One of the first things we learn about each other is that we are all different. We look different. We have different interests. We like different foods. We like different movies. Some are tall and some are short. Some have blue eyes while others have brown ones. Some of us are good at sports, some are good at writing, and some of us are good at math.
Despite this difference, believe it or not, surgeons are taught to do the exact same knee replacement on every single patient.
When most orthopedic surgeons perform a total knee replacement, they choose the same alignment, known as mechanical alignment, for everyone. They make the femur cut and the tibia cut the same for everyone regardless of what that person’s specific anatomy is. If you have knock-knees, you get the same cut as someone who has bow-legs. If your knees have always been very bowed, you get the exact same cuts as someone whose knees only have a slight bow. Every knee is treated the same.
You can walk through the grocery store and realize that not everyone has the same knee. Some have different angles than others. Some have bow-legs, while others have knock-knees. Some have perfectly straight legs.
There is no one type of knee that is normal. Instead, everybody has a knee that is normal for them. Is it any wonder that some people don’t like their knee replacement?
Why Do We Make Everyone the Same?
While making the cuts the same for everyone does not make sense today, it did in the 1980’s when total knee replacement was first being developed. Back then, surgeons were just trying to figure out how to get the surgery to work well enough.
The goals of total knee arthroplasty were different then. The goal was to help a patient who could hardly walk so that they could walk some. The goal was to take a patient who has pain all of the time and simply make it so that they would have less pain.
Making the knee the same for everyone makes sense when all you are trying to do is to make the knee good enough.
Our expectations of knee replacement are different today. The goal isn’t just to get rid of some of the pain, but to make it where hardly notice your knee. The goal isn’t to make it where you can walk some, but to make it so that you can do all of the things you want to do. The goal is to help you play golf or tennis. The goal is to make it possible to travel and enjoy it. The goal is to help you spend quality time with your children or grandchildren. The goal is to help you get back the things you want to do that your knee pain took away from you.
If you want to get your life back, just good enough is no longer good enough.
Different Goals Require Different Strategies
Performing total knee replacement surgery the same on all patients works from a certain viewpoint. It creates a knee that does make life at least some better for most people. Nearly everyone experiences an improvement in their pain and would say that their life is better because they had the surgery.
If you start asking more specific questions, however, you learn that the procedure may not quite be as successful as we would like to think. In one study 88% of patients said they were satisfied with the outcome of their surgery, however, if you asked more specific questions they noticed different answers.
- 34% were unhappy with their pain levels
- 48% said they were unable to return to “normal” activities
- 56% could not return to leisure activities (tennis and golf)
- 60% had to modify their life due to their new knee
- 84% could not run, jump, twist, or kneel
Sadly, performing the exact same knee replacement on every single patient means that some people are not able to do as much with their knee as they would like.
A Patient Specific Approach to Total Knee Replacement
In 2005, a surgeon in California recognized that knee replacements do not always work well. He hypothesized that the issue had to do with anatomy. When we change the anatomy by performing a knee replacement in the standard way, we change how the ligaments on the side of the knee function.
Putting the knee in an different position means that one side of the knee can be tight while the other side is loose. This difference causes pain. Pain makes it difficult to be active and can even make the knee stiff.He developed a technique in which the goal of the surgery is to restore the anatomy of the knee the same as it was before arthritis ever developed.
The goal is to make cuts specific to each patient’s anatomy. The anatomy of the colalteral ligaments (the MCL and the LCL) are recognized and cuts are adjust to match. If their is some obliquity to the knee, it is preserved.
When I perform total knee arthroplasty I take this approach. Anatomy matters and instead of trying to make every person the same, I adjust cuts in order to try to match the patient’s specific anatomy before they ever had arthritis in their knee.
My goal is not to make every knee the same, but instead, to simply restore the normal anatomy for each invidious patient.
This individualized approach to total knee arthroplasty has been shown to be more likely to result in a knee that people like better and can be more active with. This type of strategy also results in a knee that is equivalent to or even better than a partial knee replacement.
If you would like to make an appointment with Dr. Statton to discuss the patient specific strategy to knee replacement surgery, please click here.
