Alexander Gordon, MD Resources

People with progressive pain and disability due to hip disease that has not responded to things like medications, therapy, and injections, often consider total hip arthroplasty (THA, also known as Hip Replacement Surgery) to relieve pain and regain function.

Hip replacement has helped literally millions of people improve their quality of life. People have been able to lead productive and active lifestyles for many years after this operation. Hip replacement is widely considered one of the most successful operations ever developed. However, hip replacement has also been associated with a relatively long recovery and post-operative restrictions.

Most hip replacements in the United States are carried out through a posterior approach. While very successful and widely utilized, this approach has certain limitations. Intra-operative imaging is difficult to use, and studies have shown that there is significant variability in the surgeon’s ability to accurately place the hip components through this approach. Also, this approach disrupts the muscles in the back of the hip. The posterior approach has traditionally carried the highest risk of dislocation. Patients must be cautious in the first several months after surgery to prevent dislocation of the prosthetic hip.

Anterior Approach hip replacement is becoming increasingly more popular. This approach enlists the help of a special operating room table, the HANA table, to assist the surgeon in performing the operation. With this surgical approach, there is no muscle cut or detached. Additionally, intra-operative imaging is facilitated by the table, giving the surgeon real-time information on the component position. The combination of these factors is often associated with faster recovery and allows the surgeon and patient to avoid the “hip precautions” needed with the posterior approach.

Dr. Gordon is one of the few surgeons in the Chicago area who regularly performs hip replacements through an Anterior Approach. He and his patients have enjoyed enormous success. Visit our Anterior Approach patient page to hear from Dr. Gordon’s patients.

Each patient is unique and can experience hip pain for different reasons. It’s important to talk to us about the cause of your hip pain so you can understand the treatment options available to you. One common cause of hip pain is arthritis, a degenerative condition that involves the breakdown of cartilage and bones in the hip joint. Pain from arthritis and joint degeneration can be constant or come and go, occur with movement or after a period of rest, or be located in one spot or many parts of the body. If you haven’t experienced adequate relief with medication and other conservative treatments, hip replacement may provide you with relief from your arthritis.

Total hip replacement involves removing arthritic bone and damaged cartilage in the hip joint and replacing them with an implant. The hip joint is generally described as a ball-and-socket joint. Take a look at how the end of the thigh bone (femoral head) is replaced with a metal stem and an artificial ball that is secured to the top of the stem. The hip socket (acetabulum) is reconstructed, typically using a metal cup lined with durable plastic (polyethylene). The femoral and acetabular components work together to form the artificial hip implant.

Your surgery may be performed using the Direct Anterior Approach, a minimally invasive surgical technique used in total hip replacement. This technique may be associated with:

• Reduced muscle damage
• Reduced pain
• Faster post-operative recovery

What are the differences between the Direct Anterior Approach and a traditional hip replacement? One difference is the location of the incision. During a traditional hip replacement, the surgeon will operate on the patient from the side. Using the Direct Anterior Approach, the surgeon operates on the patient from the front. Another difference is the length of the incision. Traditional hip replacement may require an 10-12 inch incision while the incision used in the Direct Anterior Approach may be 3-4 inches in length.

Download the Anterior Approach Hip Replacement Information Sheet

Read More About the Benefits of Anterior Approach Hip Replacement

Based on the severity of the arthritis in the knee, total or partial knee replacement may be recommended by a surgeon. Both procedures involve the orthopaedic surgeon guiding the Mako Robotic-Arm to remove diseased bone and cartilage.

Mako Robotic-Arm Assisted Technology provides you with a personalized surgical plan based on your unique anatomy. First, a CT scan of the diseased knee joint is taken. This CT scan is uploaded into the Mako System software, where a 3D model of your knee is created. This 3D model is used to pre-plan and assist your surgeon in performing your partial knee replacement.

In the operating room, your surgeon follows your personalized surgical plan while preparing the bone for the implant. The surgeon guides the robotic-arm within the pre-defined area and the Mako System. The surgeon guides the robotic-arm within the pre-defined area and the Mako System helps the surgeon stay within the planned boundaries that were defined when the personalized pre-operative plan was created. This helps to provide more accurate placement and alignment of your implant.

Mako Robotic-Arm Assisted partial knee replacement is a treatment option for adults living with early to mid-stage osteoarthritis (OA) that has not yet progressed to all three compartments of the knee. Depending on where the arthritis affects the knee, patients may have an implant inserted in any of the following areas:

It’s important to understand that the surgery is performed by an orthopaedic surgeon, who guides the robotic-arm during the surgery to position the implant in the knee joint. The Mako Robotic-Arm does not perform surgery, make decisions on its own, or move without the surgeon guiding the robotic-arm. The Mako System also allows your surgeon to make adjustments to your plan during surgery as needed.

