WCBS-TV medical reporter Max Gomez narrates total knee replacement surgery from HSS’ OR live on Twitter

@wcbstv—June 17, 2009   

wcbstv: Its Dr Max in the OR at Hosp for Special Surgery. Dr Steve Haas about to begin a total knee replacement on 55 yr old woman

wcbstv: OR a beehive of activity. Anesthesia sedated patient and put in an epidural... no general anesthesia

wcbstv: At same time nurse prepping her right leg... scrubbing with betadine antiseptic... the orange color people emerge from surgery with

wcbstv: they also put a tourniquet on her leg so that there wont be much blood to get in the way during the replacement itself.

wcbstv: tourniquet isnt inflated or tightened until the surgery actually starts

wcbstv: techs are preparing sterile instruments, tools and the implant itself. nurses keeping track of meds, equipment etc.

wcbstv: all going on at same time. its like a football team where everybody knows what theyre supposed to be doing.

wcbstv: Drs are now inflating the tourniquet. Then they "milk" the blood out of the leg to minimize blood loss.

wcbstv: surgeons, techs wear space helmets with a large plastic face shields. that keeps blood and bone bits away from the face but more importantly

wcbstv: it isolates surgeons and techs minimizing the risk for infection. Infections in joint replacements can be very difficult to treat.

wcbstv: and often require removal of the implant. Dr Haas has made incision into knee. can now see the bones on knee

wcbstv: rather than cutting muscle and large tendon from the thigh (pattelar tendon) he separates the muscle fibers and pulls the kneecap to side

wcbstv: thats much less traumatic and makes recovery afterwards much easier and faster. its called MIS (minimally invasive surgery).

wcbstv: that requires special instruments which Haas helped develop, because the space he's working in is much smaller than conventional replacement

wcbstv: Dr Haas using a replacement that has very smooth, hard ceramic on the thigh bone side of knee and special polyethylene plastic on tibia

wcbstv: there's also a webcast going on at same time so dr is narrating technical details of the surgery. He's now sawing off the top of the tibia.

wcbstv: that's where plastic surface will rest with a sort of metal "keel" that goes into tibia to keep it in place. next: taking off end of femur.

wcbstv: that allows the new ceramic surface to be placed. Dr now determining what size implant components he'll use. tries various "dummy" implants

wcbstv: alignment of the implants is also critical to a successful replacement. so he takes care to get size and placement just right.

wcbstv: special instruments help with alignment. i can see the plastic film that covers the skin of her knee, keeping skin germs out of the incision

wcbstv: for those not used to it, a knee replacement is like a carpentry shop. hammering, drilling, sawing... but all with great precision of course

wcbstv: knee that Dr Haas is using is "female" in that the size is smaller than those used in men. Each component of the new knee is customized

wcbstv: He'll also "replace" the kneecap. Actually just puts a new artificial surface on the inside of kneecap so it will ride smoothly on new knee

wcbstv: Dr carefully testing the flex and extension of the knee to make sure size of implants will give the right "feel" and range of motion later

wcbstv: You can watch my story on this knee replacement tomorrow morning at 545AM and again at 645AM on CBS2 News

wcbstv: Patient only 55 yrs old which used to be considered too young to have knee replacement but replacements now last so long, at least 20-25 yrs

wcbstv: that means younger patients dont have to live in pain because their new knee should last their lifetime. this patient moved to new ranch home

wcbstv: because she could no longer climb or descend stairs in her old home. she was told to wait for new knee but now wants her life back

wcbstv: she told me she could no longer do the things she loved: walk, garden, dance. she'll be able to now

wcbstv: knee replacements also safe in older patients. safer anesthesia (no general) and control of complications means people in 80s and even 90s

wcbstv: can have knee replacements as well. less invasive approach also means recovery is much quicker so patient can get back to normal activities

wcbstv: much sooner.

wcbstv: Dr Haas cementing the implant components in place. essentially medical grade epoxy mixed at table and put on the implant like a green putty

wcbstv: smells just like epoxy you'd use in a workshop. It cures in a few minutes when its placed in the bone.

wcbstv: The epoxy cement sometimes mixed with antibiotics to reduce risk of infection in hi-risk patients. cement gets placed on bone and on implant

wcbstv: still amazed at how little blood there is in this procedure. thanks to tourniquet of course but for large incision, its almost bloodless

wcbstv: incision in minimally invasive procedure is about a third as long as in conventional knee replacement, so easier to heal the skin too

wcbstv: Waiting for cement to set before suturing skin. procedure normally takes less than an hour! but webcast explanations for surgeons watching

wcbstv: is slowing procedure a bit. instrument table crowded with sterile knee sizing-components of many sizes... that way only the precise size

wcbstv: of the final implants are actually "opened" and used. The metal, ceramic and plastic used in implants too expensive to use them for sizing

wcbstv: right after skin is sutured patient will have knee placed in CPM machine which slowly, continuously moves the knee right after surgery

wcbstv: drs now know that the sooner you move the knee, the quicker the recovery and the greater the range of motion the patient eventually gets

wcbstv: in fact, she'll be up and walking a little tomorrow! the sooner she moves, the fewer the complications and the faster the recovery

wcbstv: turns out the plastic component Dr Haas used has a plastic stem or keel rather than the metal one in other replacements

wcbstv: Dr Haas now checking knee alignment, tracking of kneecap with all components in place. knee actually a complex joint, not a straight hinge

wcbstv: Dr Haas now suturing skin. patient will be awake in short while. Epidural stays in for a couple days. Just enough to allow her to walk

wcbstv: without pain but not so much as to keep her from using her muscles. patient will be out of hospital in 3 days. do home physical therapy for

wcbstv: week or two and then will do outpatient physical therapy 3 times/week for a couple months. she can actually go back to work as soon as 2 wks

wcbstv: although most patients dont go back for 4-6 weeks.

wcbstv: Patient going to recovery shortly...See rest of the story tomorrow morning...

Learn more about Dr. Max Gomez's tweeting from the OR by reading Healthwatch: Next Generation Knees & Twitter.

Follow us on Twitter @hspecialsurgery for future news updates.