Saving your knees

A new technique is saving young knees. Most people take about 8,000 to 10,000 steps a day. In the average lifetime, that’s 115,000 miles.

Most cars wear out by then, so why shouldn’t your knees? More than 400,000 people will need knee replacements this year. But before the Generation X’ers go for the total trade-in, there’s a new option that will keep younger knees in place longer. 

To learn more, please read the doctor’s interview below:

Anthony Miniaci, M.D., Director of the Cleveland Clinic Sports Health Center in Cleveland, Ohio, explains how a new partial knee implant may delay the need for a total replacement.

Why did you invent the Unicap?

Dr. Anthony Miniaci: In collaboration with an engineer, we came up with the idea of a resurfacing implant for younger patients who are not ready for the conventional knee implant designs, but needed something done which was a little different than what we had to offer them. They really had run out of options that we had available to them and had nothing available to them other than a traditional total knee replacement.

Are you finding that a lot of younger people need knee replacements?

Dr. Miniaci: It's amazing that we thought that there was a number of patients out there just from personal experience and my own practice, but now that the people are hearing about this, everybody's coming out of the woodwork with these types of problems.

Does the Unicap target a certain age?

Dr. Miniaci: We designed it originally for the patient who was sort of between 40 and 55, who was very active, and wanted to maintain their activity level. That's the ideal patient – someone who had early arthritis, didn't have a lot of erosion of bone or cartilage, but had some arthritis that needed to be treated. That's what this was originally designed for.

What's the difference between this and just resurfacing or a traditional knee replacement?

Dr. Miniaci: This is actually a partial resurfacing. We are resurfacing small areas of the knee joint, and we can mix and match, depending on the implants that we have available, to resurface the areas which are arthritic in patients' knee joints as opposed to resurfacing or replacing the whole knee joint, itself.

What are the symptoms of the patients that need the Unicap as opposed to those who would need a total knee resurfacing?

Dr. Miniaci: The classic profile is someone who is an athlete who injured their knee many years ago and maybe already had a previous operation where they've had some cartilage removed or a meniscus tear and now they've developed some early arthritis in their knee. They're still very active – they run, or they do sports, or they cycle, and they're having pain on the inside part of their knee and they can't do their activities. They're limited by pain, mainly.

When you're changing that much bone, is there a lot more recovery?

Dr. Miniaci: There is a lot more recovery because it is a bigger surgery, and a lot more dissection. This allows us to get the patient up quicker and moving a little faster with very little resection of bone and soft tissues.

What's the difference between the total resurfacing and this procedure?

Dr. Miniaci: Replacement is really a resurfacing because it takes the whole joint and resurfaces it. The only thing about a replacement is that we have certain designs of implants which aren't necessarily exactly your anatomy. What we've done here is we actually have replaced your own anatomy so that once this is all healed and done, the function and range of motion of your knee should be exactly the same as it was before.

Is the procedure a "one size fits all?"

Dr. Miniaci: No. We actually fit this implant to the patient, as opposed to fitting the patient to the implant.

How long do these total replacement knees last?

Dr. Miniaci: The total replacement knees that we have nowadays, we have enough data to show that there still is a significant survivorship of those knees at 20 years. The thing with this implant is that even though some of the concepts and designs are similar, it's a very different concept. All I can tell you is that the data we have, and we've only been doing it for a year, and so all I can tell you is that for a year, things seem to be going okay.

What is the difference between the recovery time between a traditional procedure and this one?

Dr. Miniaci: The recovery time for this is a little bit quicker because some of the implant, on the bottom part, is put in arthroscopically, so we actually do that with a scope – visualizing, making all of our cuts with the arthroscope. We have to make a small incision to be able to insert the metal portion into the femur bone. You can't fold the metal, so you still end up with a small incision, but we don't dislocate the kneecap and we don't cut the muscle. In reality, what you have is a situation that once the wounds are healed, patients can get going fairly quickly so that we allow them to walk and get up. I usually ask them to stay a week or two on crutches, but usually the patients get going as quickly as they want, and then by six weeks, most of them have their range of motion back in their knee and in four to six months, they are back to doing most of their activities.

Is this an outpatient procedure?

Dr. Miniaci: What we've done for the first year here is to do them as overnight stays, so that we keep them in here just to observe them, but when you talk to patients that first evening, most of them are ready to go home that night.

What are patients able to do after the six to eight weeks of recovery time?

Dr. Miniaci: We've been very conservative in year one here. Patients are doing a lot more than we're asking. I have patients who have been out skiing at three to four months and doing those kinds of activities. We ask them not to do a lot of impact activities for the first three or four months.

What's the difference in recovery time compared with a total knee replacement?

Dr. Miniaci: The recovery is variable, but a number of patients require a number of months before they get their full range of motion back and their strength back before they can do that, so I say it's over six to nine months.

Do patients go through rehab after this procedure?

Dr. Miniaci: There is rehab. We ask them to also go for strengthening and range of motion and things like that, so there still is a rehab component to this, which is very important.

Does this procedure give a lot of active people a lot more years of doing what they love?

Dr. Miniaci: We're giving people an option. There are a lot of different types of techniques that we can use, which we call biologic procedures, so that for the younger patient who has cartilage lesions or who has arthritis in their knee, we have a number of different procedures that we're working on to try and resurface their joints with a biological option. Certainly, there are some glimmers of hope in that area, and hopefully we'll be able to resurface joints biologically at some point in the future.

What do the biologic procedures involve?

Dr. Miniaci: Stem cells and cartilage cells which are injected into the area, things like microfracture, those are all biological type procedures. Unfortunately, when you get to the end of those and they haven't worked for the patient, but they're still young and active, a lot of patients either get told that they need a traditional knee replacement, which will actually significantly impact their activity level and what they're able to do, or what they have to do is decide that they're not going to do anything and just live with it for a number of years until they're ready for a traditional knee replacement. We've given them now an option, and I like to call this a gap procedure – it's right in between the failed biologic procedures and the necessity for a total knee replacement.

How long did it take you develop the Unicap?

Dr. Miniaci: My friends and I have been working on this for probably the better part of 11 years or 12 years now. I have a predominantly sports medicine, younger, active practice, so I did a lot of work in cartilage research and in some of these biologic procedures that we're talking about. What I found was it was great when they worked, but when they didn't work, there were no other options for the patient, so we started looking for another option.

What are the results so far?

Dr. Miniaci: The first year has been very exciting. I think we're cautiously optimistic.

Are there any risks to the procedure?

Dr. Miniaci: The concerns we have are loosening of the implants. One side is made out of a metal, which is like a stainless steel, and there's a cobalt chrome. There's also a screw that it fixes to, to make it solid in the bone. On the other side is a plastic component made out of something called polyethylene – it's a very dense material and very similar to materials that we use in our standard knee replacements nowadays.

For more information, please contact: 

Dr. Anthony Miniaci

Cleveland Clinic Orthopaedic and Rheumatologic Institute

(216) 518-3480

miniaca@ccf.org

http://www.clevelandclinic.org/sportshealth

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