Nurse's Notes Vol. 1 - Partial Knee Replacement

This is the first edition of nurse’s notes from AMCC. I have an opportunity to share with you information about a partial knee replacement called OrthoGlide™. The web site is www.orthodoc.aaos.org/centerforsportsortho.

I had this surgery on October 26, 2006. I want to give people the opportunity to learn about this newer procedure. I feel the best way to do that is to share my experience with you. I have ideas for consideration. Some suggestions were given to me, some I knew prior to surgery, and others I figured out after the fact. If at some future date, you decide to have this surgery, I would like to make the experience as easy on you as possible.

First, you need to know a little about OrthoGlide™. OrthoGlide™ is used in the treatment of osteoarthritis. Figure 1 shows what the implant looks like. It is contoured and crescent-shaped. It is made of a cobalt-chrome alloy. This is inserted through a small incision (my incision is approximately 3cm or 1 ½”). This small incision makes this a minimally invasive procedure. Prior to the insertion, your physician will perform an arthroscopy of your knee. This is done to remove any bone spurs or loose bodies. An arthroscopy requires 3 very small cuts. In my case, my surgeon incorporated 2 of those very small cuts into the incision line. This incision is made along the inside (medial) aspect of the kneecap.

Figure 2 shows you how the implant fits in the knee. This picture is a view from the inner side of a knee.

Why would anyone want to have this procedure? I decided to have this procedure because all of the following failed:

• Non-steroid anti-inflammatory drugs (over the counter): Acetaminophen (Tylenol*),Ibuprofen (as Advil ®, Motrin®), and Aleve®
• Non-steroid anti-inflammatory drugs ( prescription): Naprosyn, Lodine et al
• Physical Therapy
• CoxII Inhibitors (Celebrix et al)
• Cortisone
• Hylan Polymer Products (SynVisc®)

The above are considered conservative measures. None of them helped me. If I was considerably older, I would probably have had a knee replacement. A knee replacement lasts for approximately 10 to 15 years. Second replacements have a reputation for not being as “good” as a first knee replacement. There is a unicompartmental knee replacement also called a partial knee replacement. My understanding is if a total knee replacement is needed after a unicompartmental knee replacement, it creates many problems for both the surgeon and the patient.

I consider myself to be very lucky. I was seeing a rheumatologist who knew about OrthoGlide™. She recommended I look into this procedure. From her perspective, I appeared to meet all the criteria for the surgery.

Then, I did my homework. I contacted the company to request additional information and the names and phone numbers of Orthopedic Surgeons in the area. Living in the greater Chicago area, I had the opportunity to select one of four orthopedic surgeons who are trained for this procedure. (At the end of this discourse, I will have the most up to date list of names, phone numbers and addresses of all the physicians in the US who has been trained to perform this surgery.) I talked with Rehab Nurses, Case Managers and Insurance adjusters about the physicians trained in this procedure. (Rehab Nurses, Case Managers and Insurance Adjusters are part of my work world.) I like the fact that there was no cutting into bone and no screws. I know that means there will be considerably less pain. There is no need to use cement to hold the OrthoGlide™ in place. Cement is used to hold some knee replacement components in place. Sometimes knee replacements fail because there is a loosening of the cement from the bone, the component or both.

I had my first visit with David Trotter, MD (www.CenterforSportsOrtho.com) to see if I was a candidate. I had to meet specific criteria for this procedure to work. This procedure works for the medial compartment only. In plain English, it will only help if you have the femur (thigh bone) rubbing against the tibia (shin bone) on the inner side of your knee. If your kneecap (patellofemoral) or outside (lateral compartment) of your knee is involved, this may not be the solution for you. I met the requirements to have this surgery. A second visit was needed to satisfy all the pre-op needs and set the surgery date.

I had the surgery as a 23 hour observation (that means I stayed overnight in the hospital), but was never admitted as an inpatient. Physical Therapy and I spent some time together learning how to walk on level surfaces, up & down stairs, and use the bathroom.

When I got home, I had a CPM (continuous passive motion) devise, a TENS unit, a cooling system to provide constant cold to my knee and pneumatic boots. A CPM makes you bend your knee. Then TENS is for pain control and to contract your quadriceps muscles in your thigh. The cooling unit was in place of constantly needing ice packs. Pneumatic boots are used to promote blood return to your heart and decrease your risk of a blood clot.

