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O R T H O P E D I C S
Unicondylar
knee replacement is really
a partial resurfacing of the
joint. A small
skin incision is
made on
whichever side
of the knee —
the inner or
SAME-DAY SURGEON Dr. Berger (left) performs up to 9 knee
outer aspect
arthroplasties in a day.
— needs
resurfacing. A cut is then made through the articular capsule, the
structure that holds the knee in place. No muscle, tendons or ligaments are touched. Small cuts around the knee remove the diseased
segment of the bone, which is then capped with a metal prosthesis
that goes on the bottom (tibia) and top (femur). Finally, a small ultrahigh molecular weight (UHMW) polyethylene plastic piece is placed
between the caps. Total knees are done much the same way. A cut is
made through the capsule, sparing muscle, tendons and ligaments.
Instead of addressing half the knee, however, the entire joint is resurfaced and capped, including the back of the patella.
Key to my success in partial and total knees is performing the procedure with the knee in extension, with the quadriceps lax so I'm not
pulling or tearing the muscle to access the joint. Many surgeons perform knee replacements with the knee bent all the way, hyperflexed so
the heel touches the glute. In that position, the quad is stretched, forcing surgeons to tug and cut it in order to reach the joint.
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O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | J U N E 2013
Richard Berger, MD
Less trauma, better results
