Customized replacements have improved process, local doc says

Custom-designed knee replacements are giving patients better outcomes than traditional, off-the-shelf replacements, Dr. Patrick Kelly said Tuesday.

Kelly, an orthopedic surgeon, spoke to the Andalusia Rotary Club.

“This is the latest, greatest technology,” Kelly said.

With traditional knee replacements, companies manufactured six or seven sizes. A surgeon had to choose the closest size and make it fit.

“The problem with undersizing and oversizing is they both present difficulties,” Kelly said. “Both produce pain.”

But a company is revolutionizing the process by creating custom knees.

The company, Conformis, uses three-dimensional scanned images of a patient’s knee to produce a new joint that fits perfectly, Kelly said.

“The customized knee is just a box, delivered a day or two before surgery,” he said. “It’s all we need.”

In the past, all of the possible pieces for a knee – as in all sizes stocked – had to be sterilized before surgery could begin. Now, personnel only have to prepare the custom knee.

“That saves at least 20 minutes or so in the OR,” Kelly said. The actual hardware is less expensive, he said, and the recovery time is usually shorter, resulting in cost savings all around.

But the most importantly, he said, patients get better results.

“Most people who get a knee are OK, and can do the things they want to do,” he said. “One out of five people on average, are unsatisfied with the off-the-shelf knee.”

With the customized knee, there is less bone loss, he said. There is also less infection, less post op pain, and patients have better ranges of motion and fewer fewer rotation problems. The custom knee is just more stable, he said.

“For us as surgeons, using this required a leap of faith,” Kelly said. “We’re putting our faith in engineers. Changing to this was the hardest thing I’ve ever done in my life.”

He was totally convinced, however, when he had a patient scheduled for bilaterial replacements. The first custom knee arrived, but delivery of the second was delayed by a snowstorm. Rather than change her surgery, she opted to have the second knee replaced with a tradition, off-the-shelf product.

“In the follow-up she told me the custom knee felt like her own knee, and that if she had to do it over, she’d wait for the second one,” he said.

The scans are done at the local hospital, where the imaging equipment has been certified by Conformis. It takes four to six weeks for the company to build the knees.

A replacement is expected to last for 40 years, he said, which is about twice as long as a traditional knee replacement.

Kelly’s office can be reached at 222-2073.