My surgery was on a Thursday, by Monday I had no incisional pain and some knee pain. My surgery was 4 weeks ago; I can walk without an assistive device (no cane, no crutches, and no walker). My knee bends to about 87 degrees. I am looking forward to a little physical therapy to give my knee full range of motion and improve my gait when I walk.

Finally, the big question is, if I had medial Osteoarthritis with my other knee, would I have this surgery again. My response would be “Absolutely”.

Many of these points may be applied to any surgery. This listing covers both before and after surgery. The following are suggestions an individual may want to consider if they are contemplating a partial knee replacement using OrthoGlide™.

Build up those Quad muscles in your thighs. The stronger they are the easier you will recover.

• Prepare an envelope or folder for all bills, papers, contracts, business cards etc that you will receive regarding your medical care.
• Arrange for meals to be brought in or prepare and freeze some food ahead of time.
• Know how any equipment brought into your home works. Try it while the technician is there to assist you and answer your questions.
• Have the phone numbers for your medical equipment readily available. Call the vendor if you have any problems using the equipment.
• Pick up all throw rugs on the floors of your home prior to surgery. Plan on keeping them off the floor for at least 2 months after surgery. You will want them off the floor as long as you use crutches, a walker, or a cane.
• Consider purchasing a raised toilet seat if you currently have pain sitting down on or getting up from the toilet.
• Consider purchasing a shower chair for use in your shower, tub area.
• Many people find sleeping in a recliner more comfortable then a bed. If you don’t own one, or are unable to borrow one, consider renting one. I found this bit of information out from other patients in the surgeon’s waiting room. I did not know this. I wish I had. I would have borrowed one from my son.
• Pain medication has a constipating effect on the human body. It is advisable to have an over the counter stool softener at home. Follow the directions on the package. Usually it’s one tablet/capsule daily. It is usually taken in the morning.
• If you have shoulder problems, plan on using a walker as an assistive device, rather then crutches.
• If you live alone or do not have someone or several people to help you around the clock for the first 5 days, plan on a 2-night inpatient hospital stay. You need to stay for your own safety. If you have 24-hour assistance, you will probably go home late in the afternoon of the day you had surgery or you’ll go home that evening. There is an option of staying overnight as an outpatient. You need to discuss this in detail with your surgeon.
• Wear shorts or pants with a wide leg to the hospital. You will leave with a bulky dressing. Ladies may want to wear a skirt. In general, the clothes you go home in should be roomy and easy to take on and off. If it is cold out, you may still wear shorts, just wear a long topcoat over your clothes.
• Before you leave the hospital, make sure someone shows you how to walk with crutches or the walker. Be sure you know how to go up and down stairs, even if you don’t have any at home. You will encounter stairs at some point, even if it is a curb when someone lets you off by an entrance.
• Sitting on most chairs is not going to be comfortable. Make sure any chair you select to sit in is very well padded in the front.
• Getting in and out of a car. Put the car seat back as far as it will go. This way you can actually sit on the back of the seat if you need the legroom to get in or out of the car. If you can, put the affect leg in first. Bring your foot along the bottom of the door. Follow the contour of the door while sitting as far back on the seat as possible, and bring your foot in. I had to flex my foot at the ankle to bring my foot inside my car.
• You will have pain for approximately the first 5 days. It is OK to take narcotic pain medication as prescribed by your surgeon.
• You need to keep your knee elevated. Elevation means that you not only keep your knee up, you must keep it above your heart. I found that I would lie fairly flat on my bed while using the CPM (constant passive motion) devise. The machine kept my knee elevated above my heart while bending it. Besides exercising my knee, the elevation decreased the swelling. The faster the swelling goes down, the quicker the incisional pain goes away.
• Approximately 2 weeks after surgery your staples are removed and steri-strips applied. These strips should fall off in about 5 to 7 days. After 7 days, remove any remaining strips.
• If there are no open areas, begin applying lotion (Cocoa Butter, Vitamin E) to lessen the scar formation. I found it also helped me to get rid of the all the tape left on my knee from the steri-strips

Ellyn Shepard, BSN
01/03/2007