Q&A Topic: Knee Replacement Surgery
Steven Zelicof, MD, PhD
Q. When is somebody a candidate for knee replacement surgery?
A. First we should exhaust all other non-surgical options, such as lifestyle changes, exercise, bracing, physical therapy, anti-inflammatories, and injections to lubricate the knee and control pain. Qualitatively, the “bad days” should out number the “good days”. When you can’t do the things you normally like to do—walking with friends, chasing your grandkids, playing golf, etc.—it may be time to think about surgery.
Q. How does the process work? What can patients expect?
A. First we educate our patients. We meet with them. We send them to a pre-op class at the hospital, where they meet some of the members of our team, which consists of physical therapists, social workers, nurses, nurse practitioners and the OR team. We also do an extensive medical evaluation as well as a course of preoperative physical therapy to make the patient strong and flexible before the operation.
Most of the surgery is done under a regional anesthetic, as opposed to general. We use both robotic-assisted surgery (using the Mako robot) as well as computer-navigated minimally invasive surgery to optimize implant placement with minimal damage to surrounding soft tissues. After a short hospital stay, we send people home with a course of physical therapy.
Q. How has robotics changed the surgery process?
A. Depending on the particular situation, robotics gives us the ability to establish a better preoperative template. We can use CT scans and imaging studies before the operation to get a clearer understanding of the anatomy. During surgery, we can execute the procedure with very precise cuts thanks to robotic guidance. This process limits damage and trauma to surrounding tissues, making the operation safer and minimizing postop joint pain and soft tissue damage.
Q. Is there an optimal age for knee replacement surgery?
A. We like to look at the patient’s physiologic age, rather than their chronologic age. Knee replacements may last about 30 to 35 years. For younger patients, we want to make sure they’re not living in pain and not functionally disabled. For older patients, we want to help them maintain balance, mobility, and independence. We also want to minimize the need for pain medications.
Q. What preventive measures can people take to protect their knees?
A. Stay as active as possible. For every 10 pounds that you lose, your knee sees 40 pounds of relief. Keeping weight off makes a big difference! If you have a bad knee, avoid high-impact sports, like running, and switch over to lower impact activities, like bicycling, elliptical walking, and swimming. Be aware. If your knees hurt, seek advice from a qualified orthopedic surgeon. There are many nonsurgical solutions: more often than not, surgery can be avoided.