Application of new techniques and protocols in the replacement of large hip and knee joints
Modern needs require us to focus our efforts on individual factors.
- As fast as possible reintegration of the operated patient with fasttrack protocols.
- Less morbidity with minimization of pain and blood loss achieved by performing small atraumatic incisions and techniques (minimal invasive techniques).
- The least bone removal, safer and more correct placement of implantable materials for a longer period of time.
We achieve this either:
a) By creating personalized models after precise preoperative planning with CT or MRI.
b) With intraoperative passive robotic assistance (navigation).
c) With intraoperative active robotic assistance (robotic).
d) With the help and guidance of all of these, osteotomies are performed in order to accurately apply the implantable prosthetic materials.
The small atraumatic incisions of 8-10 centimeters that we apply to the hip in our clinic with great experience are the small anterior with the use of a traction table (AMIS), the small anterior without the use of a table (ASI) and the small posterior (PATH or SUPERPATH). The choice of surgical approach is made according to the body structure and anatomy of the area and the knowledge and experience of all approaches offers us the possibility of choosing according to the needs of each patient. The use robotically assisted placement of the materials allows us to be precise in completing the operation.
In the knee, we apply a small medial parapatellar incision of 10-12 centimeters through the medial vastus muscle without abduction and inversion of the patella. The use of preoperatively designed personalized models or the robotically assisted technique allows us to place the prostheses safer and more accurately.
In our clinic, there is always a study and careful preoperative planning of each patient individually, whether it is a hip or knee joint replacement.
The surgical team deals with the needs of each patient individually, both in preoperative preparation, the choice of the type of anesthesia to be applied, as well as intraoperative and postoperative monitoring and the administration of appropriate medication aimed at minimizing pain and blood loss. Anesthesia can be general or short epidural, so that there is the possibility of mobilization the same day after surgery.
We usually do not use a bladder catheter, nor a blood collection container (Redon). The duration of the surgical procedure, whether it is for the hip or the knee, is on average 1 hour and 15 minutes and the patient’s stay in our clinic is 1-2 days so that the patient can be sufficiently mobilized by an experienced physiotherapy team and discharged safely. We always make sure to apply the fast track protocol, without this becoming an end in itself but applied to the condition and capabilities of each patient.
The majority of our patients walk without the need for assistance 10 days after surgery and 30-45 days after surgery they can return to daily activities and work.
The knee joint is one of the largest and most complex joints in the body. The knee consists of the lower end of the thigh bone (femur) that rotates on the upper end of the shin bone (tibia) and the kneecap, which slides in a groove at the end of the thigh.
Stability is provided by large ligaments, attached to the thigh and shin. The knee gains strength from the long muscles of the thigh.
The most common causes of cartilage damage in the knee joint are degenerative arthritis, inflammatory or rheumatic diseases, and injuries. The complaints mainly concern pain, joint instability, and stiffness.
The experienced and sufficiently studied physician, taking into account the extent of the cartilage damage, the deformity, the age, the patient’s profession as well as other factors, has to choose each time in surgical procedures that focus on the remission of the patient’s complaints.
These can be:
- Knee osteotomy. (at ages under 60 when the damage concerns one compartment of the knee, and there is a deformity of varus or valgus)
- Unicompartmental knee arthroplasty
- Total knee arthroplasty.
