Get­ting a LEG UP

What you need to know about knee re­place­ment surgery

201 Health - - Knee Replacement - WRIT­TEN BY JOSEPH RITACCO

Life with­out knee pain is suit­ing Ha­worth res­i­dent Mark Zurlini just fine. Af­ter five surg­eries to treat mul­ti­ple tears to his menis­cus and an­te­rior cru­ci­ate lig­a­ment (ACL), as well as sev­eral in­jec­tions over the years to ease his dis­com­fort, Zurlini was un­der­stand­ably frus­trated when walk­ing the golf course and even climb­ing the stairs be­came painful tasks by the time he reached his early 40s.

Con­ver­sa­tions with his brother, Michael, who works at Stryker Or­thopaedics, a Mah­wah-based man­u­fac­turer of med­i­cal de­vices and med­i­cal equip­ment, led to a meet­ing with Dr. Mark Piz­zurro, an or­tho­pe­dic sur­geon at Ridgewood Or­tho­pe­dic Group and The Val­ley Hos­pi­tal in Ridgewood, who be­lieved Stryker’s Get Around Knee Sys­tem was the so­lu­tion to Zurlini’s knee woes. The sin­gle ra­dius de­sign of the im­plant, which has been used in more than 1 mil­lion knee-re­place­ment surg­eries world­wide since 1996, repli­cates the knee’s nat­u­rally cir­cu­lar mo­tion, eas­ing the stress on sur­round­ing mus­cles.

“Knees are trick­ier to re­place than hips be­cause there are three bones com­ing to­gether in the knee and a num­ber of mus­cles,” says Piz­zurro, who per­formed Zurlini’s surgery in 2009.

Dur­ing the pro­ce­dure, the sur­geon makes an in­ci­sion to the front of the knee and uses spe­cial in­stru­ments to make pre­cise cuts of the bones, in­clud­ing the fe­mur (thigh bone), tibia (shin bone) and, if needed, the patella (knee cap). The bones are cut into a shape that cor­re­sponds with the metal al­loys and high-grade plas­tic com­po­nents be­ing im­planted.

For Zurlini, who had suf­fered from knee pain of one kind or an­other since child­hood, the GetAroundKnee Sys­tem paid al­most im­me­di­ate div­i­dends.

“I had the surgery in April 2009,” he says, “and by Au­gust I was play­ing soft­ball. Now I have zero pain. I can feel it – the piece of metal – but I have zero pain.”

Uti­liz­ing a Stryker prod­uct came with an added bonus five years later, when Stryker and the PGA Tour an­nounced a new mar­ket­ing re­la­tion­ship that des­ig­nated Stryker as the “Of­fi­cial Joint Re­place­ment Prod­ucts of PGA Tour and Cham­pi­ons Tour.” Over the past year, Stryker has been a pres­ence at sev­eral PGA Tour events, in­clud­ing The Bar­clays, held last Au­gust at Ridgewood Coun­try Club in Para­mus. The cen­ter­piece of its on­site tour­na­ment pres­ence is its Stryker Mo­bil­ity Zone, where fans are pro­vided with in­for­ma­tion and joint health as­sess­ments from or­tho­pe­dic sur­geons and have a chance to meet Cham­pi­ons Tour mem­bers Fred Funk and Hal Sut­ton, both of whom have un­der­gone joint re­place­ment pro­ce­dures with Stryker prod­ucts.

Zurlini rec­om­mended to his brother that Stryker in­clude an “av­er­age Joe” at The Bar­clays to com­mu­ni­cate with fans about the benefits of knee re­place­ment surgery. Shortly there­after, he was named an “Hon­orary Ob­server” at the tour­na­ment, gain­ing a level of ac­cess to the golf course that is typ­i­cally re­served for play­ers, of­fi­cials and me­dia mem­bers.

“I was in­vited to The Bar­clays and got to walk with Matt Kuchar and Zach John­son,” re­calls Zurlini, a vice pres­i­dent at M&T Bank in Sad­dle Brook. “It was a great ex­pe­ri­ence. I spent a lot of time in the Stryker tent speak­ing to folks who were go­ing to get the op­er­a­tion.”

His ad­vice for them: “If I had known how suc­cess­ful it was,” he says, “I would have done it two years ear­lier and saved my­self a lot of pain.”

Suc­cess sto­ries like Zurlini’s have be­come more preva­lent in re­cent years, as im­prove­ments have been made in knee-re­place­ment pro­ce­dures and sub­se­quent re­cov­er­ies.

