The Anterior Approach: A better hip replacement option

The Anterior Approach: A better hip replacement option

anterior_hip_surgery_golfHave you ever noticed that there seems to be a direct correlation between a person’s age and the amount of time they spend talking about their health? Think about those who are a bit more beautifully seasoned in life, outside of the weather and their grandkids, health related concerns often prove to be a hot topic of conversation at the dinner table.

At AppOrtho, we believe that age is just a number and that all of our patients should have something more to look forward to in life than their next doctor’s appointment. That’s why we are proud to offer anterior hip replacement surgery right here in the High Country. Unlike limited hip replacement options of the past, the anterior approach is less invasive and typically results in a faster recovery time for patients.

 

Are you ready for a hip replacement?

 

If you are suffering from hip or groin pain, soreness or stiffness after exercise or an inability to walk short distances, then you may have osteoarthritis of the hip. This wear-and-tear type of arthritis is common in older adults and is caused by inflammation of the joint. Although there is no cure for osteoarthritis, many treatment options exist to help relieve pain and improve quality of life.

At AppOrtho, all non-operative treatment options are considered before recommending surgery. In many cases, a combination of physical therapy, medication, injections and simple life-style changes can result in reduced pain and improved functionality for the patient. However, if symptoms persist, hip replacement surgery is available at Watauga Medical Center.

 

Taking a different approach

 

Think of the hip as a ball-and-socket joint. A healthy layer of cartilage in the joint allows the ball to move freely within the socket. However, when osteoarthritis causes that cartilage to wear out, hip movement can become restricted and painful for the patient.

Hip replacement surgery can address this issue by removing the damaged ball-and-socket joint and then replacing it with a new artificial implant. Although the procedure itself is pretty straight forward, a decision must be made on the front end to determine which approach the surgeon will use to access the hip joint.

Traditional hip replacement surgery calls for a posterior or back-of-the-joint approach. Using this technique, the surgeon must cut through several muscles in order to reach and replace the hip. These muscles are then repaired at the end of the procedure. Although outcomes are typically good with this approach, recovery time can vary due to the invasive nature of the procedure.

Anterior hip replacement surgery has recently become popular among patients due to its less invasive front-of-the-hip approach. In most cases, surgeons using this technique are able to access the hip joint without having to cut through any muscles. Not every patient is a candidate for this approach, but those who are often enjoy less discomfort after surgery and a faster return to normal activities.

 

Don’t leave the mountain for hip surgery

 

Steven Anderson, MDDr. Steven Anderson, an orthopedic surgeon at AppOrtho, is the only orthopedist in the High Country who performs anterior hip replacement surgery at Watauga Medical Center. With more than 15 years of experience, Dr. Anderson specializes in primary and revision (redo) hip, knee and shoulder reconstruction.

“At AppOrtho, we are pleased to offer advanced hip replacement surgery right here in the High Country,” said Dr. Anderson. “Our goal is to help our patients feel like people again. We do that by helping them get back to the things they enjoy doing.”

To learn more about hip surgery at AppOrtho, call 828-386-2663 or request an appointment here. No referral is required.

New treatment option at AppOrtho: Use your body’s own cells to repair knee cartilage

New treatment option at AppOrtho: Use your body’s own cells to repair knee cartilage

Dr. Parker with Maci product_1200Are you a put ‘er offer when it comes to knee pain? Like so many of us, you grin and bear it, hoping to avoid or at least prolong the need for an eventual knee replacement. At AppOrtho, we understand that no one likes to think about knee replacement surgery. That’s why we are pleased to present a new and less-invasive treatment option that involves using the patient’s own cells to repair cartilage in the knee.

Yes, you read that correctly, welcome to the world of orthobiologics, now available right here in the High Country.

 

Breaking new ground

The first cartilage restoration procedure, otherwise known as Matrix-induced autologous chondrocyte implantation (MACI), was recently performed by Dr. Benjamin Parker at Watauga Medical Center.

To be clear, cartilage restoration in the knee is not a new concept. Similar procedures have actually been around for several years, but surgeons have been hesitant to recommend them due to the historically invasive and technically demanding nature of the surgery.

Now, thanks to new technology, this FDA approved procedure is simplified, less invasive and easily reproducible. It also provides long-lasting pain relief and improved knee functionality for the patient.1

 

How it works

Cartilage restoration surgery is a three-step process.

