Ask the Expert

This month, Suburban Hospital celebrates the first anniversary of the opening of its Joint Replacement Center, which offers a “best practice” program and a patient care model emphasizing wellness, empowerment, and efficiency. 

According to Medical Director Dr. J. Patrick Caulfield, the success has been overwhelming. “In one year, we have become the busiest joint replacement program in Montgomery County, doubling our expectations, and helping nearly 750 patients achieve their goal of living more active lives.”

Universally, patients, family members, and physicians have praised the program. The entire process is streamlined, from the preadmission education class through discharge, and the nursing care–led by a dedicated joint replacement program manager–is exceptional.

In addition to ensuring a quality patient care experience, Suburban Hospital is improving patient outcomes by providing access to emerging technology on the leading-edge of joint replacement surgery. Two of the latest techniques that offer potential benefits to patients include computer-assisted joint replacement surgery and gender-specific implants for joint replacement, which are discussed below by, respectively, Dr. Bill Sadlack and Dr. Christopher Cannova.   

What is computer-assisted joint replacement surgery?
The BrainLAB VectorVision navigation system, now available in Suburban Hospital’s operating room, is an image-guided surgery system that consists of a powerful computer, a touch-screen monitor, and two cameras that emit infrared signals to determine the position of the patient and surgical instruments. Data is continuously transmitted during the surgery so that the surgeon can follow the instrument movement on the computer screen in real-time. The system calculates a three-dimensional representation of the patient’s anatomy based on preoperative images, such as x-rays and CT scans. The computer dictates exactly where to operate, ensuring that all components are properly aligned and balanced.

For the surgeon, computer-assisted surgery is akin to using a GPS navigation system instead of a map while traveling. The VectorVision navigation system supports surgeons in making more informed decisions about the variability of a patient’s anatomy.

What are the benefits of this technology?
Traditionally, the most common issues associated with knee implant surgery are related to finding the precise alignment of the leg axis, positioning of the implant, and ensuring that ligaments had the correct amount of tension after the operation. By using a computer-assisted technique, the surgeon is able to determine if cuts are being made properly and correct alignment errors as they occur. An added benefit, computer-assisted surgery can potentially increase the life of the implant by allowing a more accurate alignment of the components.

Which patients would benefit from this tool during surgery?
Any patient in need of a total knee replacement would benefit from Suburban Hospital’s use of computer-assisted navigation. Patients should note that there is no radioactivity associated with the use of this technology.

Why choose Suburban Hospital?
Through Suburban’s Joint Replacement Center, patients have access to preoperative classes, private rooms, individualized care by physical therapists, physician assistants, and nurses, and post-operative physical therapy twice a day. While healing and recovery times vary with each individual, patients who take advantage of Suburban’s Joint Replacement Center are more likely to go home after discharge rather than being discharged to a rehabilitation program. The Joint Replacement Center’s unique approach to patient care together with the hospital’s implementation of state-of-the-art surgical techniques such as computer-assisted surgery makes Suburban an ideal choice for joint replacement surgery.

Gender-Specific Implants

What is a gender-specific implant?
A gender-specific total joint replacement implant is a new advance in knee replacement surgery. The implant is designed specifically to be female-friendly, taking into consideration the anatomical differences between men and women. The gender-specific implant mimics the female’s anatomy more closely than traditional joint replacement implants. With women making up the majority of joint replacement patients, this particular advance in joint prosthetics is exciting news.

How does a gender-specific implant differ from a traditional implant?
Knee replacements have long been available in many sizes and were designed based on an average between the size of women’s and men’s knees. However, merely using a different size implant for women doesn’t account for the anatomical differences between women and men. Various studies show that women’s knees differ significantly in shape from men’s knees.

When determining the appropriate-sized implant, surgeons choose the implant based on the measurement of the end of the femur from front to back. However, an implant that fits a woman’s knee from front to back occasionally may be too wide from side to side, leading to the implant overhanging the bone and potentially pressing on, or damaging, surrounding ligaments and tendons, possibly causing pain. The gender-specific implant is specifically designed to adjust for the difference in width.

Additionally, the angle between the pelvis and the knee affects how the kneecap tracks over the end of the femur as the knee moves through a range of motion. Women tend to have a different angle than men due to their specific shape and contour. The traditional artificial knee may tend to track at an angle that can result in pain in the kneecap, especially when walking up and down stairs. The gender-specific implant was designed to accommodate the different tracking angle and function more like a woman’s natural knee.

What patients would benefit from a gender-specific implant?
Any female patient in need of a first-time total knee replacement would be a potential candidate for a gender-specific implant. However, anyone who will undergo revision surgery on a previous knee replacement would not qualify for this implant. The surgeon must evaluate the patient’s anatomy to determine if it is conducive to the gender-specific implant.

What are the potential benefits of this implant?
Women who receive gender-specific implant may experience less pain in the kneecap (mostly when walking up and down stairs) and the potential for better range of motion. The goal of the implant is to alleviate pain and restore mobility while offering custom fit, improved functioning, and potentially improved durability.

Dr. Bill Sadlack can be reached at (301) 530-3220. His office is located in the Champlain Building at 6410 Rockledge Drive, Suite 309, in Bethesda.

Dr. Christopher Cannova can be reached at (301) 530-1010. His office is located in the Camalier Building at 10215 Fernwood Road, Suite 506, in Bethesda.