Getting a LEG UP
What you need to know about knee replacement surgery
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.