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    What to Consider When You're Considering a Knee Replacement

    If you find yourself in need of a knee replacement, perhaps the most important consideration is where to have it. The hospital you choose is just as important as your decision to have the surgery. Before making your selection, do some fact finding. These are important questions to ask:

    • Is knee replacement a specialty of the facility and staff?
    • What do patients say about their experience?
    • How many knee replacements does the hospital perform each year?
    • What is the hospital's infection rate?
    • How many of the knee surgeries they perform require revisions?

    Consider an Orthopedic Center of Excellence

    "At Hospital for Special Surgery, we concentrate on orthopedics. In fact, the modern total knee replacement was designed, developed and implanted here in 1974," says Dr. Steven Haas, Chief of the Knee Service at HSS, where 11,000 partial and total knee replacement surgeries are performed each year. "As a surgeon, when you see so many patients for total and partial knee replacements, there's a lot of diversity, which means you're rarely surprised. Data proves that the more experienced you are, the more accurate you are."

    Consider the Technique and Precision

    Such experience leads to innovation, like the minimally invasive knee replacement technique developed by Dr. Haas. Instead of the usual six to eight-inch incision, this approach requires an incision of only three-and-a-half to five inches. It's an important point since the smaller incision reduces blood loss and trauma to the body. Healing is faster, too.

    While minimally invasive surgery is now standard procedure for most knee replacements, patients who are obese or have bone deformities may require larger incisions. The size of the incision also depends on the implant being used. At HSS, implants are measured using very specific MRI and X-ray results prior to surgery. "Plus, we measure the bone again in the operating room before using the implant," Dr. Haas adds. In addition, if a patient has abnormal bone structure, HSS has a staff of biomechanics who design custom implants specific to that person's unique shape and contours. They also create custom-made instruments for doctors to use with these implants.

    Consider the Rates of Infection

    While accurately fitted implant devices and surgical expertise are crucial to successful knee replacement surgery, preventing infection is another critically important factor. HSS's infection rate is about half that of the New York state average and, according to Dr. Haas, some infection rates at HSS are less than a quarter of the national average.

    There are good reasons for this: As a specialty hospital, HSS does not treat sick people, so it's not as heavily contaminated as a regular hospital. The hospital also takes extraordinary precautions in the operating room. The specific area where the surgery takes place is enclosed with Plexiglas panels and has a high-flow filtered air system. In addition, everyone inside the paneled area wears a "space suit" so they remain sterile from head to toe. No one is allowed in the paneled area unless they are involved in the operation. Even the patient's head is outside the enclosure with the anesthesiologist.

    In the unlikely event of an infection, the patient is isolated in a contained environment and cared for by staff who treat only those in isolation. This attention to detail prevents cross-contamination to other patients.

    Consider Your Recovery

    Pain is an unavoidable byproduct of any operation, especially knee replacement surgery. But thanks to HSS's Interventional Pain Management Division, Acute Pain Service, and Recuperative Pain Medicine Service, its patients require 33% fewer pain medications and experience less pain overall after surgery. "The medical team in the Recuperative Pain Medicine Service has a bigger tool box than other physicians," says Dr. Haas. "They are our experts in pain control."

    Rehabilitation is another important part of a successful knee replacement surgery and recovery. At HSS, every physical therapist has advanced training in specific orthopedic recovery procedures. Working with orthopedic rehabilitation specialists, patients experience a 25% faster rate of regaining range of motions. "Studies show that 98% of our patients have good or excellent results from their procedure," notes Dr. Haas. And that says it all.

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