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Joint
Replacement
Program
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Total Joint Surgeons
Dr. Kelli Baum
Total Joint Replacement Program Co-Medical Director
Samaritan Medical Group Orthopedics-Albany
Dr. James Ryan
Total Joint Replacement Program Co-Medical Director
Samaritan Medical Group Orthopedics-Albany
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What We do:
• We specialize in primary hip and knee replacement as well as revision hip and knee replacement surgery
• Samaritan Joint Replacement Program offers:
– DNV Certified Joint Replacement Center of Excellence – Minimally invasive hip and knee replacement
– Customized patient instrumentation – Computer navigation
– Anterior hip replacement
– Computer assisted surgical planning
– Dedicated care teams of nurses, therapists, and aides that specialize in caring exclusively for joint replacement patients
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Hip and Knee Replacement
• We perform 15-20 primary and revision joint replacements every week at the Albany General Hospital
• We utilize technology to improve outcomes and deliver the highest quality care to our patients
– Minimally invasive surgical technique – Computer navigation
– Patient specific instrumentation – Advanced materials
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Outline
• Knee Anatomy
• Hip Anatomy
• Arthritis Overview
• Non-surgical treatment options
• Total knee replacement
– Procedure – Materials
– Visionaire patient specific instrumentation
• Total hip replacement
– Procedure – Materials
– Computer navigation
• Questions and discussion
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Knee Anatomy
• The lower femur and upper tibia are covered in cartilage
• LCL/MCL ligaments provide stability
• The patella tracks through the groove on the end of the thigh bone, aligning the quad muscle during flexion and extension
Femur
Ligaments Patella
Tibia
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Knee Anatomy
• Hinge joint
• Two menisci - cushion pads
– Stabilize
– Distribute body weight
• ACL/PCL – ligaments that stabilize knee from front to back
Meniscus ACL
PCL
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Hip Anatomy
• Pelvic cup (acetabulum) and femoral ball covered in cartilage
• Ball and socket joint
• Surrounded by stabilizing ligaments and muscles
Socket Ball
Femoral neck Smooth weight- bearing surfaces Smooth cartilage Femur
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Similarities Between Hip & Knee
• Fluid producing joints (synovial joints)
• Cartilage-on-cartilage surfaces
• Weight bearing joints
• Severely effected by arthritis
process
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What is Osteoarthritis or OA?
• The most common form of arthritis and often called “wear and tear” arthritis.
• Joint lining becomes pitted, eroded, uneven…and painful.
• Bone spurs, or osteophytes, often form around the joint.
• The common activities of daily living become limited by extreme pain.
• Most of the people who have
osteoarthritis are older than age 45, and women are more commonly affected than men.
Arthritic Knee
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Osteoarthritis Symptoms
• The main symptom of osteoarthritis is PAIN.
• You may feel pain during movement and even at rest.
• Your joints may also be stiff and swollen, and you may even
experience a loss of range of movement in the joint.
• The symptoms of osteoarthritis may interfere with your normal activities, such as walking and dressing.
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Treatment
• Treatment is sought at any and all stages of knee arthritis
• Treatments can be divided into:
1. Non-Surgical Options 2. Surgical Options
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Non- Surgical
Treatments
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Non-Surgical Options
• Lifestyle modification
• Weight Control
• Exercise and physical therapy
• Oral medication
• Steroid Injection
• Joint fluid therapy*
(hyaluronic acid)
• Bracing*
*Knees only
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Exercise & Weight Control
• Research shows that
exercise is one of the best treatments for osteoarthritis.
• Exercise decreases pain,
improves flexibility and helps maintain weight.
• A healthy diet can facilitate weight loss resulting in
reduced stress on weight-
bearing joints and limiting
further injury.
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Medications
• Medicines commonly used in treating OA include:
– Oral:
• Acetaminophen
• NSAIDs (nonsteroidal anti-inflammatory drugs)
• Topical pain-relieving creams and sprays
• N
arcotic painkillers
– Injectable:
• Corticosteroids
• Hyaluronic acid
Many medicines used to treat OA have side effects, so it is important to learn about the medicines you are taking.
--1 injection --3 injections
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Knees Only
• Joint Fluid Therapy involves injecting a viscous fluid into the knee.
• This substance is similar to the fluid that occurs naturally in the knee – synovial fluid – which helps to lubricate the knee, reducing
friction and protecting from pain.
• Unloader brace shifts pressure from damaged part of joint to healthier part of joint.
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Surgical Solutions:
Total Knee
Replacement
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Total Knee Replacement
• With total knee replacement surgery, the damaged parts of the knee that need repair are removed and replaced with metal and plastic
implants.
• During surgery metallic
implants are affixed to the
underlying bones.
