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Advances in health and medicine.
Marjorie Bekaert Thomas
Advances in health and medicine.
Orthopedics Channel
Reported January 20, 2012

Replacing Knees with 3D! -- In Depth Doctor's Interview

Dr. Robert Zann, Orthopedic Surgeon in Boca Raton Florida, talks about a better procedure for replacing the knee with less trauma and faster recovery time.

Tell us about this procedure, how it’s different from normal knee surgery.

Dr. Zann: The way the trend of knee surgery is going it’s becoming much more sophisticated. Because the critical thing with doing knees is the alignment, the alignment dictates how that prosthesis is going to last. So the more perfect it’s placed the longer it’s expected to last and the better it does for the patient long-term because they get better range of motion, they get better faster. So everything kind of falls in to place and the whole picture is to get the patients on their feet quickly and back to normal with a knee that’s going to last their lifetime. Those are the goals.

With this you are actually taking a 3-D image, can you talk us through?

Dr. Zann: What would normally happen is instead of just having a normal x-ray which shows you the negative by performing an MRI scan or a CT scan of the whole extremity from the hip down to the ankle the company the company that we use right now out of California they’re able to reproduce the normal anatomy. Reconstruct what that knee and that extremity should have looked like originally when it’s lined up the way it was when you were born for instance, or developing. Not after its disease. So the images that the company has come back to us with shows what the knee should look like. Once we know what it should look like then they reconstruct certain tools that allow us to place the total knee in its exact position. This is a perfect knee it’s lined up exactly like you like to see it. Parallel to the ground and it fits properly. A knee that’s done well and lined up like that has every potential to last that patient’s lifetime. And that’s with any activity that they want to do short of jogging.

So this is an exact image of their knee because you’re taking that MRI image?

Dr. Zann: The MRI is allowing us to reproduce the pieces that are diseased and missing so that we reconstruct this knee the way the way it’s supposed to be when it was like it was before anything started.

Can you talk about some of the problems that you had in the past?

Dr. Zann: The whole object here is to find out what the normal anatomy should be. The way that we do that is arbitrary. We know where the center of the hip is on top and we know were the center of ankle is based on our best guestimates of it anatomically. So once we know where they should then the instruments that come with a particular knee allows us to make our cuts perfectly to put the pieces on as close as you can. But however, we’re still arbitrarily looking at the center of the ankle and the center of the hip, we can’t see them so we guestimating where those should be. You’ve taken that guestimate out of it now because you have a reconstructed knee and a reconstructed extremity by MRI scan. And MRI scan was done correctly it will show you the entire extremity. You don’t have to guess where they are we now know where the hip and the knee should be should be lined up with the ankle.

So what have the results been?

Dr. Zann: The results have been spectacular. One of our patients who you’ve met already she can show you how well in just a few weeks back to essentially normal activities when before she was limping badly and in constant pain. That patient was out of bed the same day she went home in three days. By the end of the first few weeks she was walking without a cane outside. These are the things that we are now able to reproduce fairly regularly because we make our incisions shorter, we don’t cut muscle. You know by having these different alignment blocks that we can put on the bone and know exactly how the bone should be ressected and where the components are placed we don’t have to make bigger incisions anymore. All this benefits the patient.

So it’s going to be less invasive and shorter recovery time?

Dr. Zann: Shorter recovery time and much less invasive.

Are her results typical then, you can be up and walking that first day?

Dr. Zann: Yes. Well she’s young and she’s very healthy of course but you have a young, healthy patient and you put the components in the right way this is exactly how they should be. They should be out of bed the same day, walking and going home and they’ve got their life back.

That’s got to be pretty exciting for you to be able to help these people, to get them back to their lives.

Dr. Zann: Well the single greatest thing I like hearing from patients when they come in and we just look at each other and they say, thank you for giving my life back that’s a wonderful thing to hear. Because you know it’s true.

Anything else you want to add about the procedure or past procedures?

Dr. Zann: I think that most of the companies now are offering products that have similar objectives in that the reconstruction is done by various companies. They just do it different ways. Now this particular company we’re talking about was really the first company I finally appreciated exactly what they were doing. I said this company has finally got the blocks right and everything is right. So that’s why we started and we switched over to this particular company. And since starting to use it it’s a tremendous, tremendous feeling that I can go home every day very comfortable that knee was done perfectly.

Do you have MRI images that you could show us?

Dr. Zann: The MRI images are just like an x-ray. The biggest thing I can show you these are actually the reconstructed components the companies make us and it allows us to take a knee, for instance this would be a knee, and place the guides over it and they fit exactly. So when they fit exactly the way they’re supposed to then we know exactly how that component is going to go in that knee. And these are custom, everybody has one made for them, theirs. So this will fit exactly, at the time of surgery there’s no guess work anymore we can place it exactly where it’s supposed to be and when we’re done the x-ray show that they’re in perfect position. And also because we have to put them in this way we don’t have to make extensive exposures anymore because I know where that piece is. I don’t even have to see up here I can feel it. So there’s less trauma to the tissue.

So what about scarring?

Dr. Zann: Well the scarring is much less, if you’re performing less of a soft tissue stripping type of operation, we don’t cut muscle either that’s the other beauty of this, you don’t have to cut muscle. By just moving the kneecap aside you haven’t cut muscle the scar is shorter. Of course if the scar is shorter the long-term scar will be shorter not only outside but inside and therefore they can mobilize the knee early and they don’t have a stiff knee. So all the function comes back faster. The smaller the scar the smaller the operation the more precise the operation all points to a better recovery.


This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.

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To read the full report, Replacing Knees with 3D! click here.

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