Mark S. Sanders, MD FACS
Special thanks to DePuy
Orthopaedics, Inc.
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Agenda
1. How your knee works
& why it hurts
Thigh bone
(femur)
2. Knee replacement
basics
3. What patients have
to say
4. Your questions
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Cartilage
Kneecap
(patella)
Shin bone
(tibia)
How your knee works
Anatomy of the knee
• Largest joint in body
• Referred to as a hinge joint because it allows the knee to flex &
extend; while hinges can only bend and straighten, the knee has
the ability to rotate (turn) & translate (glide)
• 3 bones
• Shin bone (tibia)
• Thigh bone (femur)
• Kneecap (patella)
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What’s causing your pain?
It’s estimated 70 million people in the U.S. have some form
of arthritis.1 Osteoarthritis is one of the most common types.
• Osteoarthritis
• Wear and tear that deteriorates the “cushion” in your joints
• A degenerative condition—it won’t get better and may get worse
• Rheumatoid arthritis
• An autoimmune disease that attacks the lining
of joints, causing swelling, possibly throbbing pain
and deformity
1. Landers, S. Another reason to exercise for those with arthritis. American Medical Association website.
<http://www.ama-assn.org/amednews/2005/05/02/hlsc0502.htm>, 2005.
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What’s causing your pain?
Healthy knee
The end of each bone in the joint is
covered with cartilage, acting as a
cushion so the joint functions
without pain
Diseased knee (osteoarthritis)
Wear and tear deteriorates natural
cushion, leading to bone-on-bone
contact, soreness and swelling
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Assessing your pain
• Does your knee hurt one or more days per week?
• Does the pain interfere with your sleep?
• Is it painful for you to walk more than a block?
• Are pain medications no longer working?
• Is knee pain limiting your participation in activities
(e.g. family vacations or other functions)?
• Has inactivity from knee pain caused you to gain weight?
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Assessing your pain
• Rate your pain on a scale of 1 to 5
• For most people, the tipping point is about 4 or 5—
that’s when the pain becomes too difficult and they
turn to a surgeon for relief1
Little or
no pain
1. 2007 DePuy Orthopaedics, Inc. Knee Attitudes & Usage Study.
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Excruciating,
debilitating pain
Assessing your pain
Check your mobility
If you have difficulty performing any of the movements below,
it may be time to talk to your doctor about next steps
Walk
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Bend at the
hips and knees
Pretend to drive:
push the gas/brake
Pretend to golf:
swing a club
How can your pain be treated?
• Medications
• Analgesics
• Corticosteroids
• Injections
• Corticosteroids,
hyaluronic acid
(e.g., Orthovisc®)
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• Water therapy
• Soaking, ice packs,
hot packs
• Exercise &
physical therapy
• Also good for weight
loss
Knee replacement
• Implants replace damaged surfaces
• Helps relieve pain and restore mobility
• More than 500,000 knee replacements
are performed each year in the U.S.1
• A recent Arthritis Foundation® study
shows knee replacement has a 90-95%
rate of patient satisfaction2
1. <http://www.aaos.org/Research/stats/Knee%20Facts.pdf>, 2005.
2. The Arthritis Foundation. <http://arthitis.org/research/Bulletin/vol5no11/Printable.htm>, 2006.
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What is knee replacement?
A surgical procedure that
removes and replaces
diseased joint surfaces
with implants
Femoral
component
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Tibial
component
How does it work?
• Diseased areas at top of shin bone
(tibia) and bottom of thigh bone (femur)
are removed and reshaped
• Femoral component covers the
thigh bone (femur)
• Tibial component covers the
shin bone (tibia)
• Polyethylene insert placed between
femoral and tibial components
• Patellar component replaces the
kneecap (patella)
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Femoral
component
Polyethylene
insert
Patellar
component
Tibial
component
How does it work?
Healthy knee
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Knee replacement
®
DePuy Sigma Knees
• Sigma Knees come in a wide range of shapes, sizes and
materials
• Your surgeon may be able to fit you with a Sigma Knee
designed to provide a more natural feel and movement
• Sigma Knees can be implanted using minimally invasive
surgery
• The Sigma Knee is a great example of a proven design
that continues to evolve to meet the demands of today’s
patients
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®
Sigma Fixed-Bearing Knees
• Most widely used type of knee
replacement in the U.S. today1
• Designed to enhance stability
of the joint
• New designs and advanced
materials
- Helps reduce wear
1. IMS Health
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®
Sigma Fixed-Bearing Knees
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®
Sigma Rotating Platform Knees
Rotating Platform Knee
Designed to rotate as it bends, imitating your
natural knee movement
• The surfaces of the knee joint roll
and glide against each other as
you bend. In other words, your knee
naturally rotates as it bends
• Designed for patients who want to
remain active since it minimizes
implant wear, compared to traditional
knee replacements1
• A multi-center DePuy Orthopaedics study shows 97% patient
satisfaction at 5 years after surgery2
1. McNulty, D. et al. “In Vitro Wear Rates of Fixed-bearing and Rotating Platform Knees (Rev. 2).” 2003.
2. DePuy Multi-Center Study. 2006.
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Should you wait to replace your knee?
