Best Practice Health TV
Recent advances in robotic surgery and minimally invasive approaches have made Total knee replacement better and less painful. However, it is not for everyone. Read our blog article where I will help you figure out if you have tried everything else first, show you how to take a survey to know if your condition is bad enough for TKR (Total Knee Replacement), go over the surgery and rehab to help you decide if surgery is worth it for you, and finally, if it is the right time. I will show you ONE thing you need to do to get the best new knee for you.
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If you have knee pain due to advanced arthritis that x-rays show is only the inside or outside compartments of your knee, then you are a good candidate for partial knee replacement. Legacy orthopedic surgeons considered the risk of partial knee replacement not worth the reward. Now all that has changed. With robotic assistance —and surgeons skilled in minimally invasive surgery— partial knee replacement now has among the highest patient satisfaction of any orthopedic surgery.
Doctors often divide the knee into three compartments. Seen from behind, the inside compartment is the joint between the thigh bone and the shin bone on the inside of your leg. The outside compartment is the junction between the same bones on the outside . The third compartment is where the kneecap meet the thigh bone. Arthritis can strike any one or all three of these compartments. Severe arthritis that is disabling despite physical therapy in two or more compartments is treated by total knee replacement. However, if the severe arthritis is in just the inside or the outside compartment alone, then replacing the whole knee is not needed. In these cases, a partial knee replacement is the best option.
The advantages of robotically assisted partial knee replacement make it well worth the risk of requiring a second surgery. There are several advantage of partial knee replacements compared to total knee replacement as listed in the table. The primary disadvantage of partial knee replacement in the past was that they didn’t last as long: in a study done on Australians the likelihood of having a revision surgery seventeen years after total knee replacement is 8%, whereas the risk of revision after partial replacement was 26%. However, the use of robotic assistance has improved the outcome of partial knee replacement and lowered the risk of revision. With robotic assistance you can now get all the advantages of partial knee replacement without the historical disadvantage of an unnecessarily higher risk of having a second surgery.The advantages of robotically assisted partial knee replacement make it well worth the risk of requiring a second surgery. There are several advantage of partial knee replacements compared to total knee replacement as listed in the table. The primary disadvantage of partial knee replacement in the past was that they didn’t last as long: in a study done on Australians the likelihood of having a revision surgery seventeen years after total knee replacement is 8%, whereas the risk of revision after partial replacement was 26%. However, the use of robotic assistance has improved the outcome of partial knee replacement and lowered the risk of revision. With robotic assistance you can now get all the advantages of partial knee replacement without the historical disadvantage of an unnecessarily higher risk of having a second surgery.
Advantages of Partial Knee Replacement
Robotic assistance assures you are getting the best total joint replacement available today with a personalized surgical experience. For the Stryker robot the process begins by obtaining a high-definition CT scan of your knee. This will be uploaded so the robot’s computer can construct a 3D model of your knee. The model will be used to help select the implants which will give your knee the best possible range of motion once implanted. During surgery the robot also assists to give your surgeon superhuman accuracy while removing the diseased bone.
Preparing for partial knee replacement surgery is easy. Three months before surgery make sure you stop smoking and begin a well-balanced diet. Ten days before surgery be sure you have a plan for stopping any blood thinner with your primary care doctor or surgeon’s office. Prepare your home with 7 days cooking and cleaning done and ready before surgery. One of our nurses will call and review your medical fitness for surgery a couple days out. Be sure and ask them any questions you have about your home or medications on the day of the knee replacement. Stop eating and drinking at midnight before surgery. The operation is done under a spinal, but you will need a ride home after the procedure. Dr. Amy and Ashley will get you ready for surgery here:
Partial knee replacement surgery is done under in our ambulatory surgery centers, so hospitalization is not required. By having your surgery in an ambulatory center, you avoid hospital errors, have a lower risk of infection with COVID-19 as well as in your new joint. The anesthesiologist typically performs a spinal anesthetic, which enables you to take your first steps within 90 minutes of the knee replacement surgery and to actually walk out of the surgery center yourself. Walking right after surgery reduces to the point of eliminating the risk of developing blood clots in your legs which can be fatal if they go to your lungs. That means having ambulatory surgery is not only less painful, but it may also save your life.
The recovery after partial knee replacement is shorter than after total knee replacement. While every patient is given a walker when they leave the surgery center, most no longer use them to assist in walking 1-2 days after their minimally invasive robotic assisted partial knee replacement surgery. Home exercises shown in a video series by our own Dr. Amy and Ashley direct you to in how to exercise and increase your activity after surgery to ensure the best result possible. In partial knee replacement surgery, the surgeon only removes bone from the single arthritic compartment; therefore, they remove only half as much bone for a partial knee replacement (single compartment) as a total knee replacement (two compartments). Half as much bone removal means half as much bone to heal. Most patients are ready to return to light-duty work 1-2 weeks after knee replacement, moderate duty 3-6 weeks later, and heavy duty after 12 weeks.