  1. The first step is for the surgeon to take a biopsy of healthy cartilage (arthroscopically) from a non weight-bearing area of the patient’s knee. The biopsy is then sent to a FDA-licensed, cell-processing center, where it is stored cryogenically (frozen) for up to five years.
  2. The patient can then wait and see how the knee progresses. If knee pain subsides after the initial debridement, no further action is required. However, if symptoms persist and surgery is recommended, the healthy cartilage cells from the biopsy are then expanded and seeded on a special membrane implant at the cell-processing center. The implant is then delivered back to the hospital for the surgeon to shape and fit into the area where the damaged cartilage was removed from the patient’s knee. No suture is required for this outpatient procedure; rather the implant is applied with surgical glue.
  3. The third step in the treatment process requires that the patient participate in a physician-prescribed rehabilitation program. Recovery time can vary, but patients are generally able to return to full weight-bearing and range of motion within four to six weeks.

 

Is it right for me?

This procedure may be considered for patients with acute cartilage injuries between the ages of 18 and 54. Acute cartilage injuries can occur after a fall or as a result of a traumatic athletic event. Symptoms may include pain, swelling, clicking and locking of the knee.2

In some cases, the MACI procedure may be considered to help prevent the knee from needing a joint replacement in the future. Not every patient is a good candidate for a cartilage restoration surgery. At AppOrtho, each patient is carefully evaluated in order to determine the most appropriate treatment option. All non-surgical treatment options are considered before surgery is recommended.

To make an appointment at AppOrtho, call 828-386-2663 or request an appointment here. No referral is required.

 


References

  1. Saris D, Price A, Widuchowski W, et al. Matrix-applied characterized autologous cultured chondrocytes versus microfracture: Two-year follow-up of a prospective randomized trial. Am J Sports Med. 2014;42(6):1384-94.
  2. Gomoll AH, et al. Surgical management of articular cartilage defects of the knee. J Bone Joint Surg Am. 2010 Oct 20;92(14):2470-90.

NAVIO®-Trained Surgeons

Dr. Steven Anderson is an orthopedic surgeon at AppOrtho, a member of Appalachian Regional Healthcare System.

Dr. Anderson is board certified by the American Academy of Orthopaedic Surgeons and has more than 15 years of experience in bone and joint surgery. Although he enjoys general orthopedics, Dr. Anderson’s practice focuses on hip, knee and shoulder surgery. He is particularly interested in primary and revision (or redo) joint replacement. Furthermore, Dr. Anderson is skilled in trauma surgery, hand surgery, and arthroscopic and minimally-invasive surgery.

More about Dr. Anderson >

Steven Anderson, MD

Orthopedic Surgeon, AppOrtho

Dr. James Califf is an orthopaedic surgeon at AppOrtho. He is a South Carolina native with an undergraduate degree from the University of South Carolina. He obtained his medical degree from the Duke University School of Medicine. He completed his orthopedic residency at Duke Medical Center with a focus on spinal surgery after two years of general surgery training.

Over his more than 25 years in practice, he has further refined his treatment of spinal disorders, offering non-surgical as well as minimally invasive surgical techniques.

More about Dr. Califf >

James C. Califf, MD

Orthopedic Surgeon, AppOrtho

Request an appointment

To request an appointment with an AppOrtho physician, call (828) 386-2663 or complete the form below. 

NAVIO® Total Knee Replacement Surgery

Total knee replacement surgery with the NAVIO Surgical System

More than 600,000 total knee replacement procedures are performed each year in the U.S. and more than 90% of these patients experience a dramatic relief in knee pain and are better able to perform common activities.1 The NAVIO Surgical System delivers robotics-assisted tools designed to help tailor your total knee replacement surgery to the unique shape and motion of your knee.

Robotics-assisted knee replacement planning with the NAVIO System

The total knee replacement procedure starts with your unique anatomy in mind. By the time your procedure is complete, the damaged bones and cartilage within your knee joint will be removed and replaced with new implant components. Each of these implant components must fit precisely and be aligned to your natural anatomy if they are to provide you with the best outcome possible. The challenge of aligning your implant and preparing your bones to accept it can be complex, invasive and time consuming because no two knee joints are exactly the same.

The NAVIO Surgical System is designed to help your surgeon not only plan your surgery based on your unique anatomy, but also position your total knee implant using a combination of computer and robotic assistance. The NAVIO procedure starts with an advanced computer system that gathers precise anatomic and alignment information about your joint that your surgeon will use to create your specific surgical plan.

This extra layer of data collection and planning is designed to help ensure your knee procedure is performed exactly as your surgeon intends and that your implant is positioned as accurately as possible for the best long-term outcome.

CT-free

Other robotic-assisted knee replacement systems use computerized tomography, or CT, scans to help a surgeon visualize a patient's knee anatomy. While CT scans are effective at showing the layers of knee anatomy, they can expose the patient to potentially harmful radiation. In fact, a single CT scan is equivalent to the radiation exposure received in 48 chest X-rays. 2

The NAVIO system eliminates the need for CT scans by using an advanced computer program to collect anatomic and alignment information about your knee. Once captured, this information is used to build a precise, computer-rendered 3D model of your knee that your surgeon will use to plan your surgery.

