Press Release 5.12.2003
Surgeons Wed Two Innovative Techniques in Knee Surgery
by John Crowe - Record Searchlight
Redding, Calif. - It's bad enough to have a bum knee that you've been fighting for years. But when it gets so bad that it becomes necessary to get a brand-new knee, it only adds insult to injury to realize you're facing a hospital stay of four to five days and another 10 days in a rehabilitation facility.
Patients are often in considerable pain from the knee and adjacent tendons and muscle for weeks or months.
That's been the scenario for the majority of the 250,000 or so Americans who get a new knee joint surgically emplaced each year, according to Drs. John Lange and Paul Schwartz, orthopedic surgeons at Shasta Orthopaedics and Sports Medicine in Redding.
And when the ordeal is finally over, as many as 10 percent of knee replacement patients may have to go through the whole process again some years later because of very slight misalignment between the new artificial knee and the leg bones.
But Schwartz, Lange and their colleagues are in the forefront of what they believe is a better way to do knee surgery. The new technique has two distinct features: A minimally invasive surgical approach that involves a shorter incision (about 4 inches instead of 8 to 10) that does not cut through the quadriceps tendon. They also use computer-guided equipment to ensure a precise alignment of the knee and the leg bones.
The minimally invasive approach accesses the knee from the side rather than the top and does not invert the patella (kneecap) during surgery.
The approach has been for two to three years at various centers around the country. Lange, Schwartz and Dr. Thomas Coon are among the surgeons who have used the technique in Redding and Red Bluff.
Lange and Schwartz have also used the computer guidance system, coupled with traditional knee surgery, for about a year.
With system, optical arrays are placed on both the tibia and fibula and the surgical equipment. A constant redout reveals if there is the slightest misalignment between the new knee and the leg bones.
But the minimally invasive and computer-assisted alignment techniques had never been combined in one procedure - until last month.
In mid-April, three patients at Redding Medical Center, became the first in the world to get a new knee in a procedure wedding the minimally invasive approach and the computer guidance technology.
We're leading edge. We want to make sure (the combined approach) is better," Schwartz said before the first surgeries were done.
"We're getting total knee replacement without sacrificing alignment," Lange said after the surgeries were completed. "It's the best of both worlds."
Lange said he's pleased with the outcome so far for his first two patients.
"Both were home in three days. Both were walking within 12 hours of surgery and both seem more comfortable," he said. "I couldn't be more excited about how great they (the surgeries) have gone."
One of those who underwent the pioneering surgery is Robert Lowe, 60, of Redding.
A retired California Highway Patrol officer. Lowe hurt his knee while on duty in the early '80s. Leaving his patrol car on a call, he stepped out onto a loose manhole cover that gave way, twisting his leg and knee.
The knee hurt, but he lived with it for several years before gettingarthroscopic surgery to scrape away scar tissue on the joint in 1986 0r 1987.
In the years since, his left knee got worse, he said.
He said he was taking a lot of medication for pain, "flights of stairs would get to me" and his knee buckled sometimes.
Lowe said his knee was getting more arthritic with the bone rubbing against bone and he knew he to do something about it.
When Lange approached him about the new procedure. Lowe was interested.
"The less invasive idea appealed to me. I've seen a lot of people with pretty ungodly scars," he said.
He also liked the idea that he would probably be up and about sooner with the minimally invasive approach.
Speaking of Lowe several days after his April 16 surgery, all indications are that the surgery was a success.
"I'm glad I did this. I feel much better already," he said. "I have some swelling, but I'm up and about and I'm putting weight on it."
"At this stage of the game, I'm impressed they had this ability to make sure the alignment was there and that the incision was only 4 inches."
As an extra benefit, Lowe said he thinks even his sound right knee feels stronger, probably because the new knee on the left is able to carry more than of the load that it had before.
Not long after the new techniques were applied, Lange was off to Cincinnati to learn about the combination of minimally invasive surgery and computer-aided techniques for hip replacements.
He and his colleagues believe it's the wave of the future.
"Arthroscopy was a huge advance. Total joint replacement had been a huge advance. Computer technology as it relates to joints and trauma is our next huge advance," Schwartz predicted.
"The procedures allow us to accurately align things without huge exposure. And the computer is so much better than other aids we've had. We're excited to be part of the development of these new techniques," he added.
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