Dr. Stephen Howell, standing, blue shirt, checks in with Charlesetta Stalling, in wheelchair, Thursday, June 14, 2007, two days after her total knee replacement procedure at Methodist Hospital in South Sacramento, California. Pushing Charlesetta's wheelchair is physical therapist Bobby Natividad (cq), while and Physical Therapist Stephanie Rogers stands to the right. (Carl Costas/Sacramento Bee/MCT)
SACRAMENTO, Calif. - Charlesetta Stalling likes to call herself "62 years young." Vigorous and healthy, hers is a life packed with plans, trips and stories still to be spun.
Unfortunately, Stalling's 62-year-old knees have told a different tale.
Plagued with degenerative arthritis, also called osteoarthritis, Stalling has been sidelined on and off with pain and, even worse, difficulty doing the gardening, cha-cha dancing and traveling she yearns to do.
A total knee replacement surgery in 2004 got her back on track, but the education consultant and popular storyteller knew it was only a matter of time before her other knee would meet the same fate.
That happened last month, when orthopedic surgeon Stephen Howell replaced Stalling's other knee in an operation at Methodist Hospital in Sacramento.
This time, however, Howell used a new method, aided by special three-dimensional imaging and computer software. The technology aims to customize each new knee, preserve more of the patient's own bone and ligaments and shorten recovery time.
The method, marketed by Fremont, Calif.-based OtisMed, was developed by Howell, known in the orthopedics world for his improvements in surgical techniques for anterior cruciate ligament tears.
With an aging population and the rise in joint-pounding obesity, knee replacement surgeries are multiplying. The American Academy of Orthopaedic Surgeons reports that in just seven years, the number of knee replacement surgeries has almost doubled, from 266,000 in 1998 to 455,000 in 2004.
In that time, however, few innovations have been made in knee replacement.
The problem with conventional knee replacement surgery, Howell said, is that one of five patients is unhappy with the result, either because of enduring pain or a general lack of mobility.
"I can do three surgeries in the same day and have one patient who loves me, one who had an arduous recovery and a third not that happy at all," Howell said. "And yet, I think I have done the same operation. What we don't account for is the individuality of the patient's geometry and anatomy of the knee. Everyone is a little different."
To achieve a better fit, Howell starts with an MRI of the patient's knee, which allows him to see the knee in parallel slices, like a tomato perfectly cut into equally sized rounds with a Cuisinart.
The images are used with specially developed software that reassembles the slices into a three-dimensional model of the knee's bones and cartilage, leaving out muscles and tendons.
Of course, like the patient's real knee, the model appears misshapen because of arthritis, the breakdown of cartilage that works as a cushion between the bone and joint.
"We convert that arthritic knee into a virtual, naturally aligned, normal knee," Howell said. "Where there are areas that are worn, we fill in the gap, realign the leg and end up with a knee that may have existed 15 years ago."
After that, a computerized 3-D image of the replacement parts to be used in the surgery is matched to the virtual model. That information is used to create plastic guides that fit on the end of the femur and tibia and tell the surgeon exactly where to cut the bone for the implant.
Stalling's most recent knee crisis occurred when she stood up quickly from a seated position on the floor of her home. Tests showed a torn meniscus, arthritis behind the knee and a total lack of cartilage in the front of knee. The diagnosis forced her to cancel a scheduled trip to Uruguay with a friend where they'd hoped to start a library for women.
The custom knee procedure appealed to Stalling, she said, because it promised a quicker recovery. Translation: Her trip to Hawaii in two months would go as planned.
"And this knee will be more like the one I have, but new and improved," she said.
University of California, Davis mechanical engineer Maury Hull, who has worked with Howell for 15 years on various innovations and helped refine the new knee replacement technology, is confident the technology's benefits will prove overwhelming.
"I think it's going to revolutionize knee replacement surgery," he said. "I think it will catch fire soon."
Stalling is pretty certain, too. "I don't know when," she said. "But I'll be dancing."
Posted in Local on Monday, July 2, 2007 7:00 pm Updated: 3:44 pm.
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