We understand that making sure you know what to expect from the knee replacement experience is important to you. If you have additional questions as you are reading through this material, please reach out to us to discuss.

Each patient is unique, and can experience knee pain for different reasons. It’s important to talk to us about the reason for your knee pain so you can understand the treatment options available to you.

Arthritis, one possible reason for knee pain, can affect one or more of the three compartments of the knee. Take a look at the different areas where arthritis can affect the knee joint:

• The inside of the knee, or medial compartment
• The outside of the knee, or lateral compartment
• The top of the knee is also known as the kneecap, or patella compartment

Pain from arthritis and joint degeneration can be constant or come and go, occur with movement or after a period of rest, or be located in one spot or many parts of the body. If you haven’t experienced adequate relief with medication and other conservative treatments, total knee replacement may provide you with relief from your arthritis.

We understand that making sure you know what to expect from your joint replacement experience is important to you. As you are reading through this material, if you have additional questions please reach out to us to discuss.

Each patient is unique, and can experience joint pain for different reasons. It’s important to talk to us about the reason for your knee pain so you can understand the treatment options available to you. Pain from arthritis and joint degeneration can be constant or come and go, occur with movement or after a period of rest, or be located in one spot or many parts of the body. It is common for patients to try medication and other conservative treatments to treat their knee pain. If you haven’t experienced adequate relief with those treatment options, you may be a candidate for Mako Total Knee replacement, which may provide you with relief from your knee pain.

Mako Robotic-Arm Assisted Total Knee replacement is a treatment option for adults living with mid to late-stage osteoarthritis (OA) of the knee. Mako provides you with a personalized surgical plan based on your unique anatomy. First, a CT scan of the diseased knee joint is taken. This CT scan is uploaded into the Mako System software, where a 3D model of your knee is created. This 3D model is used to pre-plan and assist your surgeon in performing your total knee replacement.

In the operating room, your surgeon follows your personalized surgical plan while preparing the bone for the Triathlon Total Knee implant. With over a decade of clinical history, Triathlon knee replacements are different than traditional knee replacements because they are designed to work with the body to promote natural-like circular motion.^1-4

The surgeon guides the robotic-arm to remove diseased bone and cartilage within the pre-defined area and the Mako System helps the surgeon stay within the planned boundaries that were defined when the personalized pre-operative plan was created. In a laboratory study, Mako Technology demonstrated accurate placement of implants to a personalized surgical plan.⁵

It’s important to understand that the surgery is performed by an orthopaedic surgeon, who guides the robotic-arm during the surgery to position the implant in the knee joint. The robotic-arm does not perform surgery, make decisions on its own, or move without the surgeon guiding the robotic-arm. The Mako System also allows your surgeon to make adjustments to your plan during surgery as needed.

Knee replacement has been proven to be a safe, effective, and durable solution to the pain and disability people suffer from when they have the severe degenerative disease of the knee. However, many people decline to seek a knee replacement fearing a long and painful recovery. Additionally, there are some patients who do not have their expectations fulfilled by the operation. So, despite its success, many patients choose to live with the limitations of their knee rather than undergo knee replacement surgery.

Dr. Gordon has a keen awareness of this issue and is always seeking ways to make knee replacement a better operation. He understands that some very subtle things have an impact on a patient’s recovery following knee replacement surgery. Dr. Gordon’s primary goal with knee replacement is a satisfied patient. He achieves that goal by using less invasive, modern surgical techniques with the specific goal to allow patients to recover quickly, and yet have a well-functioning durable knee for many years into the future. Dr. Gordon does not compromise quality for recovery but aims for both.

One-way to help achieve the goal is the use of advanced sensor technology in the operating room. Many surgeons use traditional techniques that rely on “feel” to get things just right with the knee. Traditionally, that has led to good outcomes, however, more recent research shows that many patients are still dissatisfied.

By using technology similar to what is in a modern smartphone, he is exploring new ground in the world of knee replacement. Accelerometers and advanced sensors embedded within the instruments for a knee replacement allow Dr. Gordon to use real-time information, combined with the feel of an experienced surgeon to achieve a BALANCED KNEE. A balanced knee is one that is stable, mobile, and not painful. It is the knee of a satisfied patient.

Dr. Gordon and IBJI are one of the first institutes in the country to offer patients Intelligent Orthopaedic Surgery with the VERASENSE Knee System. This innovative, surgical instrument system integrates advanced sensor, accelerometer and microelectronic technology to provide real-time data measurements of joint balance, alignment and load during total knee replacement surgery. With this data, surgeons are able to optimize the positioning of the orthopedic implant intra-operatively to improve overall implant longevity and patient outcomes.

“Quantifying and measuring the load, alignment and balance of an orthopedic implant during surgery are vitally important in ensuring a successful total knee replacement procedure,” said Dr. Gordon. “We are very excited to begin using the VERASENSE Knee System to optimize joint load, alignment and balance for each of our patients. We feel that Intelligent Orthopaedic Surgery is the latest evolution in total knee replacement and are honored to be one of the few hospitals in the country to offer this innovative technology to our patients.”

