HEALTH
Knee surgery
HEALTHTesting new surgery to repair knees
CBC News
Posted: Feb 21, 2011 9:06 AM ET
Last Updated: Feb 21, 2011 11:41 AM ET
Surgeons and computer specialists in Kingston, Ont., are working as a team to test a new way to repair damaged knee cartilage.
They are using a computer to map out the surgery through detailed imaging and create knee templates before the operation, and once in the O.R. to actually guide the surgeon's tools. The goal is greater precision than a surgeon can achieve by hand and eye alone.
Kim Sampson, 33, who lives in Kingston, had a large crevice in the cartilage in her knee, likely a congenital defect. She agreed to be a guinea pig for the new computer-assisted technique because, she said," If I don't get it fixed I basically will have the onset of arthritis at a much earlier age."
For Sampson's surgery Dr. Davide Bardana of Kingston General Hospital, a specialist in athletic injuries, says the computer imaging and templates meant he was able to anticipate more accurately what he would face during the operation.
"I have the confidence based on some of the research that we've done that the end result is actually going to be more accurate in its reconstruction of the joint surface than what I can do by eye," he said.
Bardana and the team are testing a new form of what is called mosaicplasty, a technique in which a surgeon takes plugs of cartilage from a non-essential area of the knee and patches them into a defective area. It can be done using arthroscophic techniques (small incisions) or through total open knee surgery.
Sampson's damage was extensive so her knee had to be cut wide open to get at the cartilage. (See video; warning, it shows actual surgery.)
Bardana used the computer-designed templates that were an exact match of Sampson's knee and that fit over the surface of the bone. The templates guided the doctor as he drilled into the cartilage. Sampson was awake for the surgery and watched it all on a TV monitor.
Two months after the operation she had made a lot of progress and felt she had reduced her risk of early arthritis.
The normal procedure demands exacting precision and about a third of patients have recurring problems. The search for greater accuracy is the appeal of this computer-assisted version.
James Stewart, the computer scientist who is directing the project, says, "If the plugs you put in are too high or too low, or they're at the wrong angle, then they will not form the correct surface and the joint won't heal as well. If the joint doesn't heal as well, then the patient will experience pain and have to have surgery again."
Close view of the surgery on Kim Sampson's knee. (CBC)
That's what happened to 35-year-old Cary Reed of Kingston. He's had two surgeries after hurting his knee while doing Brazilian jujitsu almost four years ago.
After months of physiotherapy he still had pain and ended up at the Human Mobility research centre in Kingston. He was the first person to have the experimental surgery arthroscopically. In his operation, the computer guided the tools Bardana used to insert a plug into the damaged area.
Five months later Reed says he has much less pain in his knee and more movement.
The Kingston team is hoping that this project is successful so that the new computer assisted form of surgery becomes an option to help young, physically active people with damaged cartilage avoid a total knee replacement at an early age.
With files from CBC's Kelly Crowe, Pauline Dakin, Heather EvansShare Tools
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