Back on their feet Back on their feet (October 14, 2005)

State of the art knee replacement surgery at ValleyCare means shorter recovery time for patients
by Carol Bogart

First she smashed her knee against her dashboard. Then she stumbled on a pothole, fell, and smashed it again. Couple those events with degenerative arthritis, and 61-year-old Joan Franco needed an artificial knee.

Her left knee was replaced the old-fashioned way: cut ligaments and muscles, excruciating pain, extensive rehabilitation.

Her 'good' knee, also impacted by arthritis, took a beating as her left knee healed. When the right knee went, too, that "bone on bone" feeling was eliminated with a new technique - one that combines minimally invasive surgery with computer-assisted imaging called Electromagnetic Navigation.

Her surgeon at ValleyCare Medical Center, Dr. Kambiz Behzadi, explains that some patients who might normally be laid up for as much as six months are driving in just three weeks with brand-new knees implanted via the combined techniques. Franco recalls being up and walking the same day as her second surgery.

Behzadi relates to the relief patients like Franco feel when they can resume their lives. As a young soccer player, he ripped ligaments in his shoulder, an injury that sparked his interest in sports medicine.

Today an orthopedic surgeon, Dr. Behzadi has privileges at both ValleyCare and San Ramon Regional Medical Center. But it's ValleyCare's computerized operating rooms that let him offer patients top of the line knee replacement surgery.

He explains that with the computer to guide him, he can make minute adjustments that allow the artificial joint to conform more perfectly to the patient's own anatomy. "Because we get this 'real time' information and can make corrections at the time of surgery, the prosthesis has a more precise fit." Earlier procedures could lay up a patient for three to six months. Hesitant to lose that much work, some, he said, would also hesitate to have the surgery.

Franco said she is a big proponent of getting a problem knee replaced before there's so much damage the patient may no longer be a candidate for the less invasive technique. Having had both types of surgery herself, she said the difference is "night and day." Less pain with option number two, and "Your ability to move around is considerably better." What once were walks that ended after just a block, now she goes for "nice long walks." On a recent vacation, she hiked up and down 100 steps without a problem.

It's too early to tell whether the improved computer assisted knee replacement technique will also improve the longevity of artificial joints, but indications are it will. A poorly positioned joint puts stress on surrounding ligaments and muscle, points out Dr. Behzadi, which can lead to failure of the replaced knee. Surgery without benefit of computer assistance presently results in artificial joints that have a shelf life of 10-15 years, sometimes 20. So it will be a few years before hard and fast comparisons can be made.

Right now, the improved surgery is no more expensive than older techniques because ValleyCare picks up the added cost of the technology, Dr. Behzadi said, adding that using computer-assisted surgery for knee replacements became available at ValleyCare three months ago. As of Oct. 7, Dr. Behzadi had used it in 20-25 procedures with good results. He believes Electromagnetic Navigation will one day be the standard of care and used for other joint replacement, like artificial hips.

Dr. Behzadi likens the technique to the navigation system in your car. "If you have a new car and you have a navigation system (like global positioning), you know where you are when you're lost and you can get yourself out. Computer assisted surgery is a navigation system. It allows you to make real time corrections during surgery." The more accurate surgery, he said, leads to better outcomes.

He cautions, though, that surgery is surgery - with inherent risks, no matter how precise. He also warns against confusing 'computer-assisted' with 'robotic' surgery (such as what San Ramon uses for removing malignant prostate glands). For knee replacement, Dr. Behzadi is still the surgeon, he assures his patients. His training, skills and judgment remain critical to the patient's outcome.

Franco said, while there was pain with both procedures, it was much higher with the first replacement. She marvels at how quickly she's healed, thanks to the technologically advanced surgery now offered at ValleyCare.

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