@wcbstv—June 17, 2009
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.
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