3D Knees

A new technology for customized knee implants.

Until now, the standard for knee replacement surgery involved pre-made “off-the-shelf” knee implants that were fitted almost solely by size. “An implant might be a little bit too big or a little small,” explains Sarasota orthopedic surgeon Dr. William Bennett. “If it’s too big, it can rub on some of the tendons and cause other adverse effects like tendonitis. If it’s not quite big enough, it may lead to earlier failure because it’s not resting on the right part of the bone.”

But five years ago, Bennett, who already specialized in minimally invasive knee replacement procedures, began combining his minimally invasive techniques with a new type of knee implant. First, a preoperative CT scan creates a three-dimensional image of not only the knee, but the hip and ankle joints as well. By looking at the whole leg, the process accounts for variations in rotation and overall knee movement; if the hip is rotated so many degrees outward, the natural plane of the knee won’t face directly forward. The scan also allows for custom fitting of peculiarities like bumps or gullies in the joint.

That scan becomes the basis for a truly customized artificial joint, which is created automatically in a process somewhat like 3D printing. And in addition to being well suited for a minimally invasive surgery, the custom implant requires less bone to be removed—and that means a much shorter recovery.

But that’s not all. Because of the extensive customization, patients often report that their new knees feel natural, without the mechanical feeling that sometimes accompanies traditional implants, says Bennett. During post-op exams, he explains, “When I range the knee—the tensioning of the soft tissue, the range of motion and the laxity—it feels like a normal knee.”

In fact, the implants feel so good, and the recovery is so fast, that Bennett has had to warn his patients about overdoing it. Two weeks after surgery, one patient walked two miles without a cane—but the rest of the leg might not be up to such a task. “Now I say, ‘Listen, your knee will function well, but for every minute that you walk, I want you to spend four minutes with your knee elevated,’” he says.

What’s Next for Knees?

While 3D technology is “pretty exciting for patients,” says Bennett, the doctor looks forward to a time when implants might be created using more natural materials. “These implants are still made of metal and plastic,” says Bennett, who already uses platelet-rich plasma during surgeries to help speed healing. Since stem cells can already be used to regrow cartilage, Bennett sees potential in moving implants “toward more biologic materials.” It might not happen soon, but eventually, there may come a time when patients who need knee replacements will actually be able to grow their own. Read more at bennettorthopedics.com.

The Affordable Care Act

Facts and figures regarding the first month of open enrollment for 2015 health care coverage (Nov. 15-Dec. 15, 2014)

37

States use the national marketplace healthcare.gov

No. 1

Florida topped the nation for new enrollees and total enrollees

330,000

New Florida enrollees

675,000

Total Florida enrollees

2 million

New enrollees nationwide

24 percent

of national enrollees are ages 18 to 34

87 percent

of national enrollees qualified for subsidized premiums

Median deductibles:

Manatee County: $7,200

Sarasota County: $8,000

Feb. 15

Last day for 2015 enrollment

Coming Attractions

Cleveland Clinic’s top 10 medical innovations for 2015.

1. Mobile stroke unit: Telemedicine now allows in-hospital stroke neurologists to interpret symptoms via broadband video link, while an onboard paramedic, critical care nurse and CT technologist administer treatment.
2. Dengue fever vaccine: Dengue fever affects approximately 100 million people in more than 100 countries each year. The world’s first vaccine is expected to be submitted to regulatory groups in 2015, with commercial distribution expected soon after.
3. Cost-effective, fast, painless blood testing: A single drop of blood from the fingertip can now produce test results within hours at as little as 10 percent of the traditional cost.
4. PCSK9 Inhibitors for cholesterol reduction: For people with statin intolerance, PCSK9 inhibitors (injectable cholesterol-lowering drugs) are expected to receive FDA approval in 2015.
5. Antibody-drug conjugates: Chemotherapy destroys cancer cells and harms healthy cells at the same time. A promising new approach selectively delivers cytotoxic agents to tumor cells while avoiding normal, healthy tissue.
6. Checkpoint inhibitors: Combined with traditional chemotherapy and radiation treatment, immune checkpoint inhibitors boost the immune system and offer significant, long-term cancer remissions for patients with metastatic melanoma; there is increasing evidence that they can work on other types of malignancies as well.
7. Leadless cardiac pacemaker: Pacemaker technology hasn’t changed much since 1958. A silver-dollar-size pulse generator and a thin wire, or lead, inserted through the vein keep the heart beating steadily. But lead can cause infections. Now wireless cardiac pacemakers, implanted nonsurgically, eliminate restriction on daily physical activities.
8. New drugs for idiopathic pulmonary fibrosis: Pirfenidone and nintedanib, recently approved by the FDA, slow the progress of idiopathic pulmonary fibrosis, which causes scarring of the air sacs. These represent the first treatments for IPF, which has a post-diagnosis life expectancy of three to five years.
9. Single-dose intra-operative radiation therapy for breast cancer: Focuses radiation on the tumor during surgery as a single dose, and has proven as effective as whole breast radiation.
10. New drug for heart failure: Angiotensin-receptor neprilysin inhibitor, or ARNI, has been fast-tracked by the FDA because of its impressive survival advantage over the ACE inhibitor enalapril, the current standard for treating patients with heart failure.

New Music, New Tech

Additions and advancements at SMH.

The Brian Johnson Music Therapy Center: An expansion of the music therapy room that was opened in 2008, this new center provides even more musical options for young patients to explore and develop their creativity. In addition to instruments, the hospital wing offers amps, lighting and flat-screen monitors for kids to experiment with and even put together their own live performances. The facility was in part designed to allow the patients to feel like famous rock stars preparing for big-time concerts.

Da Vinci Xi robotic surgery: The fourth generation of da Vinci system goes even further to become a natural extension of the surgeon’s eyes and hands. The equipment includes an overhead boom that allows the robot’s multiple arms to rotate as a group, taking up less space and allowing for better access to the patient, plus laser targeting and an easier-to-use endoscopy system.

For more Sarasota health news, click here. >>