Total Knee Replacement Surgery without rods

Another method that can be used to determine the anatomic alignment of your new implants uses long, metal devices called intramedullary (IM) rods that are drilled into the central canal of the bone to show the alignment of the knee in relation to the hip. These rods are then used to attach the cutting guides necessary to guide the surgeon's saw blade as it shapes the bones to accept the new implants.

Because the NAVIO system has already gathered the anatomic alignment information about your knee, it eliminates the need for IM rods. Instead, your surgeon will use the system's handheld robotics-assisted tool (the NAVIO handpiece) to accurately position the NAVIO-specific cut guides which are held in place with a few small pins instead of the IM rod. This process leaves the central canal of your bone untouched. Implant alignment is a crucial factor in determining how long the implant will last 3, 4.

NAVIO Brings Robotics-assisted Precision to Total Knee Surgery

After removing the cutting guides, the prosthetic knee implants are implanted and your knee is checked to make sure it moves and is balanced correctly. It is important to understand that the NAVIO system doesn't replace your surgeon. The procedure remains in the skilled hands of your surgeon, with the NAVIO system providing extra layers of planning, accuracy and precision.

Important safety notes

Individual results of joint replacement vary. Implants are intended to relieve knee pain and improve function, but may not produce the same feel or function as your original knee. There are potential risks with knee replacement surgery such as loosening, wear and infection that may result in the need for additional surgery. Patients should not perform high impact activities such as running and jumping unless their surgeon tells them that the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if a surgeon's limitations on activity level are not followed.

Disclaimer

Individual results may vary. There are risks associated with any surgical procedure including NAVIO-enabled Knee Replacement. NAVIO is not for everyone. Children, pregnant women, patients who have mental or neuromuscular disorders that do not allow control of the knee joint, and morbidly obese patients should not undergo a NAVIO procedure. Consult your physician for details to determine if NAVIO is right for you.
  1. American Academy of Orthopaedic Surgeon website, accessed March 7, 2017 //orthoinfo.aaos.org/topic.cfm?topic=A00389
  2. Ponzio DY, Lonner JH, Preoperative Mapping in Unicompartmental Knee Arthroplasty Using Computed Tomography Scans Is Associated with Radiation Exposure a..., J Arthroplasty (2014)
  3. Collier, Matthew, et al., "Patient, Implant, and Alignment Factors Associated With Revision of Medial Compartment Unicondylar Arthroplasty.", Jour of Arthro, Vol 21 No 6, Suppl. 2, 2006.
  4. Hernigou, Ph, Deschamps, G., "Alignment Influences Wear in the Knee after Medial Unicompartmental Arthroplasty.", Clin Orthop Relat Res., Volume 423, June 2004, pp 161-165

All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2019 Smith & Nephew, All Rights Reserved.

Request an appointment

To request an appointment with an AppOrtho physician, call (828) 386-2663 or complete the form below. 

NAVIO® Partial Knee Replacement Surgery

Partial knee replacement with the NAVIO Surgical System

For people suffering from knee pain caused by osteoarthritis, whose damage is limited to a single compartment or area of the knee, partial knee replacement may be an option because it preserves healthy bone and ligaments while replacing the damaged area.1, 2 The NAVIO Surgical System uses robotics-assisted technology to help tailor partial knee replacement procedures to the unique shape and motion of each patient's knee anatomy.

Robotics-assisted Planning for Better Surgical Outcome

While it may seem counterintuitive, replacing only part of a knee joint can be more challenging than replacing the entire joint. This is because partial knee replacement must achieve an exact balance between the new implant - made of metal and plastic components - and the remaining portions of your natural anatomy made of bone and cartilage. As a result, one of the primary challenges of all partial knee replacements is precisely positioning the implant for each unique patient. Even minor changes in an implant's size or placement can cause the knee to function poorly or result in early failure of the implant and the need for future surgery.

The NAVIO Surgical System addresses the challenge of partial knee replacement by using both computer and robotic assistance to accurately map the surface of your knee, align your implant to your anatomy, and physically remove the bone necessary to place your new implant.3 This added level of assistance is important because implant alignment is a crucial factor in determining how long the implant will last. 5, 6

Robotic Knee Surgery without Radiation

Other robotic knee replacement systems use computerized tomography, or CT, scans to help a surgeon visualize a patient's knee anatomy. While CT scans are effective at showing the layers of knee anatomy, they can expose the patient to potentially harmful radiation. In fact, a single CT scan is equivalent to the radiation exposure received in 48 chest X-rays.4

The NAVIO system eliminates the need for CT scans by using an advanced computer program (similar to GPS navigation on your phone) to collect anatomic and alignment information about your knee. Once captured, this information is used to build a precise, computer-rendered 3D model of your knee that your surgeon will use to plan your surgery.

