David W. Romness, MD
A judo enthusiast since the age of 12, James Bregman was a proud member of the first American team to compete in judo at the 1964 Summer Olympics in Tokyo. The 23-year- old Arlington, Virginia native made history at the games, winning a bronze medal.
His euphoria was short-lived, however. Just one year later, Bregman “destroyed” his right knee training for the world championships and, despite surgery, the joint never functioned properly again. Although he continued to be deeply involved in judo – conducting seminars around the country, coaching children and adults, taking teams to international competitions and serving as president of the U.S. Judo Association Board of Directors – he was unable to return to the mat.
After years of debilitating pain, Bregman finally consulted David Romness, MD, at OrthoVirginia about knee replacement surgery and received a mobile-bearing implant last year, at the age of 65. The results have been dramatic.
“My knee has been wonderful ever since the surgery,” Bregman says. “Not only has the pain virtually disappeared, but I have the full range of motion I need to get back on the judo mat and teach. I’m also playing a lot of tennis now and bike riding.”
Bregman says he owes it all to Dr. Romness and the OrthoVirginia team. “They are a very professional, highly competent practice and did an outstanding job. I knew just what to expect before, during and after surgery, as well as the specific things I needed to do to rehabilitate myself and come back to full functionality. Everything happened just as they said it would.”
Knee problems such as Bregman’s are the most common reason patients visit orthopaedic surgeons. As the largest joint in the body, the knee is complex and particularly susceptible to osteoarthritis, fractures and wear and tear injuries. Advanced technologies are revolutionizing knee replacements and OrthoVirginia is at the forefront, offering all of the latest treatments, procedures and products. One size does not fit all, however, and what is right for one patient may not be appropriate for another. For this reason, OrthoVirginia total joint replacement surgeons carefully assess each patient to determine the best course of action.
For Carolyn Abshire, of Alexandria, the answer was bilateral knee replacements. Suffering from debilitating and worsening osteoarthritis, this active grandmother opted to have both of her knees replaced at the same time. “I tried medicine and cortisone shots, and even had arthroscopies on each knee, but nothing much helped,” she recalls. “I was tired of the pain that limited my involvement with my family. And I liked the idea of having both knees replaced in a single operation.” Abshire underwent simultaneous bilateral total knee replacement followed by several weeks of in-home rehabilitation therapy, and is now pain-free. “I can kneel, I can walk, I’m more agile than ever before,” she says. “My experience as a OrthoVirginia patient has been a very happy one.” (Read more about simultaneous bilateral knee replacement on page x.)
Advances in knee replacement are focusing more frequently on customization, and the recent introduction of Gender Specific Knee – an implant designed specifically for women – is a prime example. According to Gender Specific Knee’s manufacturer, the implant offers three distinct differences: a thinner profile so it feels less bulky that a traditional replacement; more natural knee movement; and a more precise fit contoured to the unique size and shape of women’s knees, preventing potential damage to surrounding ligaments and tendons.
The average woman’s femur, or thigh bone, is narrower at the end and attaches to the tibia, or shin bone, at a slightly different angle than a man’s because women have wider hips. However, OrthoVirginia total joint replacement surgeons believe standard implants accommodate these differences perfectly well.
“Knee implants already come in all shapes and sizes and we pick the implant that best fits the individual patient, male or female,” says Dean Bennett, MD. “Although Gender Specific Knee is designed to be more anatomically consistent with the female anatomy, there is no evidence that it produces any better results than a properly sized, standard knee implant,”
“Women are asking for this implant and we do offer it,” says Dr. Romness. “Our job as surgeons is to discuss the pros and cons with patients before making any decision. We believe that as long as we have the right sized component and the procedure is done correctly, there is no difference in terms of outcome or long-range success. Multiple studies have shown no difference in outcome using Gender Specific Knees.”
Mark Hartley, MD, agrees that there is no scientific study to date which proves better results with a Gender Specific Knee. However, he believes there is a plus side to products such as Gender Specific Knee which has caused patients and doctors to recognize anatomic differences in all patients. “Doctors and manufacturers are focusing on the anatomic differences that can lead to potential problems in implant sizing that will lead to a greater variety of implants and more customization of the surgery for an individual patient. Ultimately, I believe this will make us look at customization for both hip and shoulder implants in the future, as well.”
Although not new, partial knee replacement, or unicompartmental knee arthroplasty, is another option that is gaining popularity thanks to advances in surgical techniques and materials. Instead of removing all cartilage from the knee joint and inserting a metal and plastic implant, surgeons remove only the most damaged tissue and resurface the affected area, preserving the remainder of an otherwise healthy knee. Patients are typically younger, with severe arthritis confined to a single knee compartment, and have tried all other conservative treatments including medications, injections, strengthening exercises, rehabilitation and weight loss.
Because it is minimally invasive surgery, partial knee replacement is far less traumatic than total knee replacement. Advantages include a smaller incision, less pain and bleeding, shorter hospitalization, and faster rehabilitation and recovery.
“This is a worthwhile option for the right patient – someone who has arthritis in just part of the knee, for example, and hasn’t had success with non-surgical treatments,” Dr. Bennett says. “It allows us to take the bad and leave the good, removing far less bone and preserving more natural motion.”
The procedure can also buy time for younger patients who may ultimately need a total knee replacement. “For those with localized knee pain, we may consider a partial knee replacement as a less invasive option that may or may not be a bridge procedure before a full replacement is necessary,” says Dr. Hartley. “Many patients want a less invasive partial knee replacement if possible but in my practice, only a small percentage of patients are candidates for this procedure. Patient selection is critical.”
The advancement that benefited James Bregman is the rotating, or mobile-bearing, knee implant, which not only swings back and forth like a hinge, but also rotates in and out in a twisting motion, more closely replicating the natural mechanics of the knee. The hope is that by acting more like a normal knee joint, the rotating replacement puts less stress on the implant and may last longer. This potentially benefits younger, active patients, who run the risk of wearing out a standard replacement during their lifetime.
Dr. Romness, who performed Bregman’s surgery, agrees. “With the rotating technology, the plastic moves with the knee as part of a controlled smooth surface, resulting in less wear and debris from the polyethylene. I think this is a good option for younger, active patients under 65, with excellent potential for long-term benefit. However, the life of any implant ultimately depends on a variety of factors, including the patient’s age, weight and activity level.”
OrthoVirginia surgeons stress the importance of carefully screening all patients who are considering a rotating platform or partial knee replacement. “But if the patient is a good candidate, this will result in a major improvement in quality of life,” explains Dr. Bennett.