Moving Forward With Knee Surgery: Q&A With Dr. Wallace Huff of Bluegrass Orthopaedics

Orthopedic Sports Medicine

Dr. HuffWallace Huff, MD, board certified in sports medicine and orthopedic surgery, practices with Bluegrass Orthopaedics Lexington, Ky. Dr. Huff earned his medical degree from the Eastern Virginia Medical School in Norfolk, Va. He completed both his residency and fellowship at the University of Virginia in Charlottesville. Dr. Huff joined Bluegrass Orthopaedics in 2010. He focuses on general orthopedics, total joint replacement and sports medicine.

Here he discusses minimally invasive knee surgery, the benefits of patient-specific instrumentation and implants and kinematic balance in total knee arthroplasty.

 

Q: What attracted you to orthopedics and sports medicine?

 

Wallace Huff: I have been an athlete my whole life. After college I became a tri-athlete and completed in an ironman in 2007. Today I'm still competing at age 48.

 

In high school, I spent some time with our football team's physician while working in his office, which piqued my interest in orthopedics and sports medicine. I could see myself doing what he did.

 

I appreciate variety in my patients as an orthopedic surgeon, from age to ailment. It is also satisfying to see the immediate results of your work as patients are relieved of their pain and back to the activities they enjoy.

 

The other compelling thing about orthopedics and sports medicine is that they are dynamic fields. I am constantly learning newer, better ways of doing things and as a result refining and improving the art of orthopedic surgery. This actually goes on to extend to additional surgical fields. For instance, the arthroscopic and minimally invasive techniques we use in sports medicine are certainly applicable to the population at large.

 

Q: How do you think minimally invasive knee surgery will evolve in the next few years?

 

WH: First, let's qualify that minimally invasive with respect to knee replacement refers to how to restore the knee to the pre-arthritic condition with the minimum bone resection and soft tissue damage. Incision size is only a very small component of accomplishing that goal.

 

In the coming years, I think we will see implants that are conducive to making limited bone resection but retaining long-term durability. I also think we will see implants that allow us to preserve native ligaments and soft tissues such as the ACL, sparing total knee replacement.

 

Q: Will patient-specific instrumentation continue to be a growing trend?

 

WH: Although the jury is still out, and we need long-term prospective studies to support patient-specific instrumentation, I have seen my patients benefit from this technology over the last two years. With CT or MRI based cutting guides one can plan bone cuts preoperatively, ensuring more accurate alignment and balance at surgery, which should promote greater longevity.

 

The ConforMIS iTotal® G2 Knee Replacement System is a CT based, customized TKA in which all cuts are planned preoperatively and the implant is specifically made to fit each individual patient's anatomy. The advantage is a perfect fitting implant that is easier to balance with less soft tissue irritation and a knee that feels more natural. For these reasons, in addition to no significant difference in cost, I think we will see the market for patient-specific implants continue to grow.

 

Q: How does kinematic balance play into total knee arthroplasty?

 

WH: Traditionally orthopedic surgeons have been taught to align total knee replacements perpendicular to the mechanical axis. The work of Dr. Stephen Howell and others has shown us that doing this places the femur in a non-anatomic position with an oblique slightly elevated joint line, which does not match the normal axes of flexion and rotation. This makes soft tissue balancing much more difficult, frequently resulting in flexion instability that can compromise function and cause pain. To kinematically balance a total knee is to restore it to its pre-arthritic state. Bone resections should exactly match the thickness of the prosthesis albeit slightly thinner on the side with the most wear. Once this is accomplished, soft tissue balancing is just a matter of removing osteophytes with minimal if any release of tissue required. This can be done freehand by measuring bone resections and being aware of the thickness of the prosthesis.

 

My preference is to use the patient-specific total knee system from ConforMIS where with a CT based three dimensional model of the knee, cutting blocks and implants are made to achieve kinematic balance in each individual patient. The only caveat with this system is that it is based on mechanical alignment in the coronal plane, but this is made up for by differential thickness of the medial and lateral poly inserts. The bottom line is that a patient with a correctly balanced total knee is a happier patient.

 

Q: What is the biggest unanswered question in orthopedics?

 

WH: In the midst of increasing governmental regulation of healthcare, can we continue to provide safe effective efficient and high quality orthopedic care? Consider this in light of an aging population that is rapidly increasing in the coming years in the midst of decreasing reimbursement to doctors and rapid increase in cost of providing care, the burden of which is born by the taxpayer and healthcare provider alike. It is a multifaceted question. As surgeons we will try to put patient care first, but our ability to do this could be limited by increasing costs.

 

More Articles on Orthopedics:
11 Orthopedic Practices Expanding or Adding Physicians
Customized Implants & the Specialization of Orthopedics: Q&AA With Dr. Barry Waldman of OrthoMaryland
Knee Surgery Totals $12B in Societal Savings

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.

 

Featured Webinars

Featured Podcast

Featured Whitepapers

Most Read - Sports Medicine