Patient Information

Advanced Solutions For Knee Pain Sufferers

A CLOSER LOOK AT THE KNEE | ARTHRITIS – THE LEADING CAUSE OF KNEE PAIN | MINIMALLY INVASIVE KNEE | TOTAL KNEE REPLACEMENT | PKR — A "PARTIAL" ALTERNATIVE TO TKR | IMPORTANT SHORT- AND LONG-TERM ADVANTAGES

Bertram Total Joint Centers prides itself on bringing the latest innovations in orthopedic care to our patients. We are pleased to be able to offer a new minimally invasive procedure for relieving arthritic knee pain and disability.

Knee Anatomy

A CLOSER LOOK AT THE KNEE

The knee, the largest joint in the body, is central to nearly every activity. It consists of the lower end of the thigh bone (femur), the upper end of the shin bone (tibia), and the knee cap (patella). Ligaments connect the bones, and a cartilage lining coats them to allow easy, flexible movement and to protect the joint from wear. TOP

ARTHRITIS – THE LEADING CAUSE OF KNEE PAIN

One of the most common causes of knee pain and loss of mobility is the wearing away of this cartilage. When this happens, the bones rub together, causing significant pain and swelling — known as osteoarthritis. Trauma or direct injury to the knee can also cause osteoarthritis.

Conservative treatments such as steroidal and non-steroidal anti-inflammatory drugs, physical therapy, and cortisone injections may effectively relieve pain and restore mobility. However, more severe pain and disability frequently require knee “resurfacing” surgery. TOP

MINIMALLY INVASIVE KNEE

There is simply no reason to hobble around on an arthritic knee any longer. Not today in an age where rapidly advancing orthopaedic treatments are boosting the quality of life for countless Americans.

In fact, a new minimally invasive procedure has arrived, bringing with it the promise of relief to thousands of patients who until now—were not considered strong candidates for knee replacement. The new procedure is called uni-compartmental knee replacement, also known as a uni-knee. It is perfectly suited for patients who have osteoarthritis that is confined to one side of the knee. Instead of replacing the entire knee, just the diseased portion is removed.

And, thanks to the uni-knee, beloved phrase minimally invasive is now associated with knee replacements for the very first time. The uni-knee typically takes less than one hour to perform. The scar is only about 3 to 4 inches long, and it requires less hospitalization and rehab time than a traditional knee replacement.

Because the uni-knee involves the replacement of only one side of the knee, the surgeon does not have to resurface the kneecap or remove much bone in the area. As a result, the uni-knee also feels more natural and offers a better range of motion for many patients.

"This is a procedure that will be in high demand and we are pleased to be able to offer it to appropriate patients", says Naples Community Hospital Orthopaedic Surgeon, H. Morton Bertram, III, M.D., who became the first surgeon in the area to perform minimally invasive uni-knee replacement at Naples Community Hospital about two years ago. "The procedure is much less traumatic so that patients get back to life much more quickly."

What's more, the uni-knee makes great surgical candidates out of people who were previously in knee replacement no man’s land: they were experiencing considerable pain but did not have arthritis in enough of the knee to warrant the total knee replacement.

"The great thing about this procedure is that it fills that gap between patients who needed a knee replacement and patients who were not benefiting from an arthroscopic debridement for an arthritic knee," explains Dr. Bertram. "Now we have a procedure which can help those patients that were previously unable to be helped."

There are a lot of patients that fit this description out there. Currently less than five percent of knee replacements are of the uni-compartmental variety, but that figure is expected to climb as high as 30 percent.

So who might be a candidate for the uni or even knee replacement? Namely those who have aching pain in the knee often associated with activity, that walk with a limp, experience stiffness, swelling, or nighttime pain.

Still, surgery is not the first treatment option. "We use an algorithm to decide in our office what is right for each individual patient," explains Dr. Bertram. "We try many nonsurgical treatment options before deciding to go down the path of surgery." As a matter of fact, Dr. Bertram has developed a "Knee Arthritis Algorithm", which he uses daily in his office to show patients exactly what their options are. This handout gives the patients a list of all available non-surgical and surgical options.

Technically speaking, the uni-compartmental knee is not a revolutionary procedure. It was first done in the 1970s, but a new specialized procedure utilizing a different technique with a smaller incision makes the procedure less invasive. If chronic knee pain is hindering your activities, please call to make an appointment to seek the advice of Dr. Bertram.

Arthritis may be a part of the normal aging process, but sacrificing your quality of life does not have to be. TOP

Total Knee Replacement

TOTAL KNEE REPLACEMENT

Total knee replacement (TKR) is a surgical procedure in which all of the surfaces in the knee joint are removed and an artificial knee joint called a prosthesis is implanted. Total knee replacement has been performed since the 1960s and has excellent long-term results. However, the 3- to 5-day hospital stay and 3- to 12-week recovery period can present an obstacle to many candidates for this procedure. TOP

PKR — A "PARTIAL" ALTERNATIVE TO TKR

For patients who have arthritis on only one surface (or compartment) of the knee, partial knee resurfacing (PKR) or uni-knee replacement, offers a promising new alternative to total knee replacement. In this procedure, only the damaged surface of the knee joint is replaced, minimizing trauma to healthy bone and tissue.

Unicompartmental knee implants, like the EIUS Uni-Knee System from Howmedica Osteonics, were developed with patient needs in mind. The implant is anatomically shaped and enables surgeons to use the latest minimally invasive surgical techniques for this procedure.

Because uni-knee implants are so much smaller than a total knee prosthesis, the surgical incision can be significantly smaller as well. The surgeon removes only damaged bone in the affected knee and fits the implant to that bone surface. The incision is closed with small, self-dissolving sutures that are hidden underneath the skin. TOP

Knee Implant

IMPORTANT SHORT- AND LONG-TERM ADVANTAGES

Because most of the knee joint is unaffected and the basic knee structure remains intact, postoperative pain is reduced and recovery is faster. Patients typically leave the hospital within 24 hours and do not require physical therapy. A few gentle exercises and progressive walking are the only rehabilitation needed.

Based on a patient’s age, weight, and activity level, a uni-knee implant can be expected to last several years. Afterwards, it can easily be replaced or, if needed, converted to a total knee replacement. TOP

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