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Not A Knee-Jerk Reaction

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By JOYCE McKENZIE

jmckenzie@tampatrib.com

Published: January 21, 2009

UNVIERSITY AREA - Victor Echeverria likens his choices for knee replacement surgery to that of having the option to buy a tailor-made suit or purchasing one right off the rack.

The traditional surgery to help solve the discomfort associated with degenerated knee joints is to implant an artificial knee from a selection of pre-made "over-the-counter" replacements. The surgeon uses pre-operative two-dimensional X-rays as his guide.
Echeverria chose the new tailor-made option. Called Signature knee replacement, the procedure is being performed at University Community Hospital by orthopedic surgeon Ira Guttentag, who is the only doctor in the state doing it.

Prior to surgery, the patient undergoes a three-dimensional magnetic resonance imaging scan from which the exact measurements of the arthritic knee and the overall leg alignment are determined.

Computer software by a company called Biomet then creates a model of the knee in its pre-arthritic state, before the gradual breakdown of cartilage between the thighbone and the shinbone that cushions the joint.

A 3-D image of the new implant is then matched to the MRI model in accordance with its size and placement within the knee socket. The software also generates guides for the surgeon to use to determine precisely where bones should be cut during surgery. The guides, according to Biomet representative Keith Fox, are known to be within one millimeter of accuracy.

The surgical process takes about an hour and a half, and Guttentag is assisted by a team of about five other medical specialists who also are trained in the use of the specific tools required.

The procedure, Fox said, has less risk than traditional knee replacement surgery because it tends to minimize the time a patient is under anesthesia and eliminates the need to insert an alignment rod into the bones. The incision, typically four or five inches, also is less than the usual 12-inch opening.
Echeverria loves his "custom-fit" prosthesis.

"It's amazing," he said. "I had the surgery in the morning, and I was up the same day. I went back to work in four weeks even though I still felt some discomfort."

When comparing his procedure to his brother's traditional knee surgery, Echeverria, who left the hospital two days after the surgery, said his recovery time beat his sibling's by two to three weeks.

Judith Jetson of Lutz was the first female patient who underwent the Signature knee surgery by Guttentag, a sports medicine specialist and team physician for the Tampa Bay Lightning.

"People said to me 'it's brutal,' but it really wasn't that bad," said Jetson, who was back at her University of South Florida job part time in six weeks and full time in eight weeks.

"The only real problem I had was sleeping at night ... but I've almost forgotten about that," said Jetson, whose surgery was Aug. 25. "I can even do yoga again, even though my physical therapist said I wouldn't."

Guttentag, who has been a physician for 13 years and practices out of Florida Medical Clinic on Bruce B. Downs Boulevard, has performed about 30 such surgeries.

"I think I'm pretty good at it," said the New Tampa resident and father of three.

Reporter Joyce McKenzie can be reached at (813) 865-4849.

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