OtisMed

[bluegrassanne]

I have scheduled my LTKR for October. Today my doctor's office called to schedule my MRI. I was totally suprised because I didn't have an MRI with my RTKR in May. Then she explained they were going to use OtisMed. I asked what it was but she had no idea. I have an appointment with the doctor next week and told her I would talk to him then. Of course I looked it up on the internet and appears to be a company that creates custom templates for cutting the bone. Just wondering if anyone was familar with this method and had heard anything good or bad about it.

It has been about nine weeks since my RTKR and I'm doing great. Earlier this week I was walking back to my office from a meeting and thought "If my left knee felt as good as my right knee, I would have it made!"

 

[Texas]

OtisMed Innovation in Motion
www.otismed.com.
Yea I think you said you looked this up, I dont know what it is.
Sounds like your fist one went well good luck on your next one..Hope it goes just as well......keep us posted....You'll be good as new with those 2 knees..

 

[Jamie]

Hmmmm, Anne......their web site is just a bunch of nothing...doesn't say or show much, does it? Maybe Jo knows something of this process and if it really is any different from other knee replacement products.

 

[Josephine]

It's just a process to enable the minimum amount of bone to be trimmed off. This is seen by some surgeons as an advantage but I haven't been party to any discussions so couldn't say. Most standard TKRs seem to do perfectly well without it. Still, it's the surgeon's choice so presumably he has his reasons!

 

[bluegrassanne]

Thanks Josephine. That was pretty much my impression. There is a "virtual" knee replacement sugery on the web. I did the virtual surgery before I had my first replacement so I knew about the templates they use.

 

[skigirl]

I had computer navigation with my knee--by Stryker. I think that when you have MIS, the opening is smaller, so any help with the cuts and alignment of the knee help to makie sure the alignment is perfect.

In a traditional total knee with a larger cut, it is easier to see the alignment. With the MIS there are various alignment aids. This is one of them.

The will use the MRI to get some bone measurements.

 

[Josephine]

They cannot do true MIS with TKRs. The prostheses are too big. True MIS is usually for hemi's. What they do with a TKR is a reduced incision. Some surgeons have managed to get them down to about 4-5" but I would imagine it to be a struggle.

 

[Titianlady]

If you take a good look at the OtisKnee website, you will be able to find the difference between traditional knee replacement surgery and the custom fit surgery. Less time under anesthisia, the bone cuts and alignment of the knee are done before the surgery not during the surgery. Traditional surgery calls for a rod to be inserted up the femur to align the knee and leg. It is this procedure that can cause the fat emboli that can cause major problems. Also, the knee is returned to the patients normal pre disease alignment not some alignment that is used for every other patient. There is no cutting or surgical separtating of the quad muscle, and no cutting of the tendons!! This makes for less pain, and a faster return to normal use.

I will be having my surgery done next spring by the orininator of the custom knee templates in Sacramento!

 

[Josephine]

Well, don't know where you got your info, Titianlady, but the rod does not cause fat emboli! It's much too small for that. In fact, it's a lot smaller than the rasps and trials used in a hip replacement and they certainly do not cause fat emboli.

Plus, no TKR involves separation of muscles and never tendons! Boy, that would be very counter-productive!

I read that website and I was very sceptical of the manufacturer's claim that there is less time under anaesthetic. In my experience, the addition of hi-tech stuff has never resulted in less time, only ever longer. And the bone cuts and alignment are only planned before surgery. No way could they be carried out beforehand!

 

[bluegrassanne]

I had a 3 month check-up last week and dicussed this with my doctor and his assistant. The assistant came in first and was very enthusiastic about the OtisMed procedure. She did say the procedure takes less time and it is only a two-day stay in the hospital instead of three. Currently my doctor is the only doctor in Kentucky using OtisMed. However my doctor came in, reviewed my chart, and nixed the OtisMed procedure. He said "Why mess with a good thing?" I did so well with the last surgery that he wants to use the same prosthesis again. I had a ROM of -5 to 120 within three weeks of surgery, was pretty much pain free, moved to a cane two weeks in, and went back to work 3 weeks from the date of my surgery. You can't argue with that. :thmb:

 

[Nancyo]

bluegrassanne
Way to go! Your doctor has nailed it completely. Can't mess with success!
Blessings Always~~
Nancyo

 

[Titianlady]

Before anyone poo poo's the Otis Custom procedure, please go the the OtisMed website and have a look around. I have done much research on the procedure and in my opinion and the opinon of many other ortho surgeons, this is fast becoming the new gold standard in knee replacement surgery. Of course, I will let you all know how it all works when I have my surgery completed. I know too many people that had their knee "balanced" by shortening the soft structures in the knee to accomodate the implant and have had problems with recovery and pain.
I like the idea of the implant being installed to accomodate MY individual anatomy, and not having my anatomy altered to accomodate the implant.

