In a paper soon to be published in the Journal or Arthroplasty, the joint replacement group at New York's Columbia University Presbyterian Hospital demonstrated that, in short-term follow-up, patients who underwent partial knee replacement did better than those who underwent total knee replacement. All measured scores were better in the partial knee group, including post-operative mental well-being, physical function, and pain relief. Patients were selected via strict criteria and critical review of the research showed that there is a trend toward excellent long-term function of these implants.

Dr. Gomberg recently joined many of the nations leading knee replacement surgeons to discuss the future of patient-specific instrumentation and new directions in knee replacement technology. Given that each person’s knee is unique, the same instrumentation solution may not necessarily be right for everyone. Dr. Gomberg is one of the region's first to use a personalized knee instrumentation solution designed specifically for each patient’s anatomy. This technology uses a three-dimensional computerized scan of the leg to create customized surgical instruments designed to deliver a  precise knee replacement based on each person’s unique anatomy. Personalized instrumentation is an exciting new technology that can add years to the life of the implant by more precisely positioning the knee implant in the patient.

A recent paper by Dr. Mike Mont's group in Baltimore was one of the first to publish excellent medium-term results of patellofemoral arthroplasty (PFA), replacement of the back of the kneecap and the groove in which it glides on the end of the thigh bone. Their promising results over the first 7 years after partial knee replacement showed excellent pain relief and function over the first 5 years that slightly decreased over the next two. About 15% of patients underwent conversion to a total knee replacement.  This paper further highlights the advantages of partial knee surgery, which can have a significantly lasting effect in those who are in the younger, active segment of our population.

I received great news today about our first full month of knee replacements at Coastal Ortho. Our hospital length of stay for all knee replacements was an outstanding 1.7 days for the month of February, 2012, compared with the National and State average of 3.4 days. We do this by:

• using the least traumatic surgical techniques and controlling blood loss
• employing a pain management regimen that starts pre-operatively and continues through the surgery
• avoiding IV narcotics that tend to have side affects of nausea, dizziness, and mental status changes
• rapid post-operative mobilization

Clearly, this regimen is quite successful as a great majority of our patients go directly home by the second post-operative day.

Early results of my new pain management protocol indicate that our patients have significantly less post-operative pain and leave the hospital earlier than ever. I've instituted a pain management protocol similar to that developed by the largest joint replacement facility in Philadelphia, employing state-of-the-art anesthesia and orthopaedic care. Patients receive regional epidural anesthesia, intraoperative injections, and post-operative oral narcotics. No longer are IV narcotics required, resulting in much less nausea and drowsiness. Patients are staying in the hospital on average 1 night for a partial knee replacement and 1-2 nights for total knee replacement. Overwhelmingly, patients are comfortable and start outpatient therapy within a few days of leaving the hospital, resulting in excellent early knee function.