Once fully recovered from minimally invasive robotic assisted partial knee replacement patient are extremely satisfied and have no permanent restrictions. Partial knee replacement surgery has the highest patient satisfaction reported (91%) of any orthopedic surgery. The level of satisfaction after partial replacement is much higher than that of total knee replacement (74%).
We’re committed to solving your knee pain problems with the least invasive treatment possible.
We utilize the only implant that’s approved to last for 30 years.
We use the robot on every knee surgery, which means a personalized implant selection that results in a better outcome.
Partial knee replacements are half the surgery and recovery time of a total knee.
No hospital stay means a much lower risk of infection.
You should do 3 weeks of physical therapy before considering an MRI—studies show worse results if you get imaging at this point. If you are not better after 3 weeks of therapy, then (6 weeks since the pan began) you should get an MRI and referral to a board-certified anesthesiologist or physiatrist with subspecialty certification and specialization in pain management. They will do a medial branch block and radiofrequency ablation as appropriate. Don’t let anyone talk you into epidural injection; that is not what you need.
You should do 3 weeks of physical therapy before considering an MRI—studies show worse results if you get imaging at this point. If you are not better after 3 weeks of therapy, then (6 weeks since the pan began) you should get an MRI. We can help you find a board-certified anesthesiologist or physiatrist with subspecialty certification and specialization in pain management who doesn’t over-prescribe dangerous narcotics.
They will offer you medial branch block and epidural injection. Those don’t really work for this problem. Your options are (off label) intradiscal injection of stem cell-derived growth factors, denervation with the relevant procedure, and then referral to a spine surgeon for interbody fusion if those fail.
You need an MRI now and referral to a spine surgeon for possible laminectomy decompression surgery. We can help you find one who is board-certified and specializes in minimally invasive surgery.
You need an MRI now and referral to a board-certified anesthesiologist or physiatrist with subspecialty certification and specialization in pain management. Don’t go to one that prescribes a lot of narcotics, they may get you killed. If you’re not better after 3 epidural injection you will be referred at 12 weeks to a spine surgeon to consider microdiscectomy. Note that you DO NOT need radiofrequency ablation; so, don’t let anyone talk you into a medial branch block.
This stuff can be confusing. Don’t sweat it. We’ve got you. Your MRI came with a report by a radiologist which describes the findings. If you don’t have a copy of your report, you can get one from the imaging center where the x-ray was taken. The doctor who prescribed the MRI has a copy as well. Find the section labeled Impression. First, under the impression, look for the word normal. If you see something like “Normal MRI of the hip then you are done. You do not need to check anything.
Next, search the impression section for the words osteonecrosis or avascular necrosis. If you see either one in the report, then ignore the rest of the report and check the osteonecrosis box. If neither of those is in the report, ignore the rest for now and continue.
This stuff can be confusing. Don’t sweat it. We’ve got you. Your x-ray came with a report by a radiologist which describes the findings. If you don’t have a copy of your report, you can get one from the imaging center where the x-ray was taken. The doctor who prescribed the x-ray has a copy as well. Find the section labeled Impression.
First, under the impression, look for the word normal. If you see something like “Normal x-ray of the hip then you are done. Check the box normal. Next, search the impression section for the word hypoplasia. If you see hypoplasia in the report then ignore the rest, and check the hypoplasia box.
If you are still going, then look for the word arthritis. The radiologist should have given the arthritis a grade from 1 to 4. If you see arthritis in the impression section but there is no grade, then look at the rest of the report for a grade 1,2,3 or 4 and check the appropriate box. If there’s no grade then you have every right to call the imaging center and ask them to have the radiologist to do their job and redo the report with a grade.
Not all orthopedic surgeons are the same. You deserve the best. That means a surgeon who is
In my experience less than 10% of orthopedic surgeons meet all five of these criteria. That means if you go to the surgeon you’ve been seeing, or the one recommended by friends or family, there’s a 90% chance you will not be getting the best.
At Phoenix Spine and Joint we make it our business to know the best. Call us for help finding the best surgeon near you who takes your insurance and is accepting new patients.
If you have any of the following red flags you need to see a doctor NOW!
Radiculopathy. This condition is most often due to herniated disc, but can also be caused by bone spurs, or compression of nerve roots as they leave the spinal canal. The traditional treatment is to confirm the herniation or compression by MRI, followed by a trial of epidural injection, with microdiscectomy or laminectomy surgery if all else fails.
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Facet syndrome. Your low back pain is most consistent with arthritis. Look for confirmation on your x-ray and MRI reports with discussion about “arthritis.” The traditional treatment is radiofrequency ablation done by a pain management physician.
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Discogenic low back pain due to an annular tear. Sorry, this is the least common and the hardest to treat. Traditionally, the recommended procedure is fusion; however, that does not always work and causes adjacent level issues. More recently a denervation procedure was approved called the Intercept procedure from Relievant. Some doctors recommend injection, The two options are stem cell-derived growth factors, and ozone.
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