 

[bluegrassanne]

Titanlady, I was not poo pooing OtisMed. I think it is a great concept and my surgeon must too or he wouldn't be using it, but I had such great success with my RTKR in May he thought we should stick with what worked well for me.

I still maintain that the greatest key to a successful TKR is exercise before the surgery. I am having my LTKR in October. I have been doing 100 straight leg lifts a day, and now I am working on doing 100 with 2 pound ankle weights. I am 60 and extremely overweight. If I can do it, anyone can.

 

[loggon]

Anne
You are so right about being in shape prior to surgery. I was more in shape for the first surgery (scope) than the TKR and I can feel the difference.

Which leg lifts are you doing. My PT showed me a couple. Just curious.

Good luck with your surgery I know you are going to do great.

 

[Josephine]

Before anyone poo poo's the Otis Custom procedure, please go the the OtisMed website and have a look around. I have done much research on the procedure and in my opinion and the opinon of many other ortho surgeons, this is fast becoming the new gold standard in knee replacement surgery. Of course, I will let you all know how it all works when I have my surgery completed. I know too many people that had their knee "balanced" by shortening the soft structures in the knee to accomodate the implant and have had problems with recovery and pain.
I like the idea of the implant being installed to accomodate MY individual anatomy, and not having my anatomy altered to accomodate the implant.

To be perfectly frank, Tlady, I am poo poo-ing neither the implant nor the procedure. I do, however, some issues with your concept of it. I would no more take as read what I read on a firm's website than I would what I read in the newspapers. Remember who their audience is, what their objectives are. To sell their product. But more importantly, a lot of what is said needs a significant amount of medical knowledge to interpret. ref your statement regarding the preparation of the bone ..

Less time under anesthisia, the bone cuts and alignment of the knee are done before the surgery not during the surgery.

Now again you say that people have their ' ' to accomodate the implant! In my 50 years in this business, I have never, ever known this to be done! There is no need as the knees come in a variety of sizes and thicknesses because this would be an absolute no-no for successful surgery.

I am also concerned by the 'and in my opinion and the opinion of many other ortho surgeons' comment. What research have you done? And how many orthopaedic surgeons do you actually know? If it turns out you are a graduate of medical research and statistics and/or a surgeon, I will unreservedly apologise.

But it is my responsibility to point out possible misquotes in posts.

 

[Titianlady]

I didn't mean to imply that I was a surgeon in any way by the way that I worded that sentence.. I am just an average future knee replacement patient with a lot of questions, and who is concerned about knee replacement just as so many others who face this surgery. My best friend who was an OR nurse at Yale just had a bilateral knee replacement in November. She had the traditional surgery by some of the best ortho Doctors around (at Yale) and is still facing some problems with her knees. They did have to do some ligament releases and such to balance her knees and she did not have a quad sparing surgery, so even now she has alot of issues. She is only 53 years old.
I need to have the surgery, but was hesitant because of the long ongoing recuperation. I came upon this article (link supplied) broken link removed: https://www.orthosupersite.com/view.asp?rID=31412
After reading this, I found Otismed and called Dr Howells office in Sacramento.
I in no way want to convey the feeling that I think traditional surgery is inferior!! For myself personnaly, I like that I have a choice, and this one looks like a good fit surgically for me.
Everyone MUST have the surgery that is right for them in every way. This is decided by the surgeon and the patient. Being comfortable and trusting your surgeon to do the best for YOU is what matters most whether it is traditionl knee replacement, or the custom fit procedure. I, for one, am certainly not qualified to determine that for anyone.
I am just passing along information that helped me come to MY decision.
Everyone must make a comfortable decision for themselves and their own medical needs.

 

[bluegrassanne]

Loggon, I have been doing a variety of exercises including plain straight leg lifts with 2 pound ankle weights. My pre-surgery left leg is up to 65 leg lifts per session, but I can only do 40 with my post-surgical leg. I try to exercise twice a day. Suggestions are welcome.

