Health & Fitness

Aging joints benefiting from 3-D technology and implants designed anatomically

BACK ON HER FEET: Charmaine Gibson with one of her paintings after hip-replacement surgery. She’s now able to climb stairs and go for daily walks.
BACK ON HER FEET: Charmaine Gibson with one of her paintings after hip-replacement surgery. She’s now able to climb stairs and go for daily walks. FOR THE MIAMI HERALD

Artist Charmaine Gibson, 82, had arthritis so bad in her hip she couldn’t climb stairs, she could barely drive and she couldn’t paint her large murals because it hurt to stand.

Then she had hip surgery and 10 days later, she was walking with no pain. “It was such a wonderful event. It has made such a difference in my life,” Gibson said.

Contractor Ricardo Cabrera, 68, said his knee was “bone against bone” before surgery. Three months after a custom-knee replacement, he went biking in Colombia while visiting his in-laws for Christmas. And in September, Cabrera lived his dream of biking on the Way of St. James in northern Spain with his wife. They biked 40 to 50 kilometers, or about 30 miles a day. “It’s a very emotional, personal thing,” Cabrera said of the Christian pilgrimage.

Laura Bennett of Florida City suffered in pain for 10 years with degenerative arthritis of the big toe, unable to wear most shoes and forced to walk on her heels. Bennett called her toe-joint replacement life-changing. “I will tell you to this day, there have been no repercussions, no pain. The only thing I had was a little swelling. I’m still waiting for the pain,” said Bennett, 61.

All three patients are benefiting from new inventions, new techniques and new ways to replace joints that are less invasive and more tailored to human anatomy.

“People want pain relief plus preservation of motion and function,” said Dr. Thomas San Giovanni, a foot and ankle specialist at Miami Orthopedics and Sports Medicine Institute at Baptist Health. “That’s what we are striving for,” Giovanni said.

Bennett was among the first to get the total great toe joint replacement that San Giovanni designed. The implant is for people with arthritis of the big toe, also called great toe arthritis, hallux rigidus or hallux limitus, San Giovanni said.

San Giovanni said there hadn’t been a toe joint replacement “that’s designed anatomically. That’s why it’s a game changer.”

The implant, which gained FDA approval in May 2014, “more closely resembles the bones of that joint,” San Giovanni said.

“It’s a very exciting time in medicine,” said Dr. Marc Umlas, who operated on Gibson and Cabrera.

Umlas, chairman of Orthopaedic Surgery and Rehabilitation at Mount Sinai Medical Center, said he has had one of the hospital’s MRI machines calibrated “to enable us to create data that can be imported into a computer-design program.”

“Using a three-dimensional printer and medical-grade nylon, we can print out patient-customized instrumentation which exactly fits the patient’s knee,” Umlas said. The 3-D model “allows us to make cuts of the bone in the exact angles they need to be.”

“Before, the only way we were able to get these exact angles was to drill holes up and down the femur and the tibia (thigh bone and shin bone) and sound them out,” Umlas said.

Coupling computer technology “with our imagining technology, allows us to perform surgery a lot more accurately and less invasively,” Umlas said.

“It’s very nice to be able to plan this all out before the patient arrives in the operating room,” Umlas said.

Cabrera, who got a custom-made implant for his left knee, said he felt super after the surgery even though it was painful. He started walking the next day.

“The most important thing is you have to force yourself” to do the exercises, Cabrera said, adding, “I did the stationery bike, which I hate.”

With hip surgery, Umlas uses a 3-D CAT scan of the hip “to see how much bone we have to replace.” By coupling surgery with advanced imaging, “we can create blueprints of the parts we’re working on,” Umlas said.

Cutting the minimum of muscle is the gold standard. In hip replacement, it’s a 3-inch incision. “We do not cut any of the major muscles,” Umlas said. The old way was to make a long incision, expose everything and do the surgery.

For knee surgery, he’s sparing the quadriceps. “Normally,” Umlas said, “you divide the tendon. We’re going on the side of the knee. Instead of cutting the muscle, we’re just moving it over.”

“The goal is to perform surgery with as little disruption to the normal tissue as possible. This type of surgery is becoming a paradigm in all of medicine now,” Umlas said.

The future may also mean less surgery for arthritic joints. Dr. Clifton Page, a sports medicine expert and Miami Marlins team doctor, is heading up a clinical trial at the University of Miami Miller School of Medicine. The goal is to find out if stem cell treatment for the knee and hip is effective.

Page, an assistant professor of clinical medicine at UM, said researchers want to ascertain whether stem cells injected into the knee or hip are actually turning into new cartilage tissue or new bone tissue.

“We want to keep everybody active as they age,” Page said.

Page will recruit 50 to 100 patients who have been diagnosed with osteoarthritis of the knee or hip. These volunteers will get stem cell injections and be assessed periodically. They will use either their own stem cells or ones derived from other sources, for which the UM stem cell center is awaiting FDA approval.

“To have an alternative outside of surgery is very promising and hopefully we can prove that this is a good and viable option moving forward,” Page said.

Meanwhile, there are surgical advances. As Cabrera said, “There are so many people who should be in wheelchairs right now who are moving and exercising and having a very active life because of the [joint] surgeries.”

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