Dr. Jeffrey H. DeClaire, MD Orthopedic Knee Surgeon and founder of the Michigan Knee Institute, talks about a new technology that assists in knee replacement surgery.
Interview conducted by Ivanhoe Broadcast News in June 2022.
No two knees are alike, right?
DeCLAIRE: Yeah, absolutely. No two knees are alike. Every patient is unique and specific to the type of knee they have, the alignment, the type of wear pattern, the status of the ligaments. We also look at knees and the elements of compartments and what compartment is involved, whether it’s one compartment or multi compartment. Therefore, the treatment as well as the surgery needs to be very specific and tailored to what that knee condition is for that patient. One knee can be different from the other. An example of that is a person that has arthritis in both knees, the condition of that arthritis may be very different in one knee compared to the other knee in the same patient. So yeah, each knee is very specific in itself.
How many patients have you done over the years with knee replacements?
DeCLAIRE: I’ve specialized in just knee surgery for over 25 years, and I probably have done over 30,000 knee procedures in my career.
Have you seen knee surgery change a lot?
DeCLAIRE: Yeah. There’s been drastic changes throughout time and the methods of treatment as well the technique of surgery and certainly design of implants. That’s changed drastically as far as the outcomes go and the longevity of the implant. In addition to what patients can do once they have their knee replacement, which is now we can return patients really to their pre-arthritic condition and performing the activities they did when they were in their 20s and their 30s, which was very distinctly different from 15, 20 years ago.
Have the robotic surgeries, and the computers that were used in the last decade, helped you try to perfectly place the implant?
DeCLAIRE: Correct. The computer navigation, we call where the computer, helps to guide the surgeon has been around for probably almost 20 years. But it didn’t change outcomes because it helped with the accuracy of preparing the bone, but it didn’t include the tension or the balance of ligaments, which is what’s evolved over time and combining now with what’s called robotic assistance, which means that a robotic cutting guide that’s guided by the computer where I as the surgeon, I’m still doing the surgery. It’s not a robot that’s doing the surgery, which some people think that. But the other unique thing that’s evolved over the last seven years, is the ability to measure ligament tension and get objective measurements of the ligament laxity or tightness throughout the range of motion in real time while I’m doing the surgery. So, I can very specifically and accurately balance those ligaments using the data that we have so that we can get a very predictable outcome.
Is that the BalanceBot?
DeCLAIRE: Yes, that’s the BalanceBot.
Can you tell me how that works?
DeCLAIRE: I always say the simple explanation is the surgeon trims the bone and puts on a new surface. But the technical part is restoring normal knee ligament, balance, and stability. The ligaments are what controls the movement. A good example of that is the athlete who tears the ACL. Once that one ligament is torn, that knee is never normal, won’t function normally until that ACL is reconstructed and restored. A lot of research has gone into the position of that ligament so we can get a predictable outcome. The same thing applies to a knee replacement – we want the ligaments of that knee to function like a normal knee ligament. So, the BalanceBot is a method to measure ligament tension throughout the full range of motion on the inner half of the knee and the outer half of the knee. The BalanceBot can measure ligament tension on the inner half and the outer half of the knee, the medial and lateral side, throughout the full range of motion. It’s a device that I place in the knee. This is before we position the implant. Even prior to that, I’m able to plan the surgery on the computer, assessing the position so that we have a balanced knee and literally being able to balance the ligaments within a half a millimeter and to achieve rotational position within a half a degree, which has really been exciting to me, because as a surgeon, to create that accuracy, there is no other method. My hands and my experience can’t determine a half a millimeter of tightness or looseness in a ligament, but this allows me to measure that. So, the device is two independent paddles that are placed into the joint with a defined load that will tension that ligament. Then, I’m able to assess that ligament tension prior to the execution of the surgery. Then, using the computer and really a large database where we now have data that supports a patient satisfaction of almost 98%, distinctly different which is what’s been published in the past, which ranges between that 75 and 80%, so that I know that I can position this implant. Once we validate the accurate positioning with the balanced ligaments, then, the robotic assisted cutting device allows me to execute that and validate that we’ve achieved that ligament balance.
Is this just like augmented intelligence?
DeCLAIRE: Yeah, exactly. It’s been referred to as a second pair of eyes. It’s not just my eyes and my experience, but it’s the eyes and experience of this data that allows me to guide position of the implant using this data in a very predictable fashion.
What is the biggest concern after knee replacement for people? With most complications, what does that involve? Like, not infections, I’m talking about the length and how this makes a difference.
DeCLAIRE: So, limb length really isn’t part of this. That’s more of a hip replacement. I know you think that. But it’s more pain and instability.
This should probably take away some of that instability, which is going to take away some of the pain, right?
DeCLAIRE: Yes. Relief of pain has been very predictable. If you go back 30, 40 years with knee arthroplasty, that was the primary goal was to relieve pain. But patients had challenge with motion. In fact, if they got 90 degrees of bend flexion, that was considered a good result. But now, we have patients that return to not only bike riding but mountain climbing, ice hockey, jogging – getting back to their pre-surgical or pre-arthritic activity level at high demand.
Is the recovery quicker now?
DeCLAIRE: Yeah, it’s quicker as well. The techniques of what we refer to as minimally invasive methods, which is combined with this, which utilizes methods to minimize what I refer to as trauma to the tissue. But what this technique of surgery using the BalanceBot has allowed for is it’s less traumatic to the tissues. Because if the surgeon has an unbalanced knee with traditional methods, typically, you have to do a release, which means you have to cut or make that ligament looser, which violates the ligament and creates pain. It’s trauma to the tissue. This is one of the studies that we’ve just published that shows a significant change in outcome. So, with this method, ligament releases have been drastically reduced, which means less trauma to the tissue, quicker recovery, and therefore better outcomes.
Do you have specific numbers on how many people reported less pain?
DeCLAIRE: We do have data on this. We use a measurement tool called the KOOS score. We look at pain, which measures pain at different times throughout the recovery. This is one of the studies we just published in one of the major journals that shows a significant difference in that pain level when this technique of surgery is utilized compared to traditional methods.
END OF INTERVIEW
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