RTKR 05-18-2009
LTKR scheuled for October

 

[Krux]

I have scheduled my LTKR for October. Today my doctor's office called to schedule my MRI. I was totally suprised because I didn't have an MRI with my RTKR in May. Then she explained they were going to use OtisMed. I asked what it was but she had no idea. I have an appointment with the doctor next week and told her I would talk to him then. Of course I looked it up on the internet and appears to be a company that creates custom templates for cutting the bone. Just wondering if anyone was familar with this method and had heard anything good or bad about it.

It has been about nine weeks since my RTKR and I'm doing great. Earlier this week I was walking back to my office from a meeting and thought "If my left knee felt as good as my right knee, I would have it made!"

OtisMed does not remove less bone and this is not about OtisMed. After quite a bit of research before mine and discussions with surgeons that do a variety of knees, OtisMed offers nothing more than a pre-fabricated external alignment guide for an “off-the-shelf” Stryker implant (small, medium, large styles as with most implant systems). If your getting an off-the-shelf implant placed in you, there is absolutely nothing this type of pre-navigated guide can do to lessen the amount of bone removed because bone-removal is implant design driven (when talking about this topic) and not pre-navigated alignment guide driven. Every Company has some kind of pre-fabricated external alignment guide that is driven off an MRI of your knee to more accurately ‘align’ an off-the-shelf type product to your anatomy more consistently. These are not custom knees, but alignment guides.

And this is not about any other company, but if you empower yourself with knowledge and some rudimentary reading on all the companies (from left to right) on the home-page of this site, the most conserving knees seem to be those that do ‘not’ resect more bone for many patients, but just ‘resurface’ what can be to most prominent problem with most patients suffering from OA and a painful knee; bone-on-bone articulation or the erosion of cartilage. One or two companies offer this resurfacing technology and the preservation of bone-stock seems to be a nice advantage since about 92% survivorship of total knees out to 15 years means that at that time, a revision is something that can happen regardless. Again, empower yourself with knowledge and be an educated consumer because many don’t ‘have’ to go to only one surgeon and just gain ‘one’ opinion. Most of the company sites have a ‘surgeon finder’ to help you consult and get feedback from surgeons doing whatever procedure with whatever technology.

Not only do a couple of these companies offer a more preserving and less traumatic resurfacing technique, the implants that accompany them are true custom, fit your individual anatomy rather then resorting to a generic-type implant where your cutting bone to fit the implant; in many of the other cases, the company makes your anatomy fit their implant rather than making an implant for you to fit your anatomy. And if a revision does happen, which is something everyone needs to be prepared for, preserving more bone-stock from your first procedure just means that you’ll probably have more bone-stock to be useful for the follow-up procedure instead of the surgeon having to resort to metallic spacers or bone augmentation to restore your joint.

Now also, procedure time with these pre-navigated external alignment guides, such as Otis (and again every off-the-shelf company has them and Stryker Triathlon is used with the Otis blocks) do not really remarkably lessen the knee procedure time versus a technique with conventional external instruments. Speed by 15 minutes or so on a 60 minute technique does not make the difference between a good outcome or bad outcome or recovery in the slightest.

Just my 2 cents after having found this site and reading a lot of generalizations, so empower yourself with knowledge; some patients are candidates for partial knee replacements, some total knee replacements, some for one type of technology, whether they use a pre-navigated alignment guide and some for technologies that not only develop pre-navigated instruments but implants as well.

 

[Josephine]

A very interesting treatise, Krux. But I'm going to ask you what I've asked a lot of people who get into detail about choosing implants - now you've have your knee replaced, how do you know the difference? And how do you know if this is, after all, the 'right' knee for you? If you should come to a conclusion that you made a mistake, what do you plan on doing about it?

 

[Jayhawk]

I did considerable research prior to my first total knee arthroplasty. Ultimately the doctor that I selected is an expert and only performs knee replacement surgery....hundreds and hundreds of surgeries per year. We have had several conversations in reference to different prostheses manufacturers and the Otis-Med procedure. In his opinion the skill of the doctor is far more important that the brand of prostheses or the use of computer oriented guidance system.....this type of system would be of benefit to a lesser experienced doctor. He stated that frequently the actual condition of the knee encountered once surgery is initiated is vastly different than expected from an X-ray or MRI. This then necessitates the ability to make changes during surgery.

While I have the DePuy Rotating Platform prostheses in both knees....at the "end of the day" I opted for a expert doctor and worked very, very hard in physical therapy. As a result I have experienced an exceptional surgery and recovery!!!!

Steve
Spring, Tx.