Dr. Anil Ranawat, who serves as or­tho­pe­dic sur­geon and med­i­cal direc­tor for the Hos­pi­tal for Spe­cial Surgery Para­mus Out­pa­tient Cen­ter, cred­its ro­botic knee re­place­ment, used for 15 per­cent of all pro­ce­dures, for im­proved suc­cess rates.

“Ten years ago, less than 1 per­cent [of knee re­place­ments] were done with ro­bots,” says Ranawat, adding that cus­tom im­plants and the ad­vent of pa­tient-spe­cific jigs (cut­ting guides) have made the pro­ce­dures more pre­cise than ever.

While the sur­gi­cal ad­vance­ments have been wel­comed by pa­tients, it is the post-op­er­a­tive pain that of­ten trou­bles them the most. In re­cent years, mul­ti­modal pain man­age­ment has been the goal among ex­perts in the field, a course of ac­tion that typ­i­cally in­cludes anti-in­flam­ma­tory med­i­ca­tions, lo­cal anes­thetic in­jec­tions and re­gional nerve and spinal blocks, com­bined, of course, with phys­i­cal re­ha­bil­i­ta­tion that be­gins im­me­di­ately.

“There’s been a big push by the in­sur­ance com­pa­nies in re­cent years to get peo­ple home sooner,” says Piz­zurro.

Dr. Asit K. Shah, as­so­ciate chief of the depart­ment of or­tho­pe­dics at Englewood Hos­pi­tal and Med­i­cal Cen­ter, says that while ev­ery pa­tient is dif­fer­ent, the av­er­age pa­tient is back to an ac­tive, in­de­pen­dent life­style in six to eight weeks. He adds that the level of con­cern about the surgery has di­min­ished in the past few years as res­i­dents have gained fa­mil­iar­ity with it.

“In Ber­gen County, the ed­u­ca­tion level is very high,” Shah says. “Ev­ery­one seems to know some­one who’s had it done, and the lo­cal hos­pi­tals all do an ex­cel­lent job of ed­u­cat­ing pa­tients.”

Dr. Raphael Lon­go­b­ardi, chief of or­tho­pe­dics at Holy Name Med­i­cal Cen­ter in Tea­neck, cred­its the med­i­cal cen­ter’s com­pre­hen­sive seminars for eas­ing the con­cerns of pa­tients.

“There’s al­ways a seg­ment that’s scared to death,” Lon­go­b­ardi says. “Holy Name brings pa­tients in prior to surgery to talk about the im­plant and show them what it looks like. Na­tion­wide, hos­pi­tals are do­ing this.”

While each pa­tient is unique, those who ex­pe­ri­ence pain that is not re­lieved by more con­ser­va­tive meth­ods – like med­i­ca­tion or phys­i­cal ther­apy – and is se­vere enough to re­strict rou­tine ac­tiv­i­ties are likely can­di­dates for knee re­place­ment.

“It’s a con­cor­dance of his­tory, phys­i­cal exam find­ings and X-ray find­ings,” says Ranawat, who adds that he also seeks feed­back from pa­tients’ spouses or sig­nif­i­cant oth­ers.

“The lack of qual­ity of life af­fects them, too,” he says, “so I’ll ask them, ‘Is he or she ready?’”

Armed with the best and most ad­vanced tools and pain re­liev­ers the field of or­tho­pe­dics has ever seen, spe­cial­ists in the area are cer­tainly ready to help knee-pain suf­fer­ers re­turn to ac­tive, healthy life­styles. At­ten­tion is al­ways paid, how­ever, to what is next, and or­tho­pe­dic sur­geons are hope­ful that fu­ture break­throughs will ease pain even more and in­crease the longevity of knee im­plants, which cur­rently ranges from 15 to 20 years, thus al­low­ing younger pa­tients to ben­e­fit from the pro­ce­dure.

Lon­go­b­ardi high­lights the ef­fec­tive­ness of bi­cru­ci­ate-re­tain­ing pros­the­ses, which re­tain the an­te­rior cru­ci­ate lig­a­ment and pos­te­rior cru­ci­ate lig­a­ment and di­min­ish wear and tear on both.

Shah be­lieves the next big break­through will be the use of bio­ma­te­ri­als other than metal. Specif­i­cally, he says, fu­tur­ist plas­tics like those cur­rently used for drilling off­shore will soon be made more read­ily avail­able to the med­i­cal de­vice in­dus­try.

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