Lawrence Kohan, Orthopaedic Surgeon
MB, BS(HONS) F.R.A.C.S. F.A.Orth.A.
Unicompartmental Knee Resurfacing
Joint Orthopaedic Centre
99 Spring Street Bondi Junction NSW 2022
Telephone: (02) 9387 5985 9387 2877
Facsimile: (02) 9287 5557
32 Norton Street, Leichhardt NSW 2040
Telephone: (02) 9569 8272
PO Box 240, Bondi Junction NSW 1355
M.B, B.S (Hons) F.R.A.C.S., F.A. ORTH.A.
What motivates my work as an orthopaedic surgeon is helping people to maintain quality of life. My work makes it possible for very ill or injured people to regain – and keep – their health and independence.
We live much longer lives these days, because of advances in medicine, nutrition and hygiene. We hope for active lives in strapping good health. But we cannot always protect ourselves from illnesses or accidents such as degenerative joint disease, rheumatoid arthritis, or severe injury to the joints.
The surgery I perform, such as hip and knee replacements, knee reconstructions and arthroscopic surgery, improves the mobility and function of the injured joint.
For older people this can mean many more years of valuable independence and active life. For younger people, particularly those with knee injuries, surgery can save them from permanent disability, and in some cases will see them right back onto the football field!
Once more they can trust their body to brace them for the brisk pace of life in today’s world. I watch my patients progress from pain and fear, to rehabilitation, and then in most cases to a return to normal life. It gives me a great deal of satisfaction. It’s my lifelong professional commitment
Medial unicompartmental knee resurfacing (Repicci), results for 588 implants at 56.8 months average follow up.
L Kohan, R Cordingley, D Kerr (Joint Orthopaedic Centre)
This is a descriptive, prospective, longitudinal analysis of functional outcomes and component survival in 588 medial unicompartmental knee resurfacing procedures. A consecutive series over 6.8 years with all implants the Biomet Repicci 11 (Biomet). An overall 97.8% implant survival rate was achieved.
All surgical implantations were carried out by one surgeon using a minimally invasive approach. All patients underwent an early mobilisation rehabilitation programme. No patient was lost to follow-up. The age range for the knee resurfacing components was 43-92 years, with 367 males and 219 females. The average age was 68 years. SF-36 and Womac Health Questionnaires were completed. The patient inclusion criteria for this cohort included articular cartilage changes no greater than grade 2 (outerbridge) in lateral compartment and more than half of the ACL intact.
Total survival was 97.8%. 588 knees were resurfaced with a mean elapsed time since re-surfacing of 56.8 months (Median 64 months, maximum 82.6 months).There were 13 failures that required revision. 2 from deep infection, 1 loose femoral component, 1 ACL failure and instability and 9 progression of arthritis. There was one DVT in a patient that remained in hospital for 5 days. 87% of patients were discharged from hospital 23 hours after surgery. SF-36 and WOMAC scores were assessed preoperatively, 6, 12 months and annually post operatively. Function, pain, stiffness, social functioning, physical function and role physical all improved dramatically in the first 6months after surgery then remained static out to 6.8 years.
Dr. Kohan Interview
1. What is the difference between total knee replacement and unicompartmental knee resurfacing?
Knee replacement is removing the edges of the joint that have been diseased by degeneration or trauma.
Knee resurfacing is like a retread. The only part of the joint that is resurfaced is the side of the joint that is diseased.
2. How long is the hospital stay?
Unicompartmental knee resurfacing is considered day only surgery.
3. What type of anaesthetic will I have?
The anaesthetic is a light general anaesthetic. You will be asleep for approximately 2 hours.
4. How long is the operation?
The operation is approximately 2hrs and 1hr in recovery.
5. Will I need help at home?
The advantage to unicompartmental knee resurfacing is the fact that you can return to your normal daily activities soon after surgery. You may need someone to stay with you the first couple of nights but you should feel independent by the third day.
6. What about stairs?
You will not be discharged from hospital until you can manage the stairs.
7. When can I walk?
Walking begins a couple of hours after your surgery. The physiotherapist will aid you.
8. How long must I use the crutches?
The crutches can be discarded when you feel strong enough or after one week.
9. How long must I wear the knee brace?
The knee brace must stay in place for 48hrs.
10. How long will my knee be swollen?
The initial swelling appears in the first week after surgery. Some patients experience the some form of swelling up to 12 months following their operation.
11. Can I get my knee wet?
You must try to keep your incision dry until the skin clips are removed. If you get the incision wet you will increase the chances of you getting an infection. Also, it is not wise to swim for 2 weeks following surgery, for skin needs time to heal.
12. How long is the incision?
7-10 cm over the front of your knee.
13. Do I need Physiotherapy?
The physiotherapists will attend at the hospital, as a general rule but you will not require any physiotherapy after your surgery.
14. When can I drive?
Approximately one week following surgery. Please check with Dr Kohan before you drive your car.
15. When are the skin clips removed?
10-14 days after surgery.
16. How much walking should I do?
Walking or weight bearing is very important in your recovery phase. You should walk around as much as you can during the day. Motion is Lotion for your knee.
17. Can I participate in high impact activity?
Running and jumping is not recommended for unicompartmental knee resurfacing. The implant can crack or wear out before their time.
18. What is the implant made up of?
The metal component is steel and the plastic is a high-density polyethylene.
19. What is the life span of the implant?
Approximately 8-10 years depending on use.