STORY BYDorothy Frost was in her 50s when arthritis attacked both her knees, making it a painful chore to walk even the shortest distance.
Her symptoms didn’t respond to anti-inflammatory medications and other non-surgical therapies, but the damage to her knees wasn’t extensive enough to warrant a total knee replacement.
Like other patients whose arthritis is confined to one compartment of the knee, Frost and her orthopedic surgeon, Terry Clyburn, M.D., director of total joint research at The University of Texas Medical School at Houston, decided that a uni-compartmental device was the best option for relieving her pain. That was more than 10 years ago.
The uni-compartmental device is designed to restore limb alignment, relieve pain, improve knee function and prevent or delay the need for a total knee replacement. The ideal candidate is someone who is between the ages of 50 and 60 who is healthy and expected to live 20 to 25 more years.
Michael Mann, M.D.
“This technique fills a much-needed gap,” says Michael Mann, M.D., assistant professor in the Department of Orthopaedic Surgery at the medical school.
If a person didn’t respond to anti-inflammatories, activity modification, physical therapy, bracing or joint injections, there wasn’t much left to do. “The only options we really had to offer in the past were arthroscopy for mechanical symptoms, osteotomy [removing a section of bone in the leg to change the load on the knee] or total knee replacement.
“This minimally-invasive surgical approach offers the advantage of restoring range of motion and reducing knee pain without interfering with possible future total joint replacement,” Mann said.
Clyburn, assistant professor of orthopedics at the university, said the uni-compartmental device may serve as a stopgap to total joint replacement.
The surgery can be done as an outpatient or short-stay procedure. First, surgeons perform a knee arthroscopy, and then insert the device through an extended three-inch incision and fix it with bone cement.
Patients are encouraged to walk within two to three hours after surgery.
The recovery time is minimal, Mann said. Generally, patients do not need formal rehabilitation and can return to their normal activities within six weeks. Many are driving within two weeks. Running and jumping activities are discouraged, but participation in other sports is allowed.
Clyburn added that because only a third of the knee is replaced, patients generally report that it feels more natural.
The relief from the uni-compartment device, which is considered temporary, may last 10 to 12 years before arthritis spreads to other areas of the knee or the plastic in the device wears thin.
Eventually, the osteoarthritis progressed in her right knee, and Clyburn had to do a total knee replacement. The left uni-knee is still doing well.
“The key here is to delay total knee replacement,” Clyburn said. “With a total knee replacement, the patient is in the hospital five or six days. They spend another 2-3 weeks on crutches, and it is 6-8 weeks before they are able to get around real well.”
He added that it’s easier on both patient and surgeon to replace a uni-compartmental device with a total knee than it is to do a total knee revision, which is a much more invasive procedure.
Repicci II, the uni-compartmental device used by Mann and Clyburn, has a good track record. In a recent study, 86 percent of patients had excellent to good results eight years after the surgery.
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Dr. Terry Clyburn is an assistant professor and director of research in the Department of Orthopaedic Surgery at the UT Medical School.
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Eating healthy
reverses metabolic syndrome
Dr. Tasnime Akbaraly of University College London and her colleagues were interested if healthy eating could actually turn-the-tide and reverse metabolic syndrome, which is having 3 or more of the following risk factors: excess abdominal fat; high triglycerides, hypertension, low levels of HDL the “good” cholesterol, or type 2 diabetes. Having metabolic syndrome doubles a persons’ risk of heart disease and greatly increases the odds of developing type 2 diabetes.
The researchers studied 339 British civil servants with metabolic syndrome, and how closely the adhered to the Alternative Healthy Eating Index (AHEI) to see if it could help reverse metabolic syndrome. The AHEI is a set of published nutritional guidelines by the Harvard School of Public Health in 2002 that emphasizes whole grains, fruits, vegetables and decreased red meat consumption.
Five years into the study, nearly 50% no longer had metabolic syndrome. People who followed the AHEI guidelines the closest were nearly twice as likely to have reversed their metabolic syndrome. The results of the study were published in Diabetes Care, online July 29, 2010.
Dr. Alice Lichtenstein, an expert on diet and heart health from Tufts University in Boston who was not involved in the study said, "It's not about focusing on individual components of the diet, it's really the whole package, and that becomes important because it means that if one of the components of a healthy diet is to eat more fruits and vegetables, just buying a pill saying that there's a concentrated extract of fruits and vegetables is probably not what's going to help you."
Call and make an appointment with Wellness Coach Sam Hester, CWC, CPT, LWMC, at 713-500-3327. It's confidential and free. For more information on the wellness services provided, visit UT Counseling and WorkLife Services.
