Torn anterior cruciate ligament repair by Dr. Steven Kassman
Older couple walks for good joint health
  • What are the non-operative options?

    The American Academy of Orthopaedic Surgeons (AAOS) has just released its 2nd Edition of “Clinical Practice Guidelines” for “The Treatment of Osteoarthritis of the Knee.”   These “Clinical Practice Guidelines” on a specific topic are put forth by the AAOS after thorough review and analysis of all related scientific knowledge and expert opinion.  They are designed to guide orthopedic surgeons in providing and their patients in selecting the most proven successful treatments for a particular disease or problem.  Non-operative treatments that were recommended included light, low impact physical activity and exercise, weight loss for those with body mass index (BMI) over 25, and medications to include anti-inflammatories such as Motrin or Naprosyn and a non-narcotic pain reliever Tramadol.   The guidelines specifically do not recommend arthroscopy when the primary diagnosis is arthritis.  Although visco-supplementation injections such as Synvisc are approved by the FDA for the treatment of osteoarthritis of the knee, the AAOS issued a strong recommendation that they provided no benefit based upon their review and assessment of the available scientific knowledge.

    For those patients in my practice who have failed these conservative measures, and feel that their symptoms warrant additional treatment, knee replacement becomes the final option.  Knee replacements can be either partial or complete.  In brief, partial knee replacements may be an option for patients where their arthritis is limited to a portion of the knee and does not involve the entire knee.  If you would like to know if you may be candidate for a partial knee replacement please click here to learn about Makoplasty.

  • When do you recommend knee replacement surgery?

    When arthritis is extensive and involves the entire knee then complete or “total” knee replacement is the best surgical option.  With this option the end of the thigh bone or femur and the top of the tibia or shin bone are resurfaced with metal and a smooth plastic gliding surface is placed between the resurfaced bone ends to correct deformity and ease pain.  We know that accurate sizing and alignment of the knee replacement are critical to good function, pain relief, and less wear with time.  There are different ways to size and align the knee replacement.  Currently in my practice my patients have an MRI of the knee done before surgery.  From that MRI a precise map of the knee is created.  I am then able to review that map and place a “virtual” knee replacement on the patient’s knee using a computer model.  That model or “virtual” knee replacement can be adjusted to obtain optimal sizing and position of the implants.  From this “pre-operative planning” several specific pieces of equipment or “patient matched guides” are made, sterilized, and used in surgery to help ensure that the “virtual” plan becomes the actual knee replacement at the time of surgery.  This technology has allowed my knee replacement patients to benefit from smaller incisions as well as more reliable sizing and alignment.  These enhancements often translate into faster recoveries.  If you would like to know more about this exciting technology for your personalized knee replacement please click here.  (visionaire link)

    There are always exceptions to the rule but most knee replacements in my practice are done with Smith and Nephew components.(to read more click here)  This manufacturer offers my patients several unique advantages including an established track record of successful long term performance, the precision of Visionaire, and the enhanced wear characteristics of Verilast.  Verilast is a proprietary Smith and Nephew technology and is the first knee replacement design to be successfully tested in the lab for 30 years of wear under normal use conditions.  If you would like to know more about Verilast technology click here.

  • Before Surgery

    My knee replacement patients undergo a very specific preoperative regimen to minimize their risk of infection and facilitate their rapid recovery.  Patients are prescribed preoperative chlorhexidine showers and mupirocin nasal ointment to reduce bacterial counts.  These two specific interventions along with perioperative antibiotics, meticulous intraoperative sterile technique, and specialized silver impregnated water proof post-operative dressing all contribute to a meaningful decrease and an overall low risk of infection.   Patients also receive a “prophylactic” or preventative pain medication regimen.  A specific combination of oral long lasting pain medications is given to the patients in the preoperative suite.  These medications, along with a long acting local anesthetic and an anti-inflammatory that are injected directly into the tissues around the knee during surgery, typically facilitate a faster and less painful recovery for most patients.  When these interventions are coupled with a conservative minimal incision approach patients are likely to be out of bed and walking the day of surgery and bending their knee to 90 degrees by the end of the first post-operative day.  Most patients are ready for discharge to home by the day after surgery.

  • How long does rehabilitation last and what does it include?

    Rehabilitation begins immediately following surgery with a supervised exercise program monitored by a physical therapist.  Typically there are no weight bearing restrictions and with the specialized surgical dressing patients can shower whenever they would like.  Therapy continues following discharge either with  home therapy visits or referral directly to an outpatient therapy facility.  Exact duration of therapy will vary from patient to patient and will be customized to in order to accommodate patient specific situations and goals.

    The therapist is important and is under my direction but I emphasize to my patients the value of a self-directed exercise program.  No special equipment is needed and I will personally and clearly instruct every patient in the exercises they need to do to optimize their probability of a fast and complete recovery.  My patients will hear me say over and over 3 words: straightening; strengthening; bending.  These are our mantra and goals following surgery.

    To see the details of these simple exercises click here. I explain to my patients that the therapist will see them at most one hour three times per week.  The patient has 14-16 waking hours each day to work on the rehabilitation of their knee.  No therapist will have as much influence on a successful outcome as the patient will have.  Important exercises can and should be done while lying down in bed or while sitting up for meals and other activities.

    Rate of recovery will vary depending upon various things to include patient’s age and overall physical condition but I will personally and closely supervise every step along the way.  Statistically patients report that they continue to improve for up to 1 or 2 years following their surgery. Most find marked improvement in their walking function as well as ability to accomplish activities of daily living.   High impact athletics such as running are not recommended but many athletic pursuits are possible and we can discuss reasonable expectations in detail during your office visit.

Knee Replacement Testimonials

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Dr. Kassman, The weather was fantastic on our vacation in Hawaii and we had a wonderful time. As you can see from the picture we sent, Joan’s scar is virtually invisible. She is walking without a cane and really doing well. Hope everything is good with you. All the best. Rob

Joan M Knee Replacement Canada 12/10/2015

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Thanks for the great job you did on my hip and knee. I am walking almost normally and no pain. Medical people are amazed how well I have recovery! Sincerely Robert

Robert Y. Knee and Hip Replacement Canada 12/10/2015

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