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Total Knee Replacement
Degenerative knee Cuts Implant components Implanted
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Total Knee Replacement
After surgery:
• You are sent to the recovery room
• Physical therapy begins right after surgery when you’ve recovered from anesthesia
• Discharge from the hospital the same day or next day
• Follow-up with your surgeon
at 3 weeks, 8 weeks, 1 year,
and every 5 years thereafter
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Visionaire
Technology
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What is Visionaire?
• Visionaire patient-matched
technology uses your MRI and x-rays to design surgical instruments that are unique to you
• Custom cutting blocks are created to match the exact shape of your bones
• Provides a custom-fit, more accurately aligned knee
*featured on How Things Are Made
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What is Visionaire?
• Allows for comprehensive, accurate preoperative planning
• Precise alignment may result in a longer lasting implant
• Eliminates time in the operating room, which reduces time under anesthesia and the risk of infection
• May lower risk of complications from surgery, such as deep vein thrombosis (DVT)
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Surgical Solutions:
Total Hip
Replacement
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Total Hip Replacement
• With your total hip replacement surgery, the damaged parts of your joint that need repair will be removed and replaced with metal and plastic implants.
• During surgery, an implant will be affixed to the underlying bones.
• - Cemented implant
• - Cement-less implant (90%)
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Total Hip Replacement
• The uppermost portion of the femur (the ball) is removed. The end of the femur is reshaped to allow the metal “hip stem”
component to fit onto it.
• The acetabulum, or socket, is
prepared and replaced by a metal cup. A smooth plastic liner is
inserted into the cup.
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Total Hip Replacement - Review
Cuts Implant components Implanted
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Total Replacement
After surgery:
• The patient is sent to recovery
• Physical therapy begins the day of surgery
• Discharge from the hospital same day or next morning
• Follow-up with your surgeon in the
weeks that follow through your
recovery
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Total Replacement Technology
We utilize the latest techniques in hip replacement using:
• Computer Navigation
• Anterior Hip Replacement using live radiographs
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Implant
Longevity
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Hip and Knee Replacement Materials
• Metals:
– Cobalt and Chromium Alloy is traditional metal used
• Highly polished
• Tried and true
• Durable
– Oxinium: oxidized zirconium
• highly polished and is extremely smooth
• Safe for those with metal allergies
• Plastic
– Highly cross-linked polyethylene (XLPE)
– More highly polished and harder than conventional plastics
Traditional metal implant
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Why a Total Knee or Hip Replacement Won’t Last Forever
• Metal rubs against plastic
• Microscopic plastic debris released into tissues
• Body reacts to plastic debris by releasing inflammatory cells
• These cells irritate tissue and cause bone damage
• With time, implant loosens from bone
• Loosening of implants causes pain
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The solution: Better materials
• Oxinium
– Takes on low-friction ceramic qualities during proprietary heating process
• Surface becomes 4,900-times more resistant to the commonly experienced metal abrasion that wears through plastic components
• The oxidized surface reduces plastic component wear by 85%
– May substantially extend the life of the implant and reduce need for future surgeries – Appropriate for young patients or those who are very physically active
• Highly Crosslinked Polyethelene (XLPE)
• This combination is VERILAST™ technology
– Highest survivorship of all bearing categories at 10 years – 96.6% seen in large joint registry – Lab-tested to simulate the number of steps the average person takes in 30 years*
– Offers the younger, more active patients a TKA solution designed to address their increased expectations for wear performance.
– Solution in total knee replacement for patients with metal sensitivity.
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DNV Certified Center of Excellence in Joint Replacement
• One of 2 hospitals in Oregon with this designation
• Recognizes excellence in patient care, quality of surgical service, and outcomes.
“This certification tells our community that we have the resources
and commitment to provide the best possible care for hip and knee
replacement” - Dan Keteri, CEO Albany General Hospital
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Patient Experience
• Once a scheduled for joint replacement the path to surgery is highly organized and streamlined with the patient at the center of the care pathway
• Each patient has extensive medical clearance to ensure proper risk reduction
• All patients complete an education class to prepare them for their surgery and recovery
• Our dedicated Joint Replacement Floor provides:
– Private rooms
– Specialty trained nurses
– Individual rounding with each
patient to get feedback about their care and experience
– Streamlined discharge process individualized to each patient
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Patient Feedback
• I can’t say enough about the doctors, and staff. I’ve had many surgeries, and this was the best care I’ve ever had. The staff bent over backwards
• I’ve been so happy. Best hospital food I’ve had
• They all did a great job
• My care was very great, just wonderful
• All of the staff were exceptional. The OR prep ladies made me feel better
• Amazing care
• Everybody has been great
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Our Team
• James Ryan, MD and Kelli Baum, DO
• Eric Moen, PA-C and Tina Williamson, NP
• Madi Sadowsky, MA – Total Joint Care Coordinator
• Keri Ballinger, RN and Casey Kaczmarek, MA
Want to learn more?
[email protected]
541-812-5770
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Thank you!
James Ryan, MD
and
Kelli Baum, DO Samaritan
Orthopedics Albany
samhealth.org/Orthopedics
