Goodbye, Knee Pain

By Gailon Totheroh

CBN News Science and Medical Reporter

May 21, 2007

CBNNews.com - Problems with the body's dozens of joints are widespread among all age groups, and getting worse, say reports. But the remedies are getting better too, such as new surgery.

Pat Robertson recently opted for an innovative, minimally invasive surgery to correct the pain and damage in his right knee.

In April, Pat found out from a doctor that part of his right knee was bad - there was no gap between the bones -- that is, no cartilage to cushion them.

The bones on that side have been grinding together.

But Pat is not alone. Joint afflictions lead to 500,000 knee replacements and 300,000 hip replacements a year.

Dr. Richard Berger says that thousands more -- even younger people -- could benefit, but they're reluctant "because they're afraid of pain, they're afraid of their having to have a slow recovery."

"Minimally invasive surgery prevents that," Berger says. "It minimizes their pain, quickens their recovery so they can get back to work and back to life."

The new surgery means recovery of about two weeks, sometimes less. Recovery from the old surgery runs two to three months.

So how did Pat get back in action? With minimally invasive knee surgery, there's less cutting.

With a small incision, Pat's knee was moved around to get access. In the old surgery, the incision is huge to get access.

Once the knee is opened up, the surgery takes about 45 minutes with many steps, including removing rough bumps on the upper and lower leg bones, and sawing off very thin wafers of damaged bone.

While operating on Pat's knee, Berger said that there is "a little rim of cartilage left, but it's bone just rubbing on bone. There are big grooves worn into the bone that obviously shouldn't be there."

Plus, there is old cartilage and damaged tissue to take out.

"And again, we're just taking out some scar tissue which has formed in different spots," Berger said.

The doctor got ready to figure out what size of metal implants to use for the ends of the leg bones -- but first he had to make the inner joint ready for the implants. He also had to ensure that the knee works, with a "trial piece" of replacement cartilage.

"This is not the real piece, of course," he explained. "We're going to put it in and make sure that it fits real well."

Berger must ensure that the knee works with the trial cartilage in. The trial cartilage replacement, which fits in between the metal implants, is called a spacer.

"So we have different-sized spacers," Berger said. "They come in one-millimeter increments, so very, very small -- and we can make very fine adjustments to how the knee works so it's not too tight and not too loose."

"If at some point down the line it wears out, we can take it out and just put a new one in," he said. "Doesn't usually happen, but if it were to happen. This is how the knee moves -- and it's a special design that allows the knee to bend back, very, very far."

Berger uses glue in the metal implants with Plexiglas, showing CBN News the cement he'll be using.

"It comes out kind of doughy," he said, "and then very quickly sets up and becomes rock hard."

And he says it gets heated up, so it's initially very hot to the touch.

The extra cement is pushed out as he taps in the upper implant. Then Berger slides in the lower implant.

"So the important part of this is," he explained, "I haven't cut any muscle, haven't cut any tendons, haven't forced and pulled anything, as you've seen during this whole surgery -- no pulling, no tugging -- just moving the knee in certain positions to get to where you need to get -- without beating things up."

With joint disease on the rise, better surgeries like this and other arthritis remedies are going to be even more in demand.

The CDC says that by 2030, arthritis, joint, and related conditions will afflict 67 million adults.

Of those, 25 million will have faced limited activity of one or more joints from the disease. That will include not only the knee and hip but the shoulder, elbow, wrist, finger, and ankle.

With those high numbers, the economic advantage of less invasive surgery could be huge. By using fewer medical resources, the new surgery saves at least $5,000.

And, if only 10 percent of current knee replacements converted to the new methods, hospital costs to Medicare could drop $200 million annually.

Looking to the future, the proof for this current surgery's success is walking -- or in Pat's case, using stairs just hours after surgery.

The other proof is the x-rays that show Pat's knee evened out with that artificial cartilage and smooth implants above and below.

And he's back in the saddle again - riding his horse just one week after surgery.

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