Surgical Treatments

people have asked what what's join preservation seems ill-defined in a nutshell I'm trying to keep a knee replacement out of you and me out of your life for as long as I can cartilage damage in your name it's a little bit like a pothole in a street and potholes are not great they're not great for your car they're not great for your knee joint and they can grow over time with all the preoperative workup MRI scans may be in our foster game we can figure out what would be best for in your specific situation and some patients they have an issue with the underlying bone so it's really the surface and the foundation underneath if you will one of the repair techniques is austere Colonel hella graft transplantation and that's essentially taking cartage as a plug of cartridge and going from a donor and transplanted that into the defect depending on where the defect is located in the knee you make your incision and you expose it so that you can see what you need to see it's not like the old days where we made gigantic incisions so luckily we can do this much more minimally invasive these days we look at the defect and first we get a sense of how biggest it affects the next step then is preparing the cartilage defect that scent is pouring out the the area of damage and then essentially go to the graft make a plug off cartridge and bone and when the graft is prepared to take some of your bone marrow I add that to the graphed and then the instrumentation such that you really get what's called press fit to fixation so nine out of ten times I don't need any screws or little darts to stabilize things the plug just goes into the recreated hole and a stable and then over time your body grows in and makes it your own it's gently days your dream unless we do other bigger things at the same time and you end up on crutches for about four weeks but you can move your name patients often ask isn't there risk of rejection can I get a disease from the donor and luckily air both that risk is very very low and especially on the disease side almost non-existent nothing is 0% unfortunate life but I always tell patients at least driving to the hospital is more dangerous than having the surgery and success rate long term is very good so depending on your specific situation could be anywhere between 80 and 95 percent success even up to 20 years you

[Music] preserving your options is really important when you're young so ideally I try and avoid knee replacements if I can now there are some patients who have bone-on-bone arthritis they've had multiple operations they've failed and they're tired they want something like in the ear placement and when to cross over that's a longer discussion we look at your images we look what has been done what has been tried and frankly we discuss what your goals are so in terms of knee replacement surgery there are different types of New York placements there's the standard knee replacement that's a complete knee replacement so ultimately today we replace all the surfaces inside your knee joint and then there are partial knee replacements partial knee replacements are just one part of unity and if you think about your knee almost as having three different sections it's like a tricycle with three wheels just because your first fight is in one part of your knee it doesn't mean that you have to have a full set of new tires partial knee replacements one technique that I've been using for a while is called Mako I use a robot in the operating room that helps you make the cuts more precisely because we're trying to remove the least amount of bone to preserve more of your whole name essentially we get a CT scan pre-op and based on the CT scan we make a 3d computer model and that gets fed into the robot and then the first job in the operating room is to tell the robot where your knee is in space it doesn't really have eyes that cannot see your extremity itself but we secure these little pegs with little reflective balls and the robot camera can see the reflective balls and then you move the knee so the robot gets a sense of your range of motion the joint position and then it shows me specific points on the the 3d model in its brain and I tap those same corresponding points on the patient so that after tapping 2030 points the robot then knows exactly where your mean and the structure of the music space so that it can guide me and help make those cuts more precisely partial knee replacements are nice because you preserve more of your own medium she's going to replace one part it feels more natural the emotions better the recovery is a little bit quicker so whenever I can I try and do that rather than a full knee replacement you want to stay active for as long as we can so it's really important for me to make sure as I get older when I have issues that arise orthopedically including surgery that I'm very comfortable with who's going to be my partner in terms of going through what can be a life altering process to make sure I'm able to resume those activities as quickly as possible [Music] you