Not too long ago, people suffering from arthritis and other debilitating joint conditions were forced to accept a difficult truth: for the remainder of their lives the best any doctor could do was minimize their pain and make them as comfortable as possible through medication and rest. There were no “long-term” solutions. The lack of available treatment options meant that patients were often robbed of their mobility and presence of mind, diminishing their quality of life.
Today, nearly 500,000 Americans undergo total joint replacement surgery every year, which enables them to move around as if their original knees and hips were still in good condition.1 Robert Booth, MD, of Philadelphia, Pa., knows this has not happened by accident. “Total joint replacement technology really came into being about 35 years ago, and since then, physicians have consistently taken on the huge challenge of updating and developing the technology to make it work better for patients.”
“Twenty-five years ago, joint replacement surgeries were just becoming popular,” said Dr. Booth. “Physicians and their patients were initially wary of the new technology, but once they saw the patient outcomes that resulted from the surgery, it was hard to ignore the evolution from using traditional pain treatments to the total joint replacement system.” Dr. Booth continues to see the field evolve and grow with new ideas such as gender-specific knees coming into development. “This is a watershed moment in orthopedics. We’ll see a lot of changes happening over the next several years.”
LEARNING FROM A LEGEND
Dr. Booth became interested in knee replacement during his internship at Pennsylvania Hospital in the early 1970s and was particularly captivated by the work of Dr. John Insall, regarded by many to be the father of total knee replacement surgery. Dr. Insall was a pioneer in the process to develop what has become the framework of total knee replacement. He initially created a prosthesis that concentrated on the mechanics of the knee but was not successful in reproducing normal knee motion. Dr. Booth admired Dr. Insall and carefully followed the progress he made in developing this revolutionary device.
Later, as Dr. Booth operated on more patients and worked passionately to become a top knee replacement surgeon, he discovered that there was room to improve existing prosthetic knees. While the replacement knees available then did allow for an improved range of motion for some patients, they were not particularly stable and did not bend well. “After surgery, patients still complained about poor range of motion and increased pain as the devices wore out,” said Dr. Booth.
DEVELOPING A BETTER SOLUTION
Determined to seek solutions and improve patient outcomes following knee replacement surgery, Dr. Booth teamed with his hero, Dr. Insall, to develop the next generation of prosthetic knee technology. Working with a team of physicians, Drs. Booth and Insall sought to improve the current knee technology by using enhanced designs to create a better prosthetic knee.
Prosthetic KneeDuring this time, Dr. Booth as well as several other physicians and representatives from the device manufacturer performed rigorous clinical tests on the device. For example, using a series of plastic models of the artificial knee, they were able to analyze its various components and offer ideas and criticism on specific aspects, such as the shape and size. The device was also tested on cadavers and examined on plastic “sawbone” knees to ensure the shape was correct. The artificial knee’s resiliency also was tested using sophisticated equipment to see if it was able to bear the strain of typical knee movements, such as walking and running. Dr. Booth noted, “We all learned a lot more from our failures than from our successes.”
Once the knee was cleared by the FDA in the late 1970s, physicians gradually became informed about it through professional meetings and physician referrals. They evaluated it, provided their feedback and it eventually became one of the most widely used prosthetic knees worldwide. According to Dr. Booth's research, ten years after surgery, only two percent of patients required further adjustment surgeries due to disease complications, loosening or pain, and only seven percent needed to return 20 years after surgery. Since then, Dr. Booth has continued to advance this technology. “Even today, the prosthetic knee technology continues to evolve based on physician feedback and product adjustments, in hopes of making it stronger and longer-lasting,” said Dr. Booth.
SURGEONS HELPING SURGEONS
Besides his pioneering work in helping develop a better prosthetic knee, Dr. Booth has also helped design new and improved surgical tools for performing hip or knee replacement surgery. Many of his ideas for new equipment come to him in the operating room, such as the Vacuum Instrument System which helps reduce the occurrence of emboli, a potentially deadly complication that can develop during joint replacement surgery.
Total Knee
Replacement Facts
- Knee replacement was first performed in 1968.2
- Today, there are roughly 300,000 total knee replacements performed annually in the United States.2
- Research has shown that knee replacements work well in 90-95 percent of patients between 10 and 15 years after surgery.3
“I have found that 80 percent of knee surgeries are performed by surgeons who only do an average of 20 knee surgeries a year,” said Dr. Booth. “My goal is to create devices that allow these surgeons to perform their surgeries as skillfully as someone who does 1,000 surgeries a year.” To try and accomplish this goal, Dr. Booth regularly trains other physicians how to use these devices and tools most efficiently and effectively.
“Orthopedics is really the carpentry of medicine,” said Dr. Booth, “and it is important that physicians get both the intellectual and hands-on experience to perform these surgeries.” Dr. Booth encourages physicians to attend training seminars sponsored by professional orthopedics societies and those led by device manufacturing companies, which allow physicians to practice using the devices on cadavers and receive the technical training they need.
Much like he did with his mentor Dr. Insall, Dr. Booth believes strongly in the need for the next generation of physicians to examine – as well as question – the devices currently available, and provide the necessary feedback to the manufacturers. He remarked, “Innovation comes from a fresh set of eyes looking at what you have done and helping you think of what more can be done to improve patients’ outcomes.”
- DukeMed Magazine. Joint Effort. (14 September 2006).
- American Academy of Orthopaedic Surgery Total Knee Replacement (4 October 2006)
- About.com Total Knee Replacement (4 October 2006)