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MONROE: Local orthopedic surgeon on cutting edge

By Nicole M. Wells, Special Writer
   MONROE — While orthopedic surgeon Dr. Donald Polakoff has been extending his patients’ range of motion for more than 20 years, a new development in his field is putting him on the cutting-edge of surgical medicine and offering patients the chance to possibly live pain free.
   For patients needing total knee replacement surgery, there is a new option available, designed to exactly reproduce the anatomy of the patient’s own knee.
   ”It’s an exciting development in knee replacement (surgery),” Dr. Polakoff said.
   Privately-held ConforMIS, Inc., a medical device company based in Massachusetts, was founded in 2004 to provide dramatic advancements in patient care through the use of imaging technology, according to the company’s website.
   The iTotal knee implant is a personalized, patient-specific product that is part of a comprehensive line of minimally traumatic implant solutions offered by the company.
   Dr. Polakoff is one of the few surgeons in New Jersey currently able to perform ConforMIS iTotal total knee replacement surgery at St. Peter’s University Hospital in New Brunswick, the only hospital in central New Jersey currently approved for this procedure.
   The first class of orthopedic surgeons trained by the company to perform total knee replacement surgery using the iTotal is very small, according to Dr. Polakoff. There are only a handful of surgeons scattered across the United States currently performing the procedure.
   According to Dr. Polakoff, the difference between the iTotal knee implant and other types of implants is that, while other implants may claim to be “patient-specific,” the iTotal actually is.
   ”It’s the implant that’s patient-specific,” Dr. Polakoff said.
   The instruments used in other knee replacement surgeries may be patient-specific but the implant itself is not. With the iTotal, everything from the instruments to the implant is personalized, according to the company’s website.
   Traditional standard knee implants come in a wide range of sizes, so while most patients are fitted with a close approximation of their size, the fit is not exact, according to Dr. Polakoff.
   The customized fit of the iTotal implant is created using the geometry of the individual patient, resulting in a fit that feels like the patient’s own joint, he said.
   ”It’s very bone and ligament preserving, the fit is precise, most early patient experience has been that it’s a more natural feeling knee and it promotes a quicker recovery,” Dr. Polakoff said.
   The estimated recovery time from the iTotal surgery is about six weeks, according to company literature.
   Once a patient’s doctor has decided they are a candidate for total knee replacement surgery using the ConforMIS iTotal implant, the doctor writes a prescription for a CT scan.
   The CT scan combines a series of x-ray views taken from multiple angles with computer processing to create cross-sectional images of the patient’s body, according to the Mayo Clinic.
   The scan is performed at an imaging center and a report is sent to the patient’s surgeon for evaluation.
   Based on the scan images, a computer generated 3-D virtual model of the patient’s knee is created.
   Using that model, the patient’s iTotal implant is then designed and manufactured to the patient’s specifications. The design and manufacture process takes seven weeks, according to company literature.
   ”For something that just got FDA approval a year ago, it’s really taken off,” Dr. Polakoff said.
   Monroe Township resident Harriet Rosen said the iTotal has helped her get back to her life, more or less pain free.
   ”I’m walking, I’m driving,” Ms. Rosen said. “I really don’t have pain.”
   Dr. Polakoff performed his first ConforMIS iTotal total knee replacement surgery on Ms. Rosen on June 26.
   Ms. Rosen gave up the walker she was initially using during her rehabilitation and now does two exercises at home to continue her recovery. She credits the custom design of the iTotal knee implant with cutting down her recovery time.
   ”This was made especially to fit my leg and I think because it was custom made I recuperated very, very quickly,” Ms. Rosen said.
   Diane Altman, of Monroe, had both knees replaced with iTotal implants on Aug. 7 and attributes any soreness now to her rehabilitation exercises.
   ”I’m just sore because I get therapy three times a week,” Ms. Altman said.
   Ms. Altman uses a cane when she’s outside but is able to get around without it inside her home. She has been a patient of Dr. Polakoff’s for five years and was initially being treated with joint injections until her knees became too painful.
   ”It stopped me from playing tennis,” Ms. Altman said. “I could not do the things I wanted to do.”
   Ms. Altman said she decided on iTotal implants because of Dr. Polakoff’s recommendation.
   It has now been more than six weeks since Ms. Altman’s surgery and although one knee is lagging behind the other in terms of progress and she is still on over the counter pain medications, she said she is recovering nicely.
   ”The knees are progressing very well,” Ms. Altman said.
   In addition to the benefit to the patient, the iTotal system delivers savings for hospitals as well, Dr. Polakoff said.
   Because the single-use instruments and custom implant arrive packaged as a disposable kit on the day of the patient’s surgery, there are opportunities for savings on inventory management, sterilization and operating room set up and turnover, he said.
   Dr. Polakoff is Harvard fellowship-trained and certified by the American Board of Orthopedic Surgery.
   He is affiliated with St. Peter’s University Hospital, Robert Wood Johnson University Hospital in New Brunswick and the University Medical Center of Princeton at Plainsboro.
   The ConforMIS iTotal CR Knee Replacement System won a silver award in the 2012 Medical Design Excellence Awards, and is scheduled for broad launch later this year, according to the company.