1. Cutting Edge Orthopedics for the Knee
Howard J. Gelb, MD, FAAOS Board certified Orthopaedic Surgeon Fellowship trained in Sports Medicine Sub-specialty Certified in Sports Medicine
Cutting Edge Orthopedics for the Knee

2. Cutting Edge Orthopedics for the Knee
*Advancements in partial knee replacement*
Hylagan injections
*On-Q Pump – what it is and why it is utilized in surgery
* Sports Medicine –Torn meniscus and ACL reconstruction

3. Cutting Edge Orthopedics for the Knee
Broward Association of Rehab Nurses Conference on March 4,2016
from 10am to 11am
Signature Grand6900 St Rd 84 Ft Lauderdale Fl 33317

4. Advancements in Partial Knee Replacements
Advantages of Partial Knees over Total
Less invasive
More normal mechanics and feel
Shorter recovery
Generally better range of motion
Bone conservation
Easier to convert to total than a failed total
More easily done as outpatient procedure

5. Advancements in Partial Knee Replacements
Rehab less intensive
Range of motion and strengthening of muscles
Postop pain management
Exparel lipsomal bupivicaine
Blocks
Anticoagulation: ecotrin vs. xarelto
Wound care
No need for inpatient rehab facility

6. Advancements in Partial Knee Replacements
partial knee replacements indications
Medial compartment osteoarthritis
Patellofemoral osteoarthritis
Lateral compartment osteoarthritis
Intact cruciate ligaments, esp ACL
ROM of knee
10 degrees of varus, 5 degrees of valgus
Grade2-3 cmp if not symptomatic

7. Advancements in Partial Knee Replacements
Technique and Design
Zimmer Uni: ZUC- third generation instruments
Oxford Uni: Zimmer Biomet
Mako: robotic assisted uni

8. Advancements in Partial Knee Replacements
Partial vs Total Knee replacement

9. Indication for Partial Knee Replacement
Medial Uni

10. Advancements in Partial Knee Replacements

11. Advancements in Partial Knee Replacements

12. Advancements in Partial Knee Replacements
Work comp advantages
Less invasive
Quicker return to work
Less risk for return to jobs that require mobility
Doesn’t burn as many bridges as TKR
Patient satifaction with procedure
Good-Excellent long term outcomes with modern techniques

13. Advancements in Partial Knee Replacements
Design differences
Anatomic uni
Ball and socket design
Instruments, guides
Robotics

14. Advancements in Partial Knee Replacements
The Oxford Partial Knee

15. Advancements in Partial Knee Replacements

16. Advancements in Partial Knee Replacements

17. ACL Injuries History is key Twisting Noncontact injury Contact injury
Swelling in 75%
Pop 75%

18. ACL Injuries Physical exam Lachman test effusion+/-
check for collaterals
check PCL
ROM
compare with contralateral if possible

19. ACL Injuries

20. ACL Injuries

21. ACL Injuries

22. What’s New with ACL surgery
BTB autograft is best in younger athletic populations, hamstring is another option
Newer allograft preparations: allowash, biocleanse
No need for CPM
Blocks can help postop
Outpatient procedure
Possible to fix or brace partial tears?

23. ACL Injuries

24. What’s New with ACL surgery
Postop rehab is essential for good outcome
Start range of motion next day
Older patients will get DVT prophylaxis with aspirin or xarelto in very high risk group
Use hinged brace for postop discontinue once quad control is back
No twisting or pivoting for 6 months min.

25. What’s New with ACL surgery
Work comp considerations
Modify job if possible no twisting or pivoting
Early surgery is better than delaying
Get motion early preop
Early clinical diagnosis is best.
MRI is helpful for confirmation and meniscal pathology
Meniscus will generally determine weight bearing

26. What’s New with ACL surgery
Motion problems are minimized with PT
Motion problems are minimized with good technique
Allografts can be useful for revisions and patients >35yo
Meniscal preservation is preferred but not always possible

27. What’s New with ACL surgery
ACL nonoperative treatment often results in further damage to knee over time in the active individual with twisting, cutting and pivoting
ACL brace are controversial, do not prevent injury in active individuals
ACL brace is good for skiers and can be helpful in patients who are at increased risk for contact later in postop phase

28. Meniscal injuries Meniscal tears are the most common knee injuries
Repairable tears are generally seen in younger patients
Pattern of tear: longitudinal, peripheral are best to repair
Complex tears may need resection

29. Meniscal injuries
Key to leave as much meniscus as possible to protect the knee and articular cartilage
Meniscal resection vs repair
Treatment dependent on multiple factors
Mensical repair
Inside out
Outside in
All inside

30. Meniscal injuries

31. Meniscal injuries

32. Meniscal injuries

33. Meniscal injuries

34. Cartilage Preservation
Meniscal transplant
Cartilage transplant
New cartilage techniques
Fetal cells
Stem cells
Allograft cartilage
OATS
Microfracture

35. Treatment for Knee OA Weight loss Cortisone shots
Exercise and strengthening
Bracing unloaders
Lubricant shots: Hyaluronic Acid Injections
PRP : RECENT STUDIES LOOK REALLY GOOD!
Stem Cells

36. Treatment for Knee OA LUBRICANT SHOTS
Effective for mild to moderate cases
Low complication rate, safe
Effectiveness may relate to degree of OA
May improve cartilage nutrition

37. Treatment for Knee OA PRP
Has potential for treatment of mild to moderate OA
Safe
Can have long lasting effect on pain
Series of three shots recommended by FDA study

38. Pain pumps
Pain pumps can be useful for peripheral nerve blocks but should not be used in the joint.
Pain pumps are rarely used now
If used in shoulder or knee should be extraarticular …NO marcaine
Potential for chondrolysis of articular surface especially shoulder

39. Pain pumps

40. Cutting Edge Orthopedics for the Knee 561-558-8898 www.gelbmd.com
Howard J. Gelb, MD, FAAOS Board certified Orthopaedic Surgeon Fellowship trained in Sports Medicine Sub-specialty Certified in Sports Medicine
Cutting Edge Orthopedics for the Knee