Hot topics in joint replacement surgery

Dr. Kolisek uses the following methods to improve his patients' outcomes.

Package Pricing Program

Dr. Kolisek, along with OrthoIndy Hospital, has developed a package pricing program for primary hip and knee replacement, as well as partial knee replacement. This program offers a unique option of payment for international patients, for medical tourism patients, for those patients without insurance and for those who choose to seek care outside of traditional insurance programs. Dr. Kolisek offers a single price that covers preoperative testing, hospital care and postoperative follow-up care. Physician fees, implant costs, medicines and even necessary durable medical equipment are covered in this one price. Because we are a single-specialty hospital, Dr. Kolisek can offer world-class orthopedic services at very competitive rates. For more information, please contact Dr. Kolisek’s office directly at 317.884.5200.

Advanced Surgical Pain Movement

Always looking for ways to improve the postoperative experience and improve patient outcomes, Dr. Kolisek, in conjunction with our anesthesiologists, utilizes a “multimodal” pain management protocol for all knee and hip replacement patients. Most patients are able to walk in the hallway with minimal pain within hours of their surgery. This protocol begins with preoperative medications used to treat different pain pathways to help stop pain before it begins and utilizes regional nerve blocks specifically designed for a hip or knee replacement. A special pain-reducing cocktail is injected into your joint upon completion of the surgery. Medicines to limit post-operative nausea, vomiting and constipation are used after surgery. This protocol is helping patients feel better, go home sooner and have less pain after surgery.

Minimally Invasive Hip and Knee Replacement

There has been intense patient interest regarding “minimally invasive” joint replacement surgery, particularly surrounding different surgical approaches to the hip. Many claims about postoperative benefits of various techniques are made without sound clinical evidence to support those claims. Over the years, Dr. Kolisek has continued to reduce his incision length, operative time, and minimize soft tissue trauma, making these operations less invasive to the body. He currently utilizes a medial parapatellar approach for knees and has performed many hip surgical techniques including the traditional posterior approach, the two-incision approach, the direct anterior approach and presently the direct superior approach. The goal is always to hasten short-term recovery while maintaining long-term clinical success. The surgeon is more important than the technique used, because if it were the technique itself, then all surgeons would be using the same approach. Dr. Kolisek rarely takes more than 45 minutes to replace your hip or knee joint and with minimal blood loss. This is why his patients are able to go home in one to two days.

Computer and Robotic Assisted Orthopedic Surgical Navigation

Traditionally, orthopedic surgeons have used guides and jigs to help them position the knee and hip implants in the appropriate position during joint replacement surgery. Furthermore, the early failure of a total joint replacement and poor function can be the result of an improperly positioned knee and hip implant. The development of computer navigation and robotic-assisted surgery may help more accurately position the implant in the patient which could lead to better long-term function. Studies are currently being done to validate this assumption. Dr. Kolisek has used surgical navigation since 2004 and is currently on the clinical development panel of a major orthopedic company for robotic surgery. He continues to work on finding the best position for the prosthesis for each individual patient, otherwise known as patient-specific functional positioning.

Rapid Rehabilitation

All of Dr. Kolisek’s patients get out of bed the day of surgery in order to get them moving and decrease post-operative complications. For knees, Dr. Kolisek works on range of motion exercises first (SAFTE exercises, see handout) and then advance to strengthening exercises once functional motion is achieved and the pain and swelling are less at around four weeks. For hips, we work on the activities of daily living, allowing the bone to grow to the implant for the first few weeks and the soft tissues to heal. A strengthening program is then added at four weeks. Many patients are already active prior to starting the strengthening exercises at four weeks including walking, golfing and low impact exercise. Strengthening exercises are important to continue for two years after surgery. The goal is to first allow the soft tissues to heal and the bone to grow to the implant to stabilize it for long-term function and then increase your activities as you wish.

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