Knee Procedure Cuts Recovery

BRMC Newswatch by Sharon Miller
Baxter Bulletin 12/21/04

More than two years ago, Baxter Regional Medical Center, through the efforts of orthopaedic surgeon Dr. Thomas Knox, became one of only two hospitals in the nation to offer a less-invasive form of knee-replacement surgery that cuts down on recovery time.

Knox explained the difference between traditional knee-replacement surgery and what has now become the method of choice for patients whose leg structure makes them candidates for it.

Total knee replacement for many years has involved an incision of six to eight inches. The surgeon then cuts through the quadriceps tendon and flips over the patella (kneecap) to allow access to the area beneath it.

Using the new technique, the surgeon makes an incision in the muscle, leaving the tendon intact, and instead of flipping over the kneecap, he pushes it to the side.

Since the tendon is not cut, the initial rehabilitation goes more quickly, Knox explained.

Patients also see a cosmetic benefit since the scar is smaller.

When orthopaedic surgeons began looking at less-invasive procedures, they realized smaller instruments would be needed to perform such surgeries.

Orthopaedic implant manufacturer Smith and Nephew, the company whose products Knox uses, manufactured such instruments. The smaller instruments were first used by Dr. Richard Laskin, who developed the procedure at the Hospital for Special Surgery in New York City.

Early on, only two sets of instrumentation were released by Smith and Nephew - one set to the New York City Hospital and the other to Baxter Regional Medical Center.

"I spent time at meetings with Dr. Laskin learning the particular nuances of the technique," Knox said. BRMC later obtained a second set of the instruments needed for the less-invasive surgery.

Knox now has a two-year follow-up with patients who had the less-invasive procedure. "They're doing every bit as well as the folks who had the standard knee surgery," he said.

The only drawback he sees is that the newer technique is not for everyone. People who are extraordinarily obese or who have larger than normal legs are not good candidates for it, Knox said.

Other hospitals now offer the technique, he said, but it was six months to a year after BRMC started performing the surgery that other facilities were able to get the instruments.

Knox is in practice at Regional Othropaedic Health Care. He does the less-invasive knee surgery and a less-invasive total hip-replacement procedure as well.