Assess your pain and ability to function
• Do you feel severe pain in your knee?
• Has the pain and loss of function affected your quality of life?
• Do you have difficulty sleeping or performing basic functions
(walking, driving, climbing stairs)?
• Does medication no longer provide relief?
Consult your physician
Early diagnosis and treatment are important1
• Delaying may lower your quality of life2
Osteoarthritis is degenerative—it won’t get
better and may get worse
1. Fortin PR, et al. Outcomes of Total Hip and Knee Replacement. Arthritis & Rheumatism. 1999;42:1722-1728.
2. Fortin PR, et al. Timing of Total Joint Replacement Affects Clinical Outcomes Among Patients With Osteoarthritis
of the Hip or Knee. Arthritis & Rheumatism. 2002;46:3327-3330.
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Information specific to Dr. Sanders’
approach
Preoperative Planning
• Long Standing X-rays (Orthoradiograms)
• Medical, Vascular, and Cardiac clearance
• Patient Education
Decreasing Postoperative Pain
• Spinal Anesthesia decreases post op pain and
thromboembolic disease
• Minimally Traumatic Surgery
• Minimal Use of the tourniquet averages 20 minutes
• Ranawat cocktail locally injected for post op pain
relief
• Rapid Surgery (averages one hour)
• Epidural catheter for pain relief x 2 days
• Oral analgesics
• Cryocuff for cold therapy
Decreasing the Incidence of
Thromboembolism
• Immediate Active Motion without CPM
machine (average patient’s motion 0-120
degrees by day one)
• Foot pumps placed before surgery to
decrease thromboembolic disease
• Ambulation with PT that afternoon TED
antiembolism stockings worn for two weeks
• Medications given to prevent clotting
• Most patients receive only Aspirin
Decreasing the Infection Rate in the OR
• Preoperative intravenous antibiotics
• Antibiotics impregnated in bone cement
• Special “Space Suits” worn by all scrubbed
OR personnel
Post Operative Rehabilitation
• Immediate active motion (no CPM machine)
averages 0-120º within 24 hours
• Ambulation with PT that same day
• Average hospital stay from Tuesday to Friday
• Most patients <70 go home
• Most patients >80 go to rehab hospital
• Average length of time with crutches/walker 10 days
• Average time in PT ranges from 4-6 weeks
Wound Management/Infection Prevention
• Patients shower daily with ® Hibiclens
starting at 24 hours post surgery
• Compression stockings worn for two weeks
• No skin staples
• ® Dermabond (medical grade ®Krazyglue)
lasts for ten days
• Intracuticular sutures (®Quill) dissolves on its
own without need for suture removal
Important safety information. . .
• As with any medical treatment, individual results may vary
• The performance of joint replacements depends on your age,
weight, activity level and other factors
• There are potential risks, and recovery takes time
• People with conditions limiting rehabilitation should not have
this surgery
• Only an Orthopaedic surgeon can tell if knee replacement is
right for you
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Summary
• The leading cause of knee pain is osteoarthritis
• Osteoarthritis is degenerative – it won’t get better and may get
worse
• Early diagnosis and treatment for total knee replacement are
important1
• A recent Arthritis Foundation® study shows knee replacement has a
90-95% rate of patient satisfaction2
• Sigma Knees come in a wide range of shapes, sizes and materials,
so your surgeon may be able to fit you with a knee designed to
provide a more natural feel and movement
1. Fortin, Paul R., et al. Outcomes of Total Hip and Knee Replacement. Arthritis & Rheumatism 42 (1999): 1722-1728
2. The Arthritis Foundation. <http://arthitis.org/research/Bulletin/vol5no11/Printable.htm>, 2006.
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And Never Forget:
• Inform every doctor or dentist you have a
knee replacement to receive antibiotics
before invasive procedures
Thank you!
To find out more about knee pain and
the treatment options available, visit:
www.kneereplacement.com
www.aaos.org
© DePuy Orthopaedics, Inc., 2010.
The third party trademarks used herein are trademarks
of their respective owners.
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