New Knees. Better Back. Big News?
Minimally invasive surgery provides exciting options
read. A big sense of dread. That’s all you feel as you consider your options for fixing the arthritic knee you can barely move anymore. Or maybe it’s your back, which hurts all the time now. The pain, swelling, limited mobility - it’s changed the quality of your life, and you’re at your wits end. But the big question is what to do. And when to do it. And perhaps most importantly, what are the best options for you and your particular set of circumstances?
“In the big picture,” says Jared Foran, MD, and board-certified orthopedic surgeon with Panorama Orthopedics and Spine Center in Golden, “for patients to be ready for any knee replacement, they should have exhausted their non-operative options and should have symptoms that substantially affect their quality of life. Once patients are ready for knee replacement, my belief is that nearly every patient is a candidate for the minimally invasive approach.”
Minimally invasive vs traditional surgery
Minimally invasive surgery. What exactly does that mean? Is it as good as, or potentially better than, more traditional knee replacement procedures?
Following six years of residency, Dr. Foran did a one-year fellowship in complex and minimally invasive joint replacement at Rush University Medical Center in Chicago, considered one of the best fellowships in the world. “Among the many brilliant mentors I had there,” says Foran, “one is known for making tremendous advancements in minimally invasive knee replacement. After spending the better part of a year with him, it was clear to me that his minimally invasive technique made a huge difference in patients’ recoveries, and I was determined to use this technique for my patients as well.”
One of those patients is Ann, 64, who underwent minimally invasive knee replacement in 2015. Twenty-two years ago, she had traditional knee replacement surgery. Her experiences were vastly different and she says the minimally invasive procedure resulted in an outcome that far exceeded her expectations.
“The difference in the time spent in the hospital, the post-operative pain, and the recovery time is remarkable,” says Ann. “The [minimally invasive] incision is small in comparison, and healed nicely. My pain after surgery was minimal. My physical therapy was excellent and my quick progress amazed me. I worked hard both on my own at home and with my therapist, and the result was far better than I expected. After six weeks I had achieved a 130-degree bend, full extension, and returned to work full time. I do not experience any pain or stiffness in that knee.”
“The advantage of minimally invasive total knee replacement,” says Dr. Foran, “is less soft tissue damage, leading to less pain and a faster, easier recovery than traditional knee replacement. We can achieve this through avoidance of dislocating the knee and less retraction and cutting of soft tissues. This is made possible through specially made low profile instruments and low profile implants.” Eighty to ninety percent of Dr. Foran’s patients experience only a one-day stay in the hospital following surgery.
Cause and effect
The most common cause of both knee and spine disease is arthritis. Ronald Hammers, MD, and board-certified neurosurgeon with Colorado Springs Neurological Associates, says, “Degenerative spine disease, commonly thought of as arthritis, refers to the effects of aging, wear and tear, which is common to all. Degenerative disease encompasses a wide range of effects upon the spine, including disc bulge or herniation, bone spurs, ligament overgrowth and more. Trauma is another common cause of spine disease.”
Dr. Hammers says many patients with degenerative spine disease have very few or minimal symptoms, but as the disease progresses, people often develop back and neck pain, or neurologic symptoms. “Many can associate with back and neck pain,” he says. “However, it’s the neurologic symptoms that are often considered the most severe, and fortunately often most treatable.” Sciatica, numbness, pins and needles and weakness of a muscle group all fall into the category of neurologic symptoms.
In people who develop knee-joint issues, says Dr. Foran, two major causes of arthritis are osteoarthritis, which is a wear-and-tear type that occurs as we age, and inflammatory arthritis. “There are strong genetic predispositions in some people to develop osteoarthritis. Interestingly enough there is not a strong correlation between activity level and the development of arthritis. Osteoarthritis is more common after knee injuries. Inflammatory arthritis is usually the result of systemic autoimmune disease. The most common type of inflammatory arthritis is rheumatoid arthritis.”
The end result
So, let’s say you’re seriously considering knee or spine surgery. What can you realistically expect?
“Despite the myths suggesting that spine surgery frequently leaves a patient worse off than they were without surgery,” says Dr. Hammers, “it has been my experience that the vast majority of spine surgery patients do exceedingly well. The key is to select patients who are appropriate for surgery and select the most appropriate (often least invasive) surgery.”
Dr. Foran says, “The vast majority of my patients have outstanding outcomes. Importantly, I spend a lot of time with patients developing realistic expectations about how their knee will feel and function when it is healed. It is imperative that patients dedicate time and effort to their recovery process. Those that do are typically rewarded, as you get out what you put in. I firmly believe that I do 10% of the work and patients do 90%. Minimally invasive knee replacement provides an advantage in that it allows patients to do their 90% with less pain and quicker recovery.”