Transcription:
Quadriceps Sparing Knee Replacement Surgery

Melanie Cole (Host): Our topic today is muscle sparing total knee replacement. My guest is Dr. John McLaughlin who's a board certified orthopedic surgeon at St. Luke's Cornwall Hospital. Dr. McLaughlin, what's typically been done? People have heard about knee replacements for years, but in terms of total joint replacement, what did you used to do, and what are we seeing different now?

Dr. John McLaughlin, MD (Guest): Well what we used to do, Melanie, is a very traditional knee replacement with an incision that's performed down the front of the knee, and in performing that procedure we would partially detach some of the muscles, some of the quadriceps muscles that attach to the knee in order to do the procedure. Through this muscle sparing, or quadriceps sparing technique, we're able to keep those quadriceps muscles attached to the knee, which really makes it a lot easier in terms of pain management after the surgery and the patient's recovery in the short-term after the procedure.

Melanie: That's amazing. Is this considered a minimally invasive procedure?

Dr. McLaughlin: It is. Because it's able to be performed through a smaller incision, and often a shorter surgical time, it is considered a minimally invasive procedure.

Melanie: So what are the benefits of this procedure versus- I mean you're still doing the old-fashioned way as it were, right? Because not everyone's candidates - and we'll get into who will be and who wouldn't be - but what are some of the benefits to this versus traditional?

Dr. McLaughlin: Sure, one of the benefits is that we're able to still use the traditional knee replacement, the implants that we use to do a total knee replacement. So we haven't changed the prosthesis, which is very important because the prosthesis has been shown and studied to be very effective in alleviating pain. But one of the advantages, or many of the advantages of doing this through this technique, is a more rapid recovering, or a more rapid return to functionality for the patient. Many of these patients can start utilizing a cane and be off a walker or crutches sometimes in as little as two weeks. In addition, the incision is often smaller, the surgical time is often a little shorter, and as a result there's often less post-operative pain.

Melanie: So who would be a candidate? Because we were talking a little bit off the air, not everybody is a candidate, it's a relatively newer procedure, yes?

Dr. McLaughlin: That's true, it is a newer procedure. Not everybody is performing the procedure. It's usually done by surgeons who have had a fair amount of experience doing knee replacements over several years, and then incorporate this technique into their practice. Again, one of the advantages is the pain relief that comes afterwards. Not everybody- not every individual is a candidate for this. Patients with very, very stiff knees, or patients who have difficulty bending their knees very far prior to surgery may not be candidates for this procedure. In addition, some obese patients may not be terrific candidates for this type of procedure either.

Melanie: So doctor, as this is a newer procedure, and it would seem to be more challenging, what additional training is required?

Dr. McLaughlin: Well for me, it was part of my fellowship training. After I completed my orthopedic residency over approximately a five-year period of time, I did an additional year of training called a fellowship specific to joint replacement. And during that additional year of training, I learned this technique as one of the techniques to perform a total knee replacement. It can also be learned after the fact, after a surgeon becomes a little bit more experienced doing traditional total knees and can be incorporated into their techniques to offer their patients.

Melanie: Do you see it's going to be kind of a wave of the future in that more and more physicians are going to be using it?

Dr. McLaughlin: I've been very happy with the result, and I certainly hope it does become the wave of the future. I've been very happy with the pain relief and the functionality of the patients, and even in the short-term after their surgery, so I hope that more and more surgeons incorporate it into their practice in the future.

Melanie: Speak a little bit about the outcomes that you've seen. Are your patients pretty happy with this?

Dr. McLaughlin: They seem to be very happy. In comparing pain scores, the patient's level of pain after a traditional knee replacement and after a quadriceps or a muscle sparing knee replacement, I've seen a significant decrease in the pain scale or the patient's post-operative pain in that period while they're hospitalized here. I've also seen them just regain function much more quickly. These patients can often lift their leg up off the bed or off the exam table within just a couple hours after surgery. And as I mentioned earlier, many of these patients can discontinue the use of crutches or a walker in as little as two weeks because their quad strength, their muscle strength that crosses the knee is much better earlier on because the muscle and tendon has never been detached from the knee during the procedure.

Melanie: Do you want patients to be strengthening their quads before a procedure like this, or any knee replacement for that matter? Do you like them to do a little prehab before they go in for the procedure?

Dr. McLaughlin: I do, I think prehab is a great term. Prior to the procedure, we often give patients a set of exercises to do that are fairly simple, they can be done in bed to strengthen their quadriceps, the muscles in the front of their thighs, because I think that makes the rehabilitation easier after the surgery. If those muscles are stronger beforehand, it makes the recovery that much easier. These exercises are usually fairly simple and don't require any deep squats or lunges or anything like that which are often difficult for a person with osteoarthritis of their knee.

Melanie: So please tell us a little bit about the Center for Joint Replacement at St. Luke's Cornwall. What can a patient expect pre- and post-surgery? What's it like for them?

Dr. McLaughlin: Sure, the Center for Total Joint Replacement at St. Luke's Hospital here in Newburgh was established approximately ten years ago. In fact, we just celebrated our ten-year anniversary. I've had the pleasure of serving as the Medical Director for the Joint Center for approximately the last two and a half years. We've implemented a number of different changes in terms of pain management, physical therapy, and an educational program before surgery, which we think is just so important the patient understands every step of the way. And as a result, we've gotten some phenomenal feedback from patients who really had a great experience through that process. As difficult as surgery in rehabilitation can be, understanding the process from the patient's perspective is just so important, so we've implemented quite a bit of that over the last two or two and a half years.

Melanie: So wrap it up for us. Give us some advice about protecting our knees, keeping healthy strong knees, and what you want people to know about this newer minimally invasive quads sparing surgery for knee replacement.

Dr. McLaughlin: Sure, one of the best ways to maintain knee health, we can call it that, is to monitor your weight. Increased weight, increased body mass puts increased forces on the knees. So even normal activities walking, climbing stairs can cause wear and tear of the knee, and that's really what osteoarthritis is, wear and tear of the cartilage. So by keeping your body weight down, there's less wear and tear over years, and the longevity of your knee can be increased. We see osteoarthritis occur in younger patients who are larger, who are overweight, because they wear out their joints more quickly. Obviously avoiding injury, avoiding meniscus tears, fractures, your life can certainly minimize the risk for developing osteoarthritis in the knees, and hopefully avoid or at least delay the need for a knee replacement. Utilization of this technique, this muscle sparing or quadriceps sparing technique, has really been I think a tremendous advantage to my patients for all the reasons that I mentioned before; increased and more quick return to functionality and to a normal life after surgery, decreased pain, smaller incision, and then sometimes even a shorter hospital stay. So we've been very happy to incorporate that into the Center of Total Joint Replacement here at St. Luke's.

Melanie: Certainly something really fascinating for potential patients to ask their physicians about if they're considering a knee replacement. Thank you so much, Dr. McLaughlin, for being with us today. This is Doc Talk, presented by St. Luke's Cornwall Hospital. For more information, please visit www.StLukesCornwallHospital.org. That's www.StLukesCornwallHospital.org. I'm Melanie Cole, thanks so much for tuning in.