We are happy that you are interested in having us help you with the surgical treatment of your arthritic knee. We feel that it
is important to make you aware of a change in the way we perform total knee replacements and what we anticipate to be the result
of those changes.
As of the first day of March 2004 we are introducing the use a new technology in performing total knee replacements that has been
shown to significantly decrease post-operative pain, shorten the length of hospitalization, shorten the length of time away
from normal activities and interfere much less with a patient's lifestyle during the first few months after surgery.
The implants that are used are exactly the same as the ones that we have used previously and the long-term outcomes are expected
to be exactly the same as prior to this change in operative technique.
Although there are a number of "minimally invasive" techniques employed in total knee replacement surgery the "Quad-Sparing"
techniques that we are introducing provides our patients with the ultimate minimally invasive procedure and will allow us to
absolutely minimize the undesirable features of total knee replacement surgery.
The new techniques and new instruments that make the techniques possible have been developed by Dr. Thomas Coon, Dr. Alfred Tria
and Dr. Marlowe Goble in cooperation with Zimmer, Inc. We have taken Dr. Coon as our mentor and have participated in didactic
and laboratory exercises under his supervision at the Zimmer Institute in Warsaw, Indiana. This training was followed up by a
visit with Dr. Coon in his operating room in California where his techniques and the use of the specialized instruments were
closely studied under actual operating conditions. We feel confident that we can emulate his surgical techniques and provide
our patients the same experience and results that are enjoyed by his patients.
The essence of the Quad-Sparing Total Knee Replacement procedure is to perform the operation without interfering with the normal
muscle attachments to the patella (kneecap). By doing so we will minimize the post-operative pain and disability experienced by
our patients. This is accomplished by the use of specially designed instruments and surgical maneuvers that allow us to prepare
the bones (femur, tibia and patella) just as we have always done with much less extensive cutting of tissues surrounding the
knee.
We anticipate that we will be able to utilize the Quad-Sparing approach for the vast majority of our patients in which one knee
is done at a time. Even for those that due to severe deformity or other reasons such as gross obesity for whom it will not be
the technique of choice the utilization of the Quad-Sparing instrumentation and modifications of its surgical techniques will
allow us to significantly minimize the surgical trauma compared to classic total knee replacement surgery.
It is important for you as a potential Quad-Sparing TKR patient to realize that this is a very important and significant
refinement of prior techniques and not something radically different. Hence, if for some reason your anatomy at the time of
surgery is found to be such that the Quad-Sparing principles cannot be rigidly adhered to the surgeon can easily extend his
exposure in small increments to easily and successfully complete the procedure. That is to say in the worst case scenario you
would simply end up with a well done total knee replacement done through the classic surgical exposure which has provided
excellent results for our patients for many years.
Since we have had the luxury of having Dr. Coon act as our mentor and we have developed our program to mimic his closely from the
time of scheduling the procedure through the follow-up care phase we can assume that his results should be reasonable goals for
us, our team and our patients. In order to do so it will be important that all members of this total team, including you the
patient, participate to the fullest.
Based upon Dr. Coon's results with approximately the first 200 of his cases we believe that realistic goals and expectations are
as follows.
1. Average length of hospital stay of two days or less.
2. Walking 100 feet with crutches or walker at time of discharge
3. No need for blood transfusion.
4. Control of postoperative pain without the use of injectable narcotics.
5. Able to bend the knee 90 degrees at time of discharge
6. Strong straight leg raising at time of discharge
7. Walking without either crutches or a limp at one week
8. Return to light duty level activities between one and two weeks
In order to achieve these goals you will need to understand our expectations of you, which are also based on what know at least
200 other people have been able to achieve when the Quad Sparing surgical and peri-operative techniques and protocols have been
utilized. Our expectations of you are:
1. You will begin walking with the assistance of a Physical Therapist as soon as your spinal anesthesia wears off on the day of
your surgery. In doing so you will place your weight on your operated leg and only use your walker or crutches to minimize your
limp.
2. You will closely follow our directions in regard to pre-operative and post-operative medications.
3. You will closely follow our directions for post-operative activity and exercise programs designed to maximize function while
minimizing pain and impairment of function.
4. You will not allow yourself to treated as handicapped by others after discharge from the hospital.
5. You will take advantage of all opportunities to walk after discharge.
6. You will take advantage of all opportunities to walk up one flight or down two flights of stairs after discharge once cleared
to do so by your Physical Therapist.
We look forward to working with you and providing you with a well functioning total knee replacement while minimizing the
unpleasantness of undergoing such treatment. We as your surgeons and our assistants in the operating room and office as well as
the nurses and technicians in the hospital will do everything under our control to provide you with a total knee replacement
utilizing Quad-Sparing principles. It is absolutely imperative that you remember that you are an extremely important, if not
the most important, member of the team that will work together to make your treatment a total success.