NAVIO Robotics-assisted Partial Knee Replacement Surgery

After all of the information about your knee is gathered and your surgical plan is created, your surgeon will use a robotics-assisted surgical tool (the NAVIO handpiece) to physically remove the damaged surface of your bone so that your new implant fits properly. Using the same 3D model of your knee, the handpiece is able to differentiate between the damaged areas that need to be removed, and the healthy areas that will remain. The NAVIO handpiece uses a burr that removes damaged bone for your implant.

The NAVIO system doesn't replace your surgeon. Rather, it assists your surgeon by adding an extra layer of planning to the procedure.

Partial Knee Replacement with Traditional Techniques

By comparison, traditional surgical methods for partial knee replacement use mechanical cutting guides that help guide a saw blade as it removes the bone necessary to place the implant. The NAVIO Surgical System helps tailor your partial knee replacement procedure.

Important safety notes

Individual results of joint replacement vary. Implants are intended to relieve knee pain and improve function, but may not produce the same feel or function as your original knee. There are potential risks with knee replacement surgery such as loosening, wear and infection that may result in the need for additional surgery. Patients should not perform high impact activities such as running and jumping unless their surgeon tells them that the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if a surgeon's limitations on activity level are not followed.

Disclaimer

Individual results may vary. There are risks associated with any surgical procedure including NAVIO-enabled Knee Replacement. NAVIO is not for everyone. Children, pregnant women, patients who have mental or neuromuscular disorders that do not allow control of the knee joint, morbidly obese patients, or any other patients contraindicated for UKR, PFA, or TKA should not undergo a NAVIO procedure. Consult your physician for details to determine if NAVIO is right for you.

  1. Willis-Owen, Charles, et al, Unicondylar knee arthroplasty in the UK National Health Service: An analysis of candidacy, outcome and cost efficacy, The Knee 16, 473-478, //www.academia.edu/22765713, January 3, 2009
  2. Liddle, A.D., Pandit, H., Et al, Optimal Usage of Unicompartmental Knee Arthroplasty, The Bone & Joint Journal, //www.bjj.boneandjoint.org.uk/content/97-B/11/1506, November 3, 2015
  3. Lonner, Jess, Moretti, Vince, "The Evolution of Image-Free Robotic Assistance in Unicompartmental Knee Arthroplasty." The American Journal of Orthopedics, May/June 2016, 249-254. Accessed June 7, 2016
  4. Ponzio DY, Lonner JH, Preoperative Mapping in Unicompartmental Knee Arthroplasty Using Computed Tomography Scans Is Associated with Radiation Exposure a..., J Arthroplasty (2014)
  5. Collier, Matthew, et al., "Patient, Implant, and Alignment Factors Associated With Revision of Medial Compartment Unicondylar Arthroplasty.", Jour of Arthro, Vol 21 No 6, Suppl. 2, 2006
  6. Hernigou, Ph, Deschamps, G., "Alignment Influences Wear in the Knee after Medial Unicompartmental Arthroplasty.", Clin Orthop Relat Res., Volume 423, June 2004, pp 161-165

All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2019 Smith & Nephew, All Rights Reserved.

Request an appointment

To request an appointment with an AppOrtho physician, call (828) 386-2663 or complete the form below. 

Patient Story

Navio Robotic-Assisted Knee Surgery

Navio Robotic-Assisted Knee Surgery

Are you ready to address your knee pain?

Call us at (828) 386-2663

AppOrtho is the first and only orthopedics practice in western NC to offer robotics-assisted partial and total knee replacement using the NAVIO® surgical system, only at Watauga Medical Center.

How do I know if I am a candidate for robotics-assisted partial or total knee replacement using the NAVIO® system?

Although each patient must consult with a physician individually, typical partial knee replacement candidates share the following characteristics:

  • Knee pain that limits your activities regularly
  • Knee pain due to osteoarthritis
  • Non-surgical treatments are no longer effective

Meet with a NAVIO® trained orthopedic surgeon at AppOrtho today to see if robotics-assisted surgery is right for you. 

Partial Knee Replacement

Total Knee Replacement

NAVIO®-Trained Surgeons

Patient Testimonials

Individual results may vary. There are risks associated with any surgical procedure including NAVIO-enabled Knee Replacement. NAVIO is not for everyone. Children, pregnant women, patients who have mental or neuromuscular disorders that do not allow control of the knee joint, morbidly obese patients, or any other patients contraindicated for UKR, PFA, or TKA should not undergo a NAVIO procedure. Consult your physician for details to determine if NAVIO is right for you.