Total Knee Arthroplasty (TKA) with Patient-Specific Instruments (PSI)
Whether you are suffering with degenerative or rheumatoid arthritis or other diseases, the pain and instability when walking is persistent. As a treatment option, Total Knee Arthroplasty has high success rates with the majority of patients experiencing rapid improvement in pain, function and quality of life. Accurate bone resection and well-calibrated alignment however, are key factors in the success of this procedure.
Minor deviations in the placement of any knee implant may occur even to with most experienced surgeon, resulting in a reduction in motion. Industry leaders endeavor to solve this problem by introducing cutting edge treatment options. A favorable new alternative to the standard surgical approach of total knee arthroplasty is the use of Patient-Specific Instruments (PSI), precisely molded to the patients’ individual anatomy.
PSI have been introduced as a means of improving bone resection accuracy through custom cutting blocks constructed using preoperative 3-dimensional (3D) imaging.
THE PRODUCTION PROCEDURE OF PSI’s
By combining a classic implant with flawless precision by using Patient-Specific Instruments, our patients enjoy a shorter operative time and smaller incisions and minimal blood loss.
The production procedure for PSI’s is organized in stages:
Stage one:
Approximately one month preoperatively, CT scans are taken using the protocol of a special software program. These images are then used to generate a 3D image of the patient’s injured knee joint.
Stage two:
Once the surgeon approves the three-dimensional image, a 3D-printed patient-specific guide or model is created, where all the lesions and injuries are defined, guiding the ideal placement of the suggested implant.
Stage three:
These guides are then used to manufacture cutting blocks that are precisely molded to the patients’ anatomy as opposed to the use of “off-the-shelf “conventional instruments. The medical device company produces PSI cutting blocks using their in house laser sintering technology and these guides and casts are then shipped to be setup for surgery.
Benefits
By improving bone resection accuracy through custom cutting blocks molded to the patients’ individual anatomy, the best surgical outcomes expected. This innovative concept combines different features providing the following benefits:
Accurate implant positioning.
Less traumatic procedure as there is no intramedullary canal violation.
Less time in the operating theater. The use of this technology is very simple and straightforward. It potentially allows the surgeon to reduce the operating time, thus decreasing the time under anesthetic and the risk of infection.
Interactive 3D web planning.
Knee Replacement Surgery Preparation
Before your departure your records will be reviewed thoroughly by our orthopedic surgeon. This includes X-rays and a complete medical and surgical history as well as your specific issues. In addition, you may be asked to consult with a physical therapist to discuss recovery, hip rehabilitation and important precautions you must take postoperatively. The physical therapist may even give you exercises you can begin prior to your surgery in order to aid with recovery.
After traveling to Cyprus, a new set of X-rays will be taken as well as an in person physical examination. The surgeon and anesthetist will also go through you medical and surgical issues with you. During this visit, your surgeon will also review your hip replacement procedure and answer any questions.
Getting your house ready before your surgery
It is also important to get your house ready for after you come home from the hospital. At first it will be harder for you to move around, so arrange your furniture and household items ahead of time to make it easier for you during your rehabilitation.
Preparation for the hospital
Here are a few things to keep in mind as you pack and prepare for the hospital and recuperation:
Clothing
Getting dressed in the morning helps you feel better, so be sure to bring some comfortable clothing to the hospital:
THE PROCEDURE
Total Knee Arthroplasty (TKA) with Patient-Specific Instruments (PSI)
In Total Knee Arthroplasty (TKA) with Patient-Specific Instruments (PSI), there is less cutting of the tissue surrounding the knee. The artificial implants used are the same as those used for traditional knee replacement.
Your orthopedic surgeon will remove the damaged cartilage and bone, using the PSI as a guide and then position the new metal and plastic joint surfaces to restore the alignment and function of your knee. With this technique, the specially designed surgical instruments indicate the precise positioning of the implant, endorsing an optimal fit.
Our orthopedic surgeon will offer you a combination of techniques: PSI and "subvastus" Minimally Invasive Surgery (MIS). Suvastus MIS makes small incisions in the muscle. Because the technique used to expose the joint involves less disruption to the muscle, it may lead to less postoperative pain and reduce recovery time.
The procedure itself takes approximately 1-2 hours.
After your Total Knee Arthroplasty with PSI, you will be taken to the recovery room for a period of observation. The staff will monitor your blood pressure, heart rate, respiration and body temperature. Special attention will be given to your circulation and sensation in your feet and legs. When you awaken and your condition is stabilized you will be transferred to your room.
Your leg may be positioned in a Continuous Passive Motion (CPM) machine after surgery. While you are in bed, this machine will continuously bend and straighten your leg. The CPM machine keeps your joint from becoming stiff and speeds recovery.
How Long Will the Knee Implant Last?
The longevity of the implant depends on many factors such as the patient’s weight, the patient’s activity level, and the presence or absence of disease in other joints of the lower extremities.
Implants can last ten to fifteen years and even longer. By applying the implants in the proper position according to the preoperative plan, the forces will be distributing equally to the prosthesis surface. In that way we expect less wear and subsequently longer survival of the implants. New techniques allow for an implant to be removed and replaced, but our goal is to be able to implant a prosthesis that will last the patient a lifetime without revision.
The Knee Replacement Surgery Advantages
Knee Replacement Surgery Results
Results are impressive and gratifying to both the patient and the surgeon. Most patients are pain-free and able to bend their knees from 90° to 100°, resuming daily activities without restriction. The remarkable results of total knee replacement are due to patient determination, the surgeon’s skill, and the bioengineers’ well-designed implants and instruments. However, a total knee replacement procedure will not make you a super-athlete or allow you to do more than you could before you developed knee problems. Activities that you can reasonably expect to be able to do after surgery are:
Hospital discharge and home instructions
The hospital stay after a Total Knee Arthroplasty (TKA) with Patient-Specific Instruments (PSI) is typically ranging from 2 to 4 days.
Progress varies from patient to patient so discharge instructions may vary.
Before leaving the hospital, our surgeon and staff will help you adjust to recovery in every way possible. You will receive specific instructions and precautions from your surgeon and physical therapist and they will show you safe techniques of simple activities like getting in and out of bed, bathing, going to the bathroom, managing steps at home and getting in and out of a car.
TOTAL KNEE REPLACEMENT RECOVERY
Physical rehabilitation is a critical component of recovery. Your surgeon and physical therapist will provide you with specific exercises to help increase your range of motion and restore your strength.
The estimated rehabilitation/recovery time after MIS partial knee replacement is approximately five weeks for many patients, but it varies.
LIFE AFTER SURGERY
In general, patients must use support in two hands for about six weeks after surgery while their muscles are rehabilitating. You will be given written instructions for the exercises you will be continuing upon your return home.
Physical Therapy
Following surgery, you will receive physical therapy. Trained professionals will determine the personalized exercise programs for your physical therapy.
Your physical therapist will start you off between parallel bars in preparation for the use of crutches or a walker. These bars allow you to practice walking by supporting part of your body weight with your arms rather than on your surgical leg. A short robe and low-heeled walking shoes are recommended when learning to walk with crutches or a walker.
As you become more comfortable with walking, your physical therapist may allow you to practice walking on the hospital unit with assistance. Before you go home, your therapist will teach you to climb stairs and to transfer from a bed, chair, and car.
Your physical therapist will design an exercise program to increase the motion and strength of your knee. Range of motion exercises will let your knee move easily from the fully straight position to a 90° bent position.
Your participation is vital. The goal is for you to become as independent in your personal care and daily activities as possible before you return home.