New procedure may help patients with that knee-jerk reaction

john burton

The Hub

For those who have a knee injury or suffer from the debilitating effects of osteoarthritis of the knee, it can be a real pain in the, well, knee.

And for these sufferers for whom the most mundane of daily activities — standing, walking, driving, exercising — can induce the gamut of pain from irritating to excruciating, the only recourse was often a total knee replacement.

But thanks to a relatively new and innovative procedure being performed at Riverview Medical Center by Dr. Bernard Murphy, M.D., a Middletown-based orthopedic surgeon, knee replacements can be postponed indefinitely or avoided entirely.

Traditionally, knee replacement surgery was performed when all avenues of medical treatment were explored and exhausted and failed to correct the condition. Even though the problem may rest in only one small section of the knee, the only alternative left for the patient and surgeon was to replace the entire knee.

Knee replacement surgery is a highly effective procedure, according to Murphy, but one that is also "highly invasive," he said.

The procedure requires an 8-inch incision and the joint is then dislocated to expose the knee surface. About a half-inch of the knee bone is removed to allow room for the knee replacement. The surgery itself can take hours, and afterward the patient is usually hospitalized for eight to 10 days and can possibly require months of physical therapy.

    JEFF HUNTLEYWhen he’s not mending other parts of the body, Dr. Bernard Murphy, Middletown, is performing a new form of knee surgery that promises less pain and quicker recovery time. JEFF HUNTLEYWhen he’s not mending other parts of the body, Dr. Bernard Murphy, Middletown, is performing a new form of knee surgery that promises less pain and quicker recovery time.

But with the advent of this alternative procedure, unicondylar surgery, the end result is, Murphy says, a much quicker recovery time for the patient with a very high rate of success.

The way unicondylar surgery works is first the knee is examined with an arthroscope (a small device that allows the doctor to actually peer into the knee) to determine if the patient would be a good candidate. Then the surgeon makes a much smaller incision, about 3 inches, and uses a instrument called a burr (similar to a dentist’s drill) to treat the damaged compartment of the knee, removing about a quarter inch of bone, without disturbing the unaffected area.

"If you have one bad tooth you don’t pull out all the teeth" is the analogy Murphy used to explain the replacement method.

"This is like putting a cap on a tooth," he said.

The operation takes about an hour to an hour and a half, and patients are encouraged to walk shortly afterward, even in the recovery room. The hospital stay is dramatically reduced to overnight, so the patient can

be monitored and treated with antibiotics to prevent infection.

The need for physical therapy is also greatly reduced with only about a month or less needed. The patient could be driving in about two weeks, Murphy said.

Murphy was the first orthopedic surgeon in Monmouth County and one of the first in New Jersey to perform this procedure. In the last two years he has done this more than 50 times at Riverview with "excellent to good results." And said he could see a time in the very near future when it would be done on an outpatient basis, thus requiring no overnight stay in the hospital.

The procedure was first performed some 20 years ago by Dr. John Repicci, of Buffalo, N.Y., a former dentist and orthopedist, and is, according to Murphy, a "really revolutionary procedure."

Dennis Traynor, a former patient of Murphy’s who underwent the procedure in December 1998, wholeheartedly agrees.

The 58-year-old Middletown resident had torn his knee cartilage a couple of years prior. Though he had surgery to repair the cartilage, he said "it just got worse and worse."

"I was honestly crippled. I couldn’t walk; I couldn’t do anything. I was in constant pain," Traynor said.

But a short while after Murphy performed the procedure and with a minimum of rehabilitation, Traynor has retrieved his quality of life.

"To be honest with you, it’s worked out well, everything’s normal," contends Traynor. "I can play golf, I can walk and I can sleep comfortably at night."

Murphy asserts that this new procedure "will carry many people through their active years." Even if a patient needs knee replacement down the road, maybe as long as 10 years or more after unicondylar surgery, Murphy said the unicondylar procedure would not impede any future replacement.

"It doesn’t burn any bridges for us," he said.