Monthly Archives: July 2011

Benefits of Fish Oil

In recent years, dietary supplementation with Fish Oil has become increasingly popular. The benefits of Fish Oil over other common forms of oil come from the presence of the omega-3 fatty acids docosahexaenic acid (DHA) and eicosapentaenoic acid (EPA).  There is strong scientific evidence to suggest that these omega-3 fatty acids help to lower triglyceride levels in the blood, lower the risk of heart attack and stroke, slows the risk of atherosclerosis (hardening of the arteries), and slightly lowers blood pressure. There is also some evidence to suggest that fish oil supplementation improves morning stiffness and joint tenderness in patients with arthritis.

The World Health Organization recommends consuming between 300-500 mg daily of EPA + DHA. The U.S. FDA classifies intake of up to 3000 mg daily of omega-3 fatty acids as Generally Regarded as Safe. It is important to know that Omega-3 fatty acids may increase the risk of bleeding, although there is little evidence of significant bleeding risk at lower doses. Gastrointestinal upset is a common side effect of fish oil supplementation, but can usually be minimized when taken with meals and if doses are started low and gradually increased. Caution should be taken by people with allergies or sensitivities to fish products.

It is recommended that you consult with your physician before beginning dietary supplementation with fish oil.

by Steven L. Bernstein PT,OMT

iTotal Knee Resurfacing now available at JFK Medical Center

We are pleased to announce that JFK will be among the firstmedical centers in the country to perform a new patient specific total knee resurfacing procedure.  The device, called the iTotal, is from a Boston area manufacturer named ConforMIS (www.conformis.com).   FDA approval was attained earlier this year.  The company is a leader in developing patient specific partial and, now, total knee implants.

Knee

Many companies and surgeons claim to perform patient specific total knee replacement, however what they are really doing is using patient specific cutting guides to implant off the shelf implants.  Off the shelf implants typically come in 6 or 7 different sizes and the patients bone is cut to fit the implant.

With ConforMIS, it is a big difference because the actual implants, as well as the cutting guides, are all specifically made for the individual patient.  This is important because we know that over or under-sizing an implant by just a few millimeters can be a predictor of pain after total knee replacement.  The ConforMIS implant fits the patient perfectly because it was made for them.  The device offers a wear optimized design with an anatomic shape and fit for natural kinematics.  Full coverage of weight bearing areas is achieved.  It can be implanted via a minimally invasive technique with less trauma to the patient and significantly less bone removed.

Patients who wish to be considered candidates are worked up with a complete history, physical, and xrays.  If they appear to be a candidate, a CT scan is obtained.  The CT scan is then sent to the company and about 6 weeks later their implant kit is ready.  The kit arrives sterile in a box with all the implants and the instruments.  The surgery typically lasts under an hour and patients can be rapidly mobilized.  Hospital stay will be 1 to 2 nights.   Recovery can be expected to last 6 to 8 weeks.

Like traditional total knee replacements, the complications can include infections and deep venous thrombosis/pulmonary embolism, amongst others.   At JFK, we do everything to prevent complications.  JFK is a high volume joint replacement center, and as many studies have demonstrated, higher volume centers have a lower risk of complications.

Total knee replacement has been widely regarded as one of the most successful surgical procedures and has been performed for about 40 years.  However, some studies show that as many as 1 in 5 patients who undergo total knee replacement are not satisfied with their outcome.  There is room for improvement.  iTotal hopes to improve satisfaction with total knee surgery by providing a device that fits the patient like their own knee.

By Gregory M. Martin, M.D.  Medical Director, Orthopedic Institute @ JFK

Knee Arthroplasty in the morning……..and home for dinner.

Osteoarthritis of the knee affects millions of Americans and is painful, debilitating and interferes with the quality of life of many of our patients.  Total Knee Replacement has been the gold standard treatment for end-stage disease, but the procedure can often be associated with pain, significant blood loss, medical risk, and recovery can often take months to years.  Because of this, plus fear of hospitalization and a period of incapacitation, may patients elect not to undergo the procedure.  Of those that do undergo total knee replacement, as many as 20 to 25% of patients end up not satisfied with their outcome.  At JFK’s Orthopedic Institute we are pioneering a procedure which may offer new hope.   We have been performing uni and bi-compartmental knee arthroplasty on an outpatient or overnight stay basis for over a year now. The procedures utilize Conformis Patient Specific Resurfacing implants called the i-Uni and i-Duo.  Soon, JFK will be one of the first centers performing total knee resurfacing with the recent FDA approval of the iTotal device.

The knee joint has three compartments (lateral, medial, and patellofemoral).  One, two or all three of these can be affected with osteoarthritis.  The implants, made specifically for each patient, are constructed off of a pre-operative ct-scan.   The technology, designed in conjunction with doctors from Harvard Medical School, has been FDA approved since 2007.  The advantage of the procedure is that it leaves the healthy parts of the knee and only addresses the diseased part or parts.  Because of this, the procedure is typically associated with less pain, minimal blood loss, shorter hospitalization, and a quicker recovery.  Minimal rehabilitation is required when compared with total knee replacement.  Patients typically say that it feels like their own knee, which is not typically heard of with total knee replacement.

Initial results have been promising.  In the first 50 cases in 45 patients, we performed 37 medial iUni’s, 7 lateral iUni’s, 5 medial iDuo’s, and 1 lateral iDuo.  Average operative time was 62 minutes.  Mean drop in hemoglobin was only 1.7 gms.  Mean length of stay was 1.3 days and recently 10 cases have been done on an outpatient basis.  Because of the diminished pain with the procedure, we have eliminated the use of continuous femoral nerve blocks for these patients in favor of other multi-modal pain control techniques.  Return to function is usually rapid with minimal physical therapy and mean flexion in the group was 125 degrees.

For those concerned about longevity of partial knee replacements, when one looks at recent follow up studies of modern partial knee designs, results are encouraging.  A study in 2004 demonstrated 96% survival at 15 years of follow-up.  In 2009, a study compared follow-up of partial versus total knee replacement, and found that 15 years after the procedures the partial knee group had higher survival and higher knee scores than the total knees.

We look forward to following the long term outcomes of these devices and are actively participating in a post-market clinical trial of the iUni device.  In addition, we are hopeful that the iTotal will address many of the shortcomings of traditional total knee replacement and meet the expectations of higher demand patients.  For more information visit www.conformis.com.

By Gregory M. Martin, M.D.  Medical Director, Orthopedic Institute @ JFK