Case Study: Custom-made knees for younger and active older patients
Consultant surgeon Mr Ian McDermott describes the implantation of a custom-made knee replacement in a younger patient with osteoarthritis
Older people are more active than they ever have been, and, nowadays, younger patients are presenting to our practice in need of knee replacements. Patients’ expectations for improvement in function are higher than they have been in previous years, and technical advances in knee replacement prostheses have made meeting these expectations possible.
Conventionally, with standard knee replacements, the bone of the patient’s knee has to be cut to fit the prosthesis, and the prostheses come in a few different sizes but only one specific shape. Different people’s knees, however, vary enormously – not just in size but also in shape and contours. Custom-made knees are now available, where pre-operative CT scans are used to create personalised, patient-specific knee implants that match the individual patient’s knee perfectly.
These knees are truly patient-specific (unlike some previous implants where patient-specific jigs were used to implant what are simply just standard off-the-shelf, non-customised prostheses). The custom-made knees have been shown to require less bone to be removed from around the patient’s knee; they provide better alignment, a more accurate fit and more normal kinematics, compared with a traditional off-the-shelf total knee replacement (TKR). This leads to better outcomes and significantly improved patient satisfaction levels compared with a standard off-the-shelf implant.
The personalised knee implants from ConformMIS have options for total knee replacement (the iTotal), unicompartmental partial knee replacement (the iUni, for either medial or lateral knee arthritis) or bicompartmental partial knee replacement (the iDuo, where the patellofemoral compartment is resurfaced as well as either the medial or lateral compartment).
Case study name: Mary Wolff-Ingham
Age: 52 years old
Treatment: Total knee replacement surgery through a custom-made ConforMIS iTotal knee replacement
Consultant: Mr Ian McDermott, consultant orthopaedic surgeon at London Bridge Hospital
Mary Wolff-Ingham is a good example of a younger patient who has benefited from a custom-made knee replacement. Mary was diagnosed with osteoarthritis aged 47. The most likely cause was the amount of sport she participated in when she was younger, such as hockey, tennis, netball, skiing, waterskiing, windsurfing, sailing, etc. Mary managed her pain for several years until it became unbearable and her mobility became severely limited. She was told by her GP that she was too young (aged 51) to have a knee replacement on the NHS so she decided to seek options to have it done privately.
“I decided that if I was going to pay to have surgery, I was going to get ‘the best’ available,” said Mary. “That’s why after much research I chose Mr Ian McDermott, primarily because of his pioneering work with custom-made knee replacements and the fact that he operated in one of the UK’s top private hospitals (London Bridge Hospital).”
At her consultation, McDermott explained to Mary that the pain, stiffness and deformity in her knee was due to widespread osteoarthritis, and he suggested that she should have a ConforMIS knee replacement. He explained the benefits of a custom-made knee compared with standard knee replacement surgery, and Mary took the decision to have a knee replacement in November 2014.
Mary is a good example of how a custom-made knee can achieve significantly better patient outcomes that a standard knee. For example:
Two weeks after surgery, she achieved a 120-degree knee bend.
Seven weeks after surgery Mary was cycling again, having achieved a significant range of movement.
Twelve weeks after surgery, she achieved a 130-degree knee bend and after 20 weeks this was 135+ degrees.
Twelve months on, she now has a full range of movement and a fully functioning knee.
Mary firmly believes that her rapid and remarkable recovery was due to the fact that she had a talented and meticulous surgeon, received a patient-specific, custom-made knee replacement, and benefited from outstanding pre- and post-operative care from London Sports Orthopaedics and London Bridge Hospital. She received regular physiotherapy support for many weeks after her surgery, and had the grit, determination and commitment to continue her post-surgery knee exercises nearly every day for a period of six months.
“I’m now 12 months on and the difference is truly amazing,” said Mary. “I no longer suffer from excruciating pain; I’m fitter, more active and feel the best I’ve felt in years. I have a super, new, fully functioning knee and couldn’t be happier. Not a day goes by that I’m not grateful to Mr McDermott for my amazing new knee.”
Mr Ian McDermott was the first surgeon in the UK to implant a G2 ConforMIS knee prosthesis, and is now one of the UK’s leading surgeons for this technique, working within the London Sports Orthopaedics practice, based at London Bridge Hospital.