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Multiple Choice

Breakthrough technologies broaden options for hip and knee replacement hopefuls

By Alex Lubischer

It had been months since Cheryl Risicato, 56, a retired cake decorator and avid dog lover, first came to Chicago’s Northwest Community Hospital (NCH) seeking partial knee replacement surgery. Risicato, like so many other Americans, suffered from osteoarthritis, a common yet potentially excruciating joint disorder brought on by the wear and tear of aging.

Over the past six years, she tried every alternative to alleviate the excruciating pain in her right knee including regular exercise, cortisone injections and physical therapy. The last straw came on Jan. 2, when her knee gave out at the top of her staircase, which caused her to fall down it. “I thought, ‘I don’t want to live like this,’” she says. “I just wanted to walk like a human again and not be afraid to go anywhere.”

On Apr. 24, Risicato checked herself into NCH for partial knee replacement surgery, an operation that, in decades past, carried the stigma of an arduous and painful recovery. Risicato hoped that her surgery, which utilized an innovative new technique known as MAKOplasty, might yield better results.

As Risicato lay unconscious in the operating room, a three-dimensional rendering of her wasted knee lit up a computer screen, informing her surgeon how to proceed. Using a robotic arm, Dr. Eduard Sladek precisely resurfaced the inner compartment of Risicato’s knee joint, burring away diseased portions while leaving healthy bone and cartilage undisturbed. Once resurfaced, her knee was ready for a metal and plastic implant, the alignment of which was optimized by Sladek’s robotic ally.

Far from science fiction, MAKOplasty Partial Knee Resurfacing is an osteoarthritis treatment that has been utilized by Northwest’s orthopedic surgeons since 2006. Its sister surgery, MAKOplasty Total Hip Arthroplasty (or, replacement), is also available, although, according to Sladek, robotic hip navigation is still “ramping up,” with one hip surgery performed per every four partial knee replacements.

Groundbreaking improvements to orthopedic technology, like MAKOplasty, have lessened the once staggering post-op recovery time for patients like Risicato and optimized the odds of regaining full mobility. These improvements, combined with longer-lasting implants and an aging baby boomer population, have made joint replacement surgery in the United States more common than ever.

According to the Organization for Economic Co-operation and Development, hip and knee replacement surgeries have nearly doubled in the United States since 2000. In 2009, 213 Americans out of every 100,000 received knee replacement surgery: the highest rate of any country in the world.

But as the rate of orthopedic surgery skyrockets, the number of cutting-edge options available to hip and knee replacement hopefuls is also on the rise. While multiple manufacturers of orthopedic technologies jockey for prominence, the opinions of top Chicago surgeons vary as to which new technique is the way of the future.

Dr. David Manning, for instance, an orthopedic surgeon at the University of Chicago Medical Center, champions Patient-Specific Instrumentation, a minimally invasive technique that has emerged as a competing player in the ever-evolving arena of orthopedic surgery. Using this technique, a surgeon first orders a CT scan or MRI of a patient’s knee. That data is then sent to an outside company, which utilizes the information to manufacture customized, disposable instruments that are specific to the unique knee of the patient. These instruments, along with an implant, are then delivered to the hospital, where they will be utilized, only once, to conduct the patient’s knee replacement surgery.

“What Patient-Specific Instrumentation is really trying to do is replace computer-assisted surgery,” says Manning. “So that all of the cognitive work that goes into using a computer for alignment purposes at the time of surgery has already been done.”

Dr. Richard A. Berger, an orthopedic surgeon at Midwest Orthopedics at Rush, brings yet another perspective to the table. Berger’s focus is on specificity. Removing all computers from the equation, he says, “We can assess how the tissues are reacting and put the knee [replacement] in precisely, based upon the patient’s soft tissues and ligaments in their knee and how things are working together.”

Like Manning, Berger specializes in minimally invasive surgery. He has said his specialized procedure typically entails a 3–1/2-inch incision and does not cut muscles, ligaments or tendons. The joint is cut out in small pieces at a time without disrupting the soft tissues. This results in less swelling, less blood loss and less pain, which all add up to a quicker recovery period.

Berger has been working to develop new, customizable prostheses that will allow the surgeons to more precisely make necessary changes during the surgery to account for the many variations. It’s his hope that it will make the operation much easier for the surgeons and the patients.

Even though Berger, Manning and Sladek have different methods in performing hip and knee replacement, each has seen success in patient recovery.

And while each of their methodologies have different appeals, most doctors believe Osteoarthritis sufferers should seek out a specialist who exclusively performs hip and knee replacements. Most importantly, patients should always consider the number of surgeries a doctor performs annually when making their decision. “You want to know that someone does hundreds and hundreds of these a year, not just a handful,” said Dr. Berger, who completed around 1,200 last year.

For Risicato, Sladek’s patient, things are looking up. The day after her partial knee replacement surgery, she was already walking with the aid of a walker. Just three days after surgery, she returned home and is currently undergoing in-home physical therapy. She looks forward to doing Tae-Bo again, to swimming and to taking long walks with her three dogs, Alex, RJ and Gizmo.

“I would recommend this MAKOplasty to anybody out there,” said Risicato on her second day at home. “Don’t be afraid to explore something new. Just because it’s new doesn’t mean it’s not going to work.”

In the end, it’s the options that are important. Like the option of walking and running again.

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Published in Chicago Health Summer/Fall 2012

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