For more information on the VERASENSE Knee System and Intelligent Orthopaedic Surgery visit www.OrthoSensor.com.

Total Knee Replacement Information Sheet

Knee replacement is a surgical treatment for chronic knee pain caused by severe damage from knee arthritis or injury.

The most common cause of chronic knee pain is arthritis. There are three main types of arthritis, the most common form of which is Osteoarthritis. Osteoarthritis occurs as we age when the cartilage in our joints wear away, causing the bones to rub together, leading to pain and stiffness in the joints.

When joint pain, swelling and stiffness limit your daily activities, and rest, medicine, and other non-invasive treatments no longer alleviate your symptoms, total knee replacement (TKR) may be a treatment option for you. The decision to have TKR should be made with your doctor after a complete orthopedic evaluation. The surgeon will also explain all risks and benefits associated with the procedure, how to prepare for knee surgery and what to expect after surgery, including knee replacement recovery time.

The procedure itself takes one to two hours, and the basic steps are as follows:

• Your surgeon first removes damaged cartilage and bone surface from the ends of your tibia and femur.
• Metal implants (knee prosthesis) are used to replace the surface areas of the joint. The artificial knee may be sealed to your bone using surgical cement, or a cement-less approach may be used, involving press-fit components, which have a porous or textured surface into which bone can grow and attach to the prosthesis over time.
• Surgeons who use VERASENSE in total knee replacement then insert this sensor technology between the metal components. As the knee is taken through the range of motion, the sensor device sends data wirelessly to a monitor in the operating room, which the surgeon uses to guide soft tissue adjustments and implant position, helping to improve knee balance. Knee balance and stability are important factors that contribute to a successful knee replacement.
• Finally, after the knee is balanced and positioned, VERASENSE is removed and replaced with a medical-grade plastic spacer to create a smooth gliding surface.

Learn more about the use of sensor technology in Total Knee Replacement: VERASENSE Sensor-Assisted Total Knee Replacement.

Reference:
1 AAOS Website, http://www.orthoinfo.org/topic.cfm?topic=A00389, accessed August 2017.

View the Patient Education brochure on VERASENSE.

The doctor utilizes a disposable sensor device called VERASENSE during total knee replacement (TKR) surgery. This technology helps the doctor by providing real-time data during surgery that allows him to make important decisions to better balance your knee and customize your implant position.

Improper soft tissue balance and implant position may result in premature implant failure and the need for revision surgery in the future.

Before VERASENSE, surgeons used their best judgment to “feel” whether or not your knee is balanced during knee replacement. With VERASENSE, surgeons now have data that quantifies soft tissue balance, allowing them to improve knee balance more consistently from patient to patient.

When compared to patients who underwent traditional total knee replacement, VERASENSE patients have experienced:

• Less pain
• Improved knee function
• Quicker return to normal activity
• Improved patient satisfaction

During your total knee replacement, your surgeon uses VERASENSE to replace the standard tibial trial spacer. The sensor sends data wirelessly to a monitor in the operating room, which assists your surgeon in making soft tissue adjustments and customizing the implant positions to improve the balance of your knee.

VERASENSE may be used in both primary and revision total knee replacement.

For more information about the use of VERASENSE in total knee replacement or to schedule an appointment, call 847-375-3000.

To learn more about the latest clinical outcomes using VERASENSE, visit www.OrthoSensor.com.

1 Parratte S, Pagnano MW. Instability after total knee arthroplasty. J Bone Joint Surg Am 2008; 90: 184–94.

2 Lombardi AV Jr1, Berend KR1, Adams JB1. Why knee replacements fail in 2013: patient, surgeon, or implant? Bone Joint J. 2014 Nov;96-B(11 Supple A):101-4.

3 Bozic KJ, Kurtz SM, Lau E, Ong K, Chiu V, Vail TP, Rubash HE, Berry DJ. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res.2010; 468(1):45–51.

4 Rodriguez-Merchan, EC. Instability Following Total Knee Arthroplasty. HSS J. Oct 2011; 7(3): 273–278.

5 Gustke K, et al. Increased Patient Satisfaction After Total Knee replacement using sensor-guided technology. Bone Joint J. 2014 Oct;96-B(10):1333- 8.

6 Gustke KA, et al. Primary TKA patients with Quantifiably Balanced Soft-Tissue Achieve Significant Clinical Gains Sooner than Unbalanced Patients. Adv Orthop. 2014:628695.

7 Gustke KA, Golladay GJ, Roche MW, Elson LC, Anderson CR. A new method for defining balance: promising short-term clinical outcomes of sensor-guided TKA. J Arthroplasty 2014;29:955–960.