip and Knee Arthroplasty Presented by: Nicole M. Boyko, PT, MS

  2. Overview • Basics of Total Joint Surgery • What is MIS? • Benefits of MIS • Application of MIS to Hip Replacement • Application of MIS to Knee Replacement • Conclusion/Implication to PT

  3. Introduction • > 21 million people in the US have some form of osteoarthritis • By 2020, 20% of Americans will be >65 y/o and at risk for OA • Annually this amounts to: • 152,000 THA surgeries • 299,000 TKA surgeries

  4. What is MIS? • MIS= Minimally invasive solutions • Widely used in gynecological, cardiac, GI surgery • Now being applied to orthopedic surgeries • Mini-incision vs Mini-invasive • Mini-incision= operation through smaller hole • Mini-invasive adds to this 3 goals: • Minimal disruption of physiology • Minimal lifestyle interference • Avoidance of interference with future Rx or surgery

  5.  operation time  blood loss peri- and post-op  hospital stay  costs  risk of infection Overall shorter recovery time Smaller incision  tissue and muscle trauma  pain 20-30% more ROM Quicker, easier rehab Benefits of MIS

  6. Application of MIS to THA • Pioneered by Zimmer Holdings, Inc. of Warsaw, IN • Global leader in design, development and manufacture of reconstructive orthopaedic implants • Two Techniques • Mini Incision Technique • Two- Incision Technique

  7. Mini Incision THA • Utilizes 3-4” incision vs 8-10” with traditional THA • Cementless metal and plastic implant • 4-6 wk projected recovery period • Two common procedures • Top ½ of posterolateral approach • Top 1/3 of anterolateral approach *In either approach, incision can be extended to full length at any time during surgery Zimmer (2002, 2003); Rodrigo (2002)

  8. Research: Wenz et al (2002)

  9. Two Incision THA • No mm are cut so < pain than mini THA • One 1.5-1.75” ant incision over fem neck for excision of head of femur and implantation of acetabular component • One 1-1.25” incision made as if IM fem rod were being placed for insertion of fem head component • 80% of 1st 50 cases able to D/C same day after 100 min OR procedure Zimmer (2002, 2003); Berger (2002)

  10. Application of MIS to Knee Replacement • Unicondylar Knee Replacement • Uni-Spacer • Repicci II Unicondylar • Zimmer M/G Uni Knee • Minimally Invasive TKA • L-I Approach • Zimmer Approaches • Smith & Nephew and BrainLAB Approaches

  11. Unicondylar Knee Arthroplasty • Involves reshaping only damaged portion of joint • Introduced in 1970s • 5,000 performed annually in U.S. • Newest innovation- minimally invasive UKA or “mini-uni” • Introduced in late 1990s • Same concepts but with 3-4” incision

  12. Ideal Candidates for UKA • 45-65 y/o • Isolated non-rheumatoid OA with cartilage NOT bone loss • Normal ligaments • No significant patella problems • Best for non-obese patients

  13. Popular Uni-Knees Uni-Spacer • Manufactured by Sulzer Orthopedics, Inc. • Cleared for use in US in Jan 2001 • > 2,500 successful surgeries to date • Cobalt and chrome alloy prosthesis • Fit b/t femur and tibia alleviates need for cement or screws • Does not compromise conversion to TKA SulzerMedica (2002); St Croix Orthopedics (2002)

  14. Popular Uni Knees Repicci II Unicondylar Program • Biomet prosthesis with 10 yr, 90% success rate • 7-10 cm incision for medial rebalancing, 10-12 cm for lateral rebalancing • Burr rather than cut bone for implant • Freelance procedure relies on anatomy not instruments to determine bone removal CBSnews.com (2002); Repicci et al (2003)

  15. Popular Uni Knees Zimmer M/G Uni Knee • Introduced in late 1990s • 2-3” incision to remove diseased portion of knee • Can be done on outpt basis • 5 wk recovery time with near full ROM • > 20,000 implanted to date Zimmer (2002, 2003)

  16. Minimally Invasive TKA L-I Approach • = Limited Incision TKA • Invented by Dr. Peter Bonutti of Bonutti Clinic in Effingham, IL • 3-4” incision, 60-75 min OR time • Uses Scorpio Total Knee Instrumentation by Stryker Howmedica Osteonics (SHO) • > 200 surgeries to date; research results pending by SHO Bonutti.net (2002)

  17. Minimally Invasive TKA Zimmer Mini-Incision TKA • Pioneered by Dr. Luke Vaugh of Scripp’s clinic in La Jolla, CA, 1999 • Comparison study of 60 MINI vs 66 traditional: • Incision: 4.3-5.5” vs 7.8-12” • Hospital stay: 3.0 days vs 3.5 days CNET (2003); Zimmer (2002, 2003)

  18. Minimally Invasive TKA Zimmer Minimally Invasive Solutions Quad-Sparing TKA • Avoids cut through quads • Pioneered by Dr. Alfred Tria of St Peter’s Hospital in New Brunswick, NJ • 3” incision, LOS < 48 hrs, 18% > ROM • Uses Zimmer NexGen Complete Knee Solution LPS Flex Components • Stealth Station optic image guidance tech Zimmer (2003)

  19. Minimally Invasive TKA Smith & Nephew and BrainLAB • April 2003: 1st mini TKR enhanced by high precision computer navigation • Performed by Dr. John Lange & Dr. Paul Schwartz of Shasta Orthopedics, Redding, CA • Utilizes 3.5” incision,  rehab by 2 mo • Accuracy of implant alignment extends life • Tested in US, Europe, Japan, Canada, Australia BrainLAB (2003), MedScape (2003)

  20. Implication to PT • Requires modification of our existing total joint protocols • In all cases, pts able to: • Walk sooner • Perform more aggressive ROM • Tolerate more advanced strengthening • D/C to home earlier

  21. Questions?

More Related