“Outpatient” and “arthroplasty” are two terms rarely used in the same sentence – unless you happen to be speaking with Dr. Carl DiLella of the Orthopedic Center of Vero Beach and one of DiLella’s patients like electrical contractor Ed Franks.
While the Johns Hopkins medical library defines any arthroplasty as “a surgical procedure to restore the function of a joint,” the term is most often associated with total hip or knee replacements which usually require patients to spend between two to five days in the hospital after surgery.
Franks, however, went home the very same day DiLella performed a patellofemoral arthroplasty – or kneecap replacement – on his left knee.
The culprit for Franks’ pre-operative knee problem was arthritis. The American Academy of Orthopedic Surgeons says “arthritis of the knee is a leading cause of disability in the United States,” but DiLella didn’t see disability in Franks’ future. He saw an opportunity.
“In Ed’s instance,” DiLella recalls, “he had selective arthritis in only one of the three compartments of the knee. There are basically three compartments in the knee; the kneecap joint, the medial or the inside portion of the knee, and the lateral or the outside.”
“Looking at Ed’s X-rays,” DiLella continues, “the inside and outside compartments of his knee were really quite pristine and I think either just from genetics or sports or what his occupation demanded of his knee, he’d worn away the cartilage [only] on the back side of the kneecap.”
When medications – including cortisone injections – and physical therapy failed to relieve Franks’ pain or increase his knee function, says DiLella, “I felt he was a good candidate for this type of surgery – selective patellofemoral arthroplasty.”
Patellofemoral arthritis affects the kneecap or patella bone. It causes pain in the front of the knee, making it difficult and painful to kneel, climb stairs and do other activities – including, in Frank’s case, flying a small plane with foot-operated controls.
“I needed to fix this thing,” says Franks. “My knee would buckle on me. I couldn’t kneel down without helping myself up. I couldn’t lift myself up from a squat and because I also fly for a hobby, it was kind of hard getting in and out of the plane and working the rudders and whatnot. The knee was just failing me.”
Then Franks jokingly adds, “My wife came to see Dr. DiLella first and I came to see him because he did such a good job on her. I didn’t just come to him – I made sure he knew what he was doing first!”
DiLella says the kneecap replacement surgery “involves making an incision on the front of the knee, not unlike what a total knee [replacement] incision would look like, but smaller, gaining access to just that kneecap joint in the front of the knee. The back side of the kneecap is basically removed with a saw and then a new plastic back side of the kneecap – or button, as we call it – is placed there and cemented in position.”
A metal piece with a specially designed groove is then placed on the thigh bone or the femur bone side that the kneecap button slides into.
This procedure is not for everyone, however. If, for example, arthritis has spread throughout the entire knee joint, the Joint Preservation Institute says, “it may be a better option to consider a total knee replacement.”
DiLella concurs and then adds that this particular procedure “may not necessarily be appropriate for the patient that’s had quadruple bypass surgery, is diabetic, or is using a list of medications a page long. They are certainly at a little higher risk for having issues with the anesthesia around the surgery and perhaps blood pressure issues and blood sugar issues.”
For Franks, however, DiLella’s procedure has yielded impressive results. Just three weeks after surgery, “the knee actually feels 100 percent better and stronger,” says this electrical contractor. “I can even put my weight on it in the shower and wash my other foot now.”
Franks is not alone in being pleased with the results. The Joint Preservation Institute reports the procedure has provided “very good” results in about 90 percent of patients over the past 10 years.
DiLella puts it even more simply. He predicts “outpatient procedures for replacement surgeries are really going to be the next big thing.”
Shorter – or no hospital stays at all – will also dramatically reduce costs to both patients and their insurers.
Dr. Carl DiLella is with the Orthopedic Center of Vero Beach at 1285 36th Street, Suite 100. The phone number is 772-778-2009.
