At the Knee Society meeting on March 13, 2010, in New Orleans, Louisiana, there were several papers discussing new techniques for performing knee replacement, including the use of custom-made guides based off preoperative MRI or CT scan, as well as robotically assisted surgical techniques for the placement of unicompartmental replacements. While all of these preliminary reports have been favorable, there remains concern over who will pay for the new technology. Customized cutting guides can cost $1,500 for their production. Robotically assisted surgery can require a machine that can cost anywhere from $750,000 to $1 million dollars. To date there has been no proof that these types of techniques or devices substantially improve the outcome or the durability. In an era of decreasing reimbursement, some of these newer technologies may prove challenging and may require the patient to pay for the increased cost. We are currently evaluating a customized cutting guide for total knee replacement called the Tru-Match system. We have done over 20 of these and the results to date have been very satisfactory. The patients enrolled in this study are not charged for the device as that is part of the inclusion in the study. We will await final results before further discussion of this with patients.
I am 50yrs old. I had my first total knee replacement in July 2003. I was 43 at the time. In Dec 2004, I had to have surgery to turn the patella, the original Doc.did not do this. In 2007, I had loosening and had the whole thing done again. Again in 2007, I had loosening and had the whole thing done again. In 2009, I had loosening and we just replaced the tibia component. It is now 2010, it is loose again. I have never had any infection. I am in severe pain but I don’t think another surgery is the answer. Have you come across this kind of problem before. What hope is there for me? By the way, I had 4 different Doctors perform the surgeries. Please help!!!!
Dear David,
That is a tough problem. I would remain concerned about a low grade infection. I would find a joint replacement specialist in your area and get evaluated for a possible infection.
Regards,
William Barrett
Hi Dr. Barrett,
Before and after every surgery, I have had a bone scan and these test showed no signs of infection. I had fluid taken from the knee and again, no signs of infection. The tibia is always the problem. I have 100mm stems and it still loosened. Has there been any studies that you know of that takes a look at multiple loosening issues? This all started with sports injuries in the late 70’s. I have come across some younger more active patients with similar issues. My gut feeling is that Total Knee Replacements were designed for more elderly, less active patients. I appreciate you responding.
Thanks,
David
David,
You should find a surgeon who does a high volume of revision total knees. Establish a diagnosis as to why these are getting loose and ask your surgeon what is the plan re: How to fix this?
Dr. William Barrett