 Most of today's knee surgery evolved in the 1980's and has become quite routine; however, more technical improvements still abound. Dr. Lurate has been particularly interested in minimally invasive techniques of anterior cruciate ligament (ACL) reconstruction in athletes. Dr. Lurate has performed scores of such knee procedures on Navy and Marine personnel, during his military career, and on area athletes since arriving in Santa Rosa county. Occasionally, he still gets calls from new physical therapists who want to verify that the patient did indeed have an ACL reconstruction through the small incision they are seeing. For general information on ACL reconstruction, click here.
On the other hand, many knee conditions still require more formal incisions (although frequently even these can be minimized). Below are such cases that are well described by x-rays. For more information on total knee replacement, click here.
Case One
This is the case of a 53-year-old woman who had sustained a fracture to her knee in the early '70's. Prior to surgery she had progressive disabling knee pain, which substantially limited her lifestyle. The knee pain persisted despite extensive conservative, non-operative treatment. At this point, most such patients would be offered a total knee replacement (TKR) which would certainly be reasonable. Total knee replacement removes all the cartilage of the knee and replaces it with artificial surfaces. In most reports of "good-to-excellent" results, the typical range of motion is 0 -120 degrees.
 
However, Dr. Lurate gave her the option of a unicompartmental knee replacement (UKR). In this operation, only the abnormal section of the knee is replaced. While total knee replacement has become a rather routine operation in general orthopaedics, UKR remains a more technically demanding operation. The potential benefit is a much more natural-feeling knee with better range or motion when compared to TKR. Younger or more active patients in particular appear to benefit from a more natural-feeling knee. She elected to have the UKR that was performed in 1996. She obtained an outstanding result that included dramatic improvement in her knee pain with no loss or motion (range 0 - 145 degrees).Case Two
This is the case of a 20-year-old Marine with longstanding pain in his knee with sport activities. In addition to pain, he had experienced several episodes of dislocation of his patella (kneecap). In the "sunrise" preoperative x-ray on the left you can see how the patella is out of alignment with the "groove" (femoral sulcus). He had failed treatment with several precious physicians and extensive physical therapy. He was in jeopardy of being discharged from the Marine Corps. In an operation known as an anterio-medializaion (AMZ), this gentleman had his patella alignment corrected. The postoperative x-ray on the right shows the substantial improvement. He returned to full duty with an excellent result.
 
Case Three
This is a case of a 78-year-old woman who came to Dr. Lurate from Alabama. She presented with post-traumatic degenerative joint disease of her right knee causing both pain and deformity. This was in part due to broken knee (tibial plateau fracture) treated non-operatively elsewhere. The preoperative x-ray has you viewing her knee from the front. Note the severe angulation of her knee giving a dramatic "bowlegged" appearance. She was treated with a specially designed artificial knee using a "wedge" and "offset stem" to restore normal alignment and improve her knee mechanics. This resulted in a dramatic improvement in her gait and marked improvement in her pain. For general information on total knee replacement click here.
 
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