Knee, hip replacements getting easier with 3D models, technology

World traveler Janet Bancroft has hiked, climbed and walked her way through 60 countries.

This is despite suffering from rheumatoid arthritis, and having her her left knee give out seven years ago while she was climbing down the Mount of Temptation overlooking the Judean Desert in Israel.

Bancroft, 79, decided she needed to have knee-replacement surgery but was buoyed by the prospect of returning to her hikes shortly after undergoing the last of her surgeries in 2012. She had her first surgery done two years before.

Dr. Marc Umlas, chairman of orthopedic surgery and rehabilitation at Mount Sinai Medical Center in Miami Beach, performed both of her knee-replacement surgeries. He and other orthopedic doctors note that muscle-sparing procedures such as anterior approach surgery, precise 3D models that can custom fit a person’s joint and advanced robotic surgery have enabled patients to recover much faster in joint-replacement surgeries.

“Over time, we’ve realized that certain muscles and tissues can simply be moved out of the way and don’t need to be detached in order to get the joint replacements in,” said Umlas.

An example: quadriceps-sparing knee replacement, where surgeons lift the muscle and the knee-replacement surgery is performed from the side, with the incision much shorter than traditional knee replacement surgeries.

“The patient ends up with a much stronger knee immediately after surgery,” Umlas says, “because you don’t have to wait for the muscle to recover.’’

Indeed, three months after her final knee surgery, Bancroft was traipsing through Yellowstone National Park in Wyoming. Since then, she has visited Lake Titicaca, straddling the Andes mountains between Peru and Bolivia, and last July hired a private guide to traverse Machu Picchu, the ancient Incan hilltop ruins set high in the Andes. She also climbed three flights to a tower in southern Peru to see the geoglyphs of the Nazca Lines, a UNESCO World Heritage Site.

“And I still want to travel,” says Bancroft, a retiree of the United Nations Industrial Development Organization.

The advances in joint surgeries are not limited to the elderly.

Sean Laria, a 16-year-old junior at Miami Sunset Senior High in Kendall, has a rare condition that affects his hips, called Femoroacetabular Impingement. He says his bones were rubbing together and created extra cartilage.

“I started losing mobility more and more as time progressed,” says Laria, who has been practicing martial arts since he was 4 and was in his school’s ROTC program.

Laria says Dr. Kevin Horowitz, a pediatric orthopedic surgeon specializing in hip preservation surgery at Nicklaus Children’s Hospital, warned he could experience loss of motion at age 30 if he didn’t have a hip-preservation procedure, due to the arthritis he’d develop. “Ever since I was a little kid, I always struggled to kick as high as the other kids because I just couldn’t lift my leg to a certain extent.”

Last August, Laria underwent his first hip-preservation procedure on his left side and had the most recent procedure done in March on the right side. In hip-preservation surgery, surgeons re-shape the shallow hip socket so it can better cover the ball of the femoral head. The hip preservation aims to postpone hip replacement surgery.

Laria did five months of physical therapy at Nicklaus’ outpatient center after the first procedure, and he’s now waiting for his femur to heal before continuing physical therapy for the second procedure. He uses crutches at school and around the house to get around. “It’s difficult at times but in the long run it’s worth it — being able to move around one day with my kids, being able to do martial arts once again, being able to be that 100 percent that I was never able to be,” he says.

“In a lot of cases hip dysplasia is what causes it — arthritis of the hip,” Horowitz says.

Horowitz says that since it’s hip preservation — not hip replacement — nothing artificial is inserted: “You want your own hip as long as you can have it. Your own hip does better than any replacement. Whether you’re 15 or 50, we’d like you to keep your hip as long as possible.’’

In a hip-arthroscopy procedure, a small camera is used to give doctors a clear view of the joint. “The understanding of this problem over the last five to 10 years has skyrocketed astronomically,” Horowitz says. “Ten years ago, there were only a handful of articles about this, and now there are hundreds a year.”

For those needing joint replacement surgery, more sophisticated instruments and 3D modeling are enabling surgeons to make much smaller incisions, hastening the patient’s recovery and mobility.

Miriam Diaz, a native of Cuba who has been living in Hialeah for two decades, was confined to a wheelchair in the months before receiving hip surgery in December from Dr. Frank Buttacavoli at Aventura Hospital. Her hip was eroding into her pelvis.

Diaz says she stopped feeling the excruciating pain from her severe arthritis and two falls after waking up from the surgery. She even started walking, little by little, that same day. She’s still doing physical therapy two to three days a week.

“I feel great,” she says in Spanish. “I’m walking without a stick, without a walker, without a wheelchair.”

Says Buttacavoli: “What’s changed over the years is the retractors, the surgical instrumentation. A lot of those things have gotten significantly better to allow us to do much smaller incisions than we used to.’’

Buttacavoli says the implants have also changed. Titanium, ceramics and stronger plastics like polyethylene have replaced the metal implants from 10 to 15 years ago. “The orthopedic community made a mistake with metal-on-metal implants, which have since been recalled, due to the wear involved in the components, which resulted in metal toxicity and pseudo tumors,’’ he says.

Dr. Carlos Alvarado, an orthopedic surgeon specializing in joint reconstruction with Miami Orthopedics and Sports Medicine Institute at Baptist Health South Florida, says computer robotic-assisted joint replacement surgery has significantly improved patients’ prognosis.

“Using a 3D model of your leg, a map is uploaded into the computer,’’ Alvarado says. “The robot is a single arm that’s directed by the surgeon. The arm has a 3D map of the knee loaded to it and it makes very precise cuts of where the implants are to be placed.

“What we found using the robot is that the placement of the implant is very precise. It minimizes the risk of a malpositioned implant,” Alvarado says.

Over 600,000 knee replacement surgeries and over 300,000 hip replacement surgeries are done annually in the U.S., according to the American Academy of Orthopedic Surgeons.

Alvarado says custom-made implants are on the rise, or implants based on CT or MRI scans. “Swelling decreases when it fits right,” he says. “We’re starting to achieve these things through improvements and innovations in technology.”

And if surgery is not an option, doctors are turning to a new treatment that uses a nerve-cooling injection to break the pain cycle and ward patients off addictive prescription pain killers.

Dr. Lowell Davis, an interventional spine/pain medical physician at Memorial Regional Hospital in Hollywood, says the “Coolief Radiofrequency Treatment,” which has been around for less than a year, is used if an orthopedic surgeon feels there’s no other operative solutions.

The outpatient procedure is done through a needle and provides patients with eight to 12 months of pain relief for hip or knee pain. The cooled radiofrequency energy targets the sensory nerves causing the pain.

“It’s a great modality to avoid patients from being placed on narcotics or opioids,” Davis says.

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This story was originally published April 21, 2016 at 8:18 AM with the headline "Knee, hip replacements getting easier with 3D models, technology."