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September 2019

By: Torey Botti, MD

 

"Patients First."  "Patients are our purpose."   Every hospital, clinic, and insurance company claim that "patients" are their mission, but statements like these have effectively become modern health care clichés.   What does a "patient first" commitment mean when you are dealing with chronic knee arthritis or have just twisted your knee during a softball game?  Flagstaff Bone and Joint puts our patients first by providing the most specialized care for complex knee conditions and we are proud to introduce our first "Specialty Knee Clinics".  

 

Navigating the health care system is difficult for all of us.   Do I need a referral?  What is my copay?  How do I choose the best doctor for my condition?  Should I follow my neighbor's advice or what I read on Google?  These are just a few of the questions that patients must take into consideration when choosing a provider to take care of their knee condition.  The truth is, the most important consideration that any patient should use when choosing a physician for a complex musculoskeletal problem is "does the physician specialize in this condition and does my surgeon do a lot of these procedures".  By creating "Specialty Knee and Shoulder Clinics", Flagstaff Bone and Joint is ensuring that patients who have complex conditions are being seen by the most specialized provider.   

 

It seems intuitive that a surgeon who frequently performs a complex surgery would develop more technical proficiency and have better patient outcomes than a surgeon who infrequently performs the same procedure.  In science, intuition doesn't cut it, as often our intuition turns out to be wrong; however, in the case of complex knee surgery, our intuition turns out to reflect the extensive scientific data which demonstrates that surgeons who perform a high number of the same complex surgeries have the best patient outcomes.  

 

With advancing technology comes the need for more technical specialization.  We can appreciate this fact when looking at many industries.  Take, for example your car mechanic.  Due to the complex design of modern cars, the fix-it-all mechanic has long been supplanted by specialty European, diesel, Japanese, and exotic mechanics.  And now we have electric cars, whose maintenance demand a completely different set of skills from a traditional car mechanic.  It should come as no surprise that modern orthopaedic surgery is just as technologically complex and requires just as much specialization to produce excellent patient outcomes.  

 

One example of the continued advancement of orthopaedic technology is computer-assisted knee replacement.  As one can imagine, surgically implanting an artificial knee is an extremely complex task.  To function properly, a knee replacement has to be aligned and implanted perfectly and ensuring proper alignment has been a challenge in knee replacement surgery since it was first performed in 1968.  I finished my orthopaedic surgery training at the University of Chicago in 2005, and during my education I learned about the many leaps of total knee replacement innovation that had made it such a successful operation at that time.  In 2005, the cutting edge of knee replacement surgical alignment involved drilling a tunnel in patient's femur (thigh) bone, sliding a long metal guide rod up the patient’s bone canal, then hooking up multiple jigs and guides to properly position the knee replacement.  Fast forward 14 years and there are now a dizzying array of computers and robots to help surgeons perfectly position and implant a knee replacement (although many surgeons still do it the old way).  And next year, there will be even newer and supposedly better robots and computers to assist with the procedure.  Knowing which robots are just marketing tools and which systems provide the best accuracy requires staying constantly up to date with both the orthopaedic knee literature as well as the different options available in the marketplace.  Amazingly, computer and robot assistance are only one area where knee replacement surgery is undergoing rapid change.  The materials, coatings, bearings and design of the knee replacements continue to evolve.  Numerous agents now exist to minimize infection, multiple different approaches can be utilized to numb the knee and minimize post-surgical pain, and specialty drugs and equipment have minimized surgical bleeding.  Amazingly, due to these advances in safety, technology, and technique, many of our patients go home the same day as their knee replacement surgery.  

 

Another example of the pace of knee surgery advancement involves complex knee ligament reconstruction.  When people think "knee ligament", they often think of the ACL, or anterior cruciate ligament, but that is only one of the many ligaments commonly fixed or rebuilt around the knee.  Knee surgeons rebuild an array of ligament acronyms including the PCL (posterior cruciate ligament), MCL (medial collateral ligament), MPFL (medial patella femoral ligament), and the PLC (posterior lateral corner).  Reconstruction of each ligament demands its own technical considerations and surgical risks.  A specialty knee surgeon must know which of the dizzying array of screws, anchors, or buttons has the best outcome data.  Should a metal or biologic device be used?  Should the surgeon use one of the patient's own tendons, part of a tendon, or a cadaver tendon to reconstruct the ligament?  Should stem cells and growth factors be employed?  Like the situation for knee replacement surgery, knee ligament surgeons also must contend with the constant flood of innovative surgical devices, new technical approaches, and surgical literature from around the globe.  Nothing illustrates the pace of knee ligament innovation and discovery more than the case of the ALL (anterior lateral ligament).  It’s been only five years since a team of researchers in Belgium published their discovery of the ALL, a previously unknown ligament in the knee.  In these five short years, numerous surgical techniques have been developed to repair the ALL, multiple studies published to describe its anatomy and function, and equipment designed towards addressing injury to this previously unknown structure.

 

Orthopaedic surgical data is very clear that patients with complex musculoskeletal problems have the best short- and long-term outcomes when they are cared for by doctors who specialize in their problem and who perform a high volume of surgical procedures.  Developing proficiency and surgical expertise in knee surgery requires a full understanding of the orthopaedic scientific literature, the ability to evaluate and scrutinize constantly changing high-tech equipment and techniques, and the aptitude to translate this information into precise surgical technique and execution.  Focused, patient-centered "Specialty Clinics" at Flagstaff Bone and Joint provide our patients with the most specialized care for their complex musculoskeletal conditions.

 

Dr. Torey Botti is a board-certified and fellowship-trained sports medicine surgeon.  He specializes in computer assisted total and partial knee replacement, complex ligament reconstruction, cartilage restoration, and minimally invasive arthroscopic techniques.  Dr. Botti is also the founder of the nonprofit organization, Flagstaff Sports Institute, which supports young local athletes with injury prevention and sports performance enhancement.

 

Dr. Botti offers a knee specialty clinic on the second Thursday of each month.  To learn more about our specialty clinics or to schedule an appointment, please call (928) 773-2280.