Knee replacement has been a commonly performed orthopedic procedure for decades, but technology continues to improve on the original concept. Many patients can safely undergo the procedure in an outpatient setting and device companies continue to create new implants. Christopher Cannova, MD, of OrthoBethesda in Maryland, shares his thoughts on the benefits patient-specific technology has for both orthopedic surgeons and knee replacement patients.
Dr. Cannova earned his medical degree from the University of Missouri-Kansas City School of Medicine and completed his residency at Georgetown University Hospital in Washington, D.C. He holds a fellowship in joint reconstruction from Hospital for Special Surgery in New York.
Q: How has joint replacement changed since you first began to practice orthopedics?
Dr. Christopher Cannova: It’s definitely come a long way. I think patient-specific knee replacements can do things that standard knee replacements we’ve had in the past really can’t do. This can be partially attributed to the fact that patient-specific knee replacements are a truly customized solution. The process of developing these implants involves taking each patient’s exact anatomy, matching that anatomy and then creating a knee replacement that will translate into that anatomy for the patient. This means each patient’s ligaments are balanced as they were prior to the knee replacement.
When we do a standard knee replacement, or an off-the-shelf knee replacement, we essentially put in a generic knee replacement and then reengineer the ligaments to that knee replacement. This process often requires the cutting of healthy bone and tissue in order to “make” an implant fit. With patient-specific knee replacements, we are allowed to take each unique anatomy and match it completely so that we don’t have to reverse-engineer the ligaments to fit the implant.
Q: How has patient-specific technology changed orthopedic practices?
CC: It opens up some knee replacement as an option for patients who may be kind of on the cusp of getting their knees done. Some patients who have typically been “in the gray zone,” where they weren’t quite ready for surgery, but they were extinguished — that is, using up the nonsurgical methods that we’d had as alternatives. Now, we can move those patients into a more pre-surgical or surgical phase, because more minimal deformity allows us to really address those problems for those patients with patient-specific technology.
Q: What is the most groundbreaking aspect of patient-specific knee replacements?
CC: For surgeons, the most groundbreaking part of this is really that restoration of anatomy. The fact that we can keep the joint line, which is what we talk about a lot in knee replacement surgery, exactly where that patient’s joint line was previous to our intervention, is critical. It is essential in allowing us to have balance and stability in the knee.
What we are looking at most as we advance knee replacement, and for that matter joint replacement surgery in general, is that we want patients to ultimately forget that they have a joint replacement. The way we are able to do that is by creating a stable knee that feels like their native knee. This technology is probably the biggest thing that we’ve seen so far that allows us to do that.
There are a lot of implants out there on the market, and there are a lot of implant companies who put a tremendous amount of research behind looking at different designs to recreate normal anatomy. Nothing to this point has been able to recreate exact anatomy like patient-specific technology really has.
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