Monterey Joint - Ryan Ranch California Knee Surgery

Overview | Minimally invasive techniques | Osteochondral grafting | Total knee replacement | Uni-compartmental knee replacement

Sometimes, if nonsurgical treatment, rehabilitation and therapy are unsuccessful, the only way to heal a knee problem may be through surgery. If the knee is irreparably damaged or has eroded away because of arthritis, then surgery may be the next logical step. Statistically, 20% of knee patients will require surgery.

Although surgery may sound like a 'scary' word to many, today, more and more people are recovering from surgery and regaining peak performance. Take, for instance, tennis player Seffi Graf who won both the French Open and Wimbledon following knee surgery. Even more astonishingly, pro-tennis player Richard Krajicek recovered from knee surgery after only three months and went on to beat world champion Pete Sampras in straight sets in 1998.

Active knee replacement candidates will find it comforting to know that they will be able to resume some athletics after surgery such as golf, swimming and walking. Some knee replacement recipients have even continued to play tennis and snow ski. Unfortunately, a knee prosthesis is not quite as effective as a healthy, natural knee, but it will be a great improvement over the preoperative pain and discomfort.

Depending on what part of the knee is actually damaged, surgery can be delayed in some cases. To highlight an extreme example, in the 1999 Stanley Cup Championships, Dallas Star hockey player Brett Hull played three periods during the final game followed by three more periods of overtime—all with a grade three torn meniscus—the most severe level of an MCL tear. Although probably not the most healthy decision for his knee, playing on a torn MCL is a sacrifice he was more than willing to make, and the Stars brought home the Stanley Cup that year. Of course, Brett subsequently had surgery to repair his MCL. While most of us have no reason to push ourselves to this sort of an extreme, this example illustrates that surgery for even the most severe injuries can be postponed in some cases.

Essentially, when surgery is done well, and the recovery period is carefully and thoroughly completed, return to athletic activity is more than likely not a problem. Below are some specifics regarding knee surgery.
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Minimally invasive techniques
Although the definition of minimally invasive surgery is elusive, this highly discussed approach involves smaller incision and tissue-sparing techniques. What is of interest is that minimally invasive surgery appears to promise the same or better long-term outcomes with a shorter, less painful recovery. However, outcomes are not validated at this time and do not have a significant amount of scientific support.

Possible advantages

Reduce immediate post-op pain
Shorter hospital stay and rehab length
Quicker return to activity
Less blood loss
Improve cosmetic aspects
Reduce scarring/muscle damage

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Osteochondral grafting
The latest advance for joint injury treatment involves restoring lost or damaged cartilage by replacing it with tissue. Osteochondral grafting is one such technique and is primarily used in knee injuries. The development of osteochondral grafting is encouraging news because it paves the way for a quicker, smoother, more successful return to full activity for those suffering torn ACL ligaments or related injuries to the ankle, hip and knee.

Articular cartilage acts as a coating of tissue on the end of bones, enabling the joints to move easily and smoothly. When articular cartilage is damaged or injured, its fragile nature does not allow it to heal quickly, and bones may begin to scrape against each other, causing pain and/or limited movement.

Osteochondral grafting involves transporting normal, healthy bone and cartilage to the site of injury. The harvested material can either be the patient’s own (autograft) or it may come from an outside source (allograft). Allograft procedures are typically used for more sizeable injuries and must be able to “match” the tissue of the patient who is receiving the transplant. Minimally invasive techniques are now being used for osteochondral grafting, which can reduce the size of incisions and the recovery time involved.
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Total knee replacement surgery
Quality of life is never to be underestimated, and when a knee problem is so debilitating that it is impossible to enjoy hobbies that are important to you, it is crucial to seek medical help.

Fortunately, before even considering knee replacement surgery as an option, generally physicians will try to find other ways of assuaging the pain. For instance, physical therapy, analgesics and walking aids might be the answer to many knee problems, including those stemming from arthritis.

However, it is also nice to know that when other treatments prove to be futile, knee replacement surgery is an option. So prevalent is this surgery, in fact, that approximately 323,448 total knee replacements were performed in 2001. Knee replacement can help renew the ability to participate in many normal, daily activities such as gardening, going on walks, golfing and overall mobility. It is important to try other options before knee replacement surgery, however, since they only last for 15 to 20 years and are not easily replaced. For this reason, physicians are very selective about the types of candidates for the surgery.

Who is a candidate?
Total knee replacement is reserved for the patient who has not benefited from conservative treatments and whose quality of life is suffering due to the debilitation caused by knee pain. Examples include those experiencing pain at night and those who cannot perform their normal, everyday activities.

Knee replacement is also generally reserved for those who are over 60 years of age who are in relatively good health. Generally, this means that they maintain a healthy weight, do not suffer from cardiovascular problems, and are not suffering from a terminal illness.

Who is not a candidate?
As mentioned before, to receive knee replacement surgery, you must be a good candidate. If not, surgery could prove counterproductive. For some, knee replacement surgery is not in their best interest. Those who are too young (except for those who suffer from severe rheumatoid arthritis) should consider other types of treatment for knee pain, since after 15 or 20 years, the prosthesis will need to be replaced. Unfortunately, the bone will need to be cut short to make room for a new prosthesis, and function and mobility is likely to be damaged during the second operation. Those who are overweight are not good candidates, as the prosthesis (just as the natural knee) is designed to carry a weight in proportion to the person’s body. Too much weight on the prosthesis can cause it to be damaged, and subsequent knee surgeries will be necessary. Those with cardiovascular problems and terminal illnesses are also not good candidates, as the surgery may be too much for the body to handle. Also, those with poor skin coverage over the knee are not good candidates, as surgery could impair movement of the knee.

Our approach to total knee replacement

Incisions will be as long as needed to place components correctly
Navigation is a helpful tool for greater surgical precision and a reasonable decrease in incision length
Ceramic on ceramic bearing surfaces are appropriate for patients with greater longevity

Why use ceramic?
One of the unique aspects of Monterey Joint is that we use ceramic-on-ceramic technology, which presents the possibility of longer-lasting joints.

Concerns over osteolysis caused by the use of polyethylene
Need more durable bearing solution for the high demand patient
Long clinical history

The procedure
During knee replacement surgery, you will be under general anesthesia. The knee is opened up, and the arthritic cartilage is removed. The prosthesis is then "glued" to the bones with special, surgical cement. The knee is sutured back together, and drainage tubes are used to prevent clogging.

Usually, a hospital stay for knee replacement surgery lasts between four and five days. During your time at the hospital, your leg will be attached to a device called continual passive movement (CPM), which will move your knee to prevent stiffness. Overall, full recovery can take anywhere from two months to one year, although dramatic improvements should be seen sooner than that.

Types of knee replacement surgery

Femoral - replaces arthritic portion of thigh bone
Tibial - replaces arthritic portion of shin bone
Tibial insert - replaces cartilage and acts as shock absorber
Patella - replaces knee cap

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Uni-Compartmental Knee Replacement
Uni-compartmental knee replacement is a minimally invasive surgery that removes and resurfaces damaged articular cartilage in a single area of the knee. The goal of this procedure is a quick return to activity and pain relief. Benefits include maintaining two-thirds of the natural knee and relieving pain through minimally invasive techniques.

During the procedure, the patient is under general anesthesia, and an incision is made. The surgeon then removes the arthritic surface at the end of the thigh bone or femur and prepares the bone for a new covering. Then the femoral component is attached, and the arthritic surface on top of the shin bone is removed. A metal tray (tibial tray) is placed on top of the remaining bone, and the tibial insert is locked into the tray. Finally, the incision is closed.
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