Total knee replacement surgery is one of the most common joint replacement procedures. Approximately 790,000 surgeries are performed in the U.S. each year, and that number is only expected to grow as the population ages, rates of obesity increase and more young people seek knee replacements.
By far the most common reason for a total knee arthroplasty, as the surgery is known, is osteoarthritis, the “wear-and-tear” arthritis that occurs with normal aging. With osteoarthritis, the protective cartilage in the knee breaks down, causing pain as the bones start to rub together. Other reasons for a replacement include rheumatoid arthritis and knee injuries.
While knee replacement surgery is considered a major operation that comes with risks, advances in technology have changed things considerably. Joint implants are more durable and robotic-assisted orthopedic surgery offers the potential for increased accuracy and precision versus traditional surgical methods.
VELYS™ Robotic-Assisted Solution from Johnson & Johnson MedTech, in conjunction with the ATTUNE™ Knee System implants, is at the forefront of these advances. “Surrounding an incredible implant with a system that allows the surgeon to personalize how that implant goes in—and ensuring that it’s executed as intended—is what makes this system so powerful,” says Will Brassel, Vice President, Velys Global Strategic Marketing & Power Tools at DePuy Synthes, a Johnson & Johnson MedTech company. The company is also working this year to expand the Velys Robotic-Assisted Solution System so that, pending clearance from the U.S. Food and Drug Administration, it can be used in both total and partial knee replacement procedures.
For Arthritis Awareness Month, we’re taking a look at the latest facts about knee replacement surgery and how Johnson & Johnson is innovating to make an impact.
1.
Used to be, total knee replacement surgery was reserved for people in their mid-60s and up, says Andrew Star, M.D., Medical Director of the Orthopaedic and Spine Institute at Jefferson Abington Hospital. “Even young people with arthritis would be told they were too young for a replacement,” he says. “What’s happening now is that younger people are coming in after an injury or with premature arthritis and their quality of life isn’t what they want it to be. As the technology has improved, younger people have a higher level of expectation that maybe they can have their knee replaced.”
As recently as the year 2000, knee implants lasted 10 to 15 years, often necessitating a repeat surgery in younger patients. Today, up to 82% of implants can last 25 years. “If we have implants that can last 20 to 25 years, it starts to expand the possibilities of who this is appropriate for,” says Dr. Star. “It’s kind of like the tread on your tires. If you have stronger tires, they don’t wear out as quickly.”
For older patients, implants are commonly attached to the bones using bone cement. Younger patients, who tend to have healthier bones, may be candidates for cementless implants.
“This has been done in hip replacements for decades, but the popularity of cementless knee replacements is much more recent,” says Dr. Star. “Implants can be made in very complex shapes and sizes so that they really match very well with the anatomy of the patient and allow the bone to knit to the implant.”
2.
In conventional, or manual, knee replacement surgery, surgeons use handheld tools to remove the damaged cartilage and rely on their judgment and expertise to determine positioning of the implant based on the patient’s anatomy.
With robotic-assisted total knee replacement surgery, however, technology assists the surgeon to gather personalized data about the patient’s knee anatomy, which can provide precision and accuracy during surgical procedures.
“If anything changes the position of the knee during surgery, even slightly, the Velys Robotic-Assisted Solution recognizes it and adjusts the cut accordingly,” says Brassel. “So you’ve got a second set of eyes, so to speak, to ensure that the surgeon is able to execute as they had planned. It eliminates any guesswork.”
3.
A total knee replacement procedure takes around an hour, not including anesthesia and post-operative care. Not only has a patient’s stay in the hospital decreased in the past few years, this procedure is sometimes done on an outpatient basis, as is physical therapy.
“Now, we firmly believe that the healthiest place for the patient is in their home, and the healthiest things for them to be doing are the things they normally do,” says Dr. Star. “We try to get people to that point as quickly as possible because that’s the way they tend to recover best. For the most part, these are not sick people who are having surgery; these are healthy people with a bad knee.”
That said, it can take a few months to a year to recover fully, though it varies considerably from patient to patient. “Some are driving and returning to work with few complaints in two weeks, while others are still doing physical therapy at three months,” says Dr. Star. “A lot of it depends on how strong they were before the surgery. Were they out of shape because they’d had a bad knee for years? Or is this an active person who can resume activities more quickly?”
No matter the case, Dr. Star says the most common reaction he gets from patients who’ve had a knee replacement is that they wish they had done it sooner.
Important Safety Information: It is important to remember that the performance of joint replacements depends on age, weight, activity level and other factors. There are potential risks and recovery takes time. People with conditions limiting rehabilitation should not have these surgeries. Only an orthopedic surgeon can determine if joint replacement is necessary based on an individual patient’s condition.
