When do you prefer using a partial knee surgery?

I prefer using a partial knee surgery when the following requirements are met: patient is not morbidly obese, the pain is mostly on the medial side and the X-rays show arthritis consistent with the location of pain, the anterior cruciate ligament is intact, and the knee does not have significant contractures or deformities.

What device do you prefer for partial knee surgery and why?

I use the Oxford Partial Knee (Biomet). I am not a paid consultant by Biomet and I do not receive any monetary fees to use this prosthesis. I use it because the Oxford knee has a worldwide proven success rate going on now for over 20 years. The surgery is technically demanding but the instrumentation is constantly improved upon so the surgeon performing
the procedure has consistent and reproducible results.

What device do you prefer for total knee replacement and why?

I use the Oxinium prosthesis made by Smith and Nephew. Oxinium is a state of the art material (oxidized zirconium) that has superior metallurgy characteristics making the implant harder, smoother, and scratch resistant over a much longer period of time. Oxinium is specially designed for the younger patients who need a total knee because they require a prosthesis that will last longer.

What approach do you use for both surgeries and why?

For my partial knee replacement, the incision is typically between 3 and 4 inches. For my total knee replacement, the incision is typically between 8 and 12 inches. The incision size varies depending on the size of the patient. Patients are concerned about the final size of the incision because of appearance. The surgeon has to respect this factor without sacrificing exposure and visibility during the procedure.

How long do you feel it takes for the bone to be fully healed, grow into the prosthesis? What is the recommended time you tell your patients before they can start to walk, run or be completely active?

I use cement in all my knee replacements. The cement bonds the prosthesis instantly into the bone. However, the soft tissue envelope may take anywhere between 8-12 weeks to completely heal. My patients begin walking 2-3 days after surgery. I advise running after six months. Complete activity returns after one year.

Do you use cement or cementless procedures and why?

Cement is necessary when implanting the Oxford Partial Knee. I also use cement for my Oxinium Total Knee. I like cement because you get instant stability and bonding of the metal to the patient's bone. Cemented implants have a proven track record that is hard to beat.

Does age determine your use of partial knee replacement or do you go by case?

Age plays a role because most people that are older who need a knee replacement already have arthritis throughout most of the knee. As such, replacing just one side will not work. However, I have implanted the Oxford in patients older than 70 years because they have limited disease and their bone quality is very good. I approach each patient on a case-by-case basis to see if the Oxford is right for them. Not every one will qualify.

What size incision do your normally use for partial knee? for total knee replacement?

3 to 4 inches for the Oxford Partial Knee and 8 to 12 inches for the Oxinium Total Knee. If my patient is particularly large, I tell them that the incision will be on the "longer" side due to difficulty of exposure.

What is your typical recovery time? Your typical rehab protocol? Use of crutches for how long ? Typical restrictions and for how long?

My Oxford Partial Knee patients stay in the hospital overnight. Less than 25% require a 2-3 day hospital stay. They begin range-of-motion exercises almost immediately. Most require crutches or a walker but are able to get rid of them after 1-2 weeks. Typical rehab protocol is 6-8 weeks. My Total Knee patients take anywhere from 3-6 months.

What type of anesthesia do you use?

I use both general and regional anesthesia. Pain control after surgery is a priority of mine. I use a special "cocktail" or mixture of 5 different medications and I inject the solution around the incision halfway during surgery and then right before skin closing. Most of my patients wake up with very little pain.

Where and when did you train for partial knee replacement? For total knee replacement?

Most orthopedic surgeons learn to perform knee and hip replacements during their residency or fellowship. When I was an orthopedic resident, the Oxford Partial Knee was not available. I obtained my Oxford Partial Knee Certification from the Food and Drug Administration in March of 2006 in San Diego. I have implanted over 150 Oxford Partial Knees since then.

Do you use a CPM (Continuous Passive Motion) machine after your knee replacement?

I employ a CPM machine immediately after a total knee while the patient is still in the hospital. The machine stays with them at home for 21 days after discharge. I don't use a CPM machine for my Oxford Partial Knees. The use of CPM machines is doctor dependent: some orthopods swear by them, some don't believe in them. In my experience, a lot of patients are familiar with it and they typically expect to have it after surgery.