Topics on This Page--Scroll Down for Each Topic Package Pricing Program
23 Hour (overnite stay) Total Knee Replacement
New Pain Management Techniques
Indiana Orthopaedic Hospital
Partial Knee Replacement
Minimally Invasive Joint Replacement
Computer Navigation for Joint Replacement
Package Pricing Program
Dr. Monesmith, working with the Indiana Orthopaedic Hospital (IOH), 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 our international patients, or those who choose to seek care outside of traditional insurance programs. We offer a single price that covers preoperative testing, hospital care, and postoperative follow-up care. Physicians fees, implant costs, medicines and even necessary durable medical equipment are covered in this one price. Because we are a single specialty hospital, we can offer these world class orthopaedic care services at very competitive rates. For more information, please contact Dr. Monesmith's office directly.
23 Hour (overnite stay) Total Knee Replacement
Since mid 2004, Dr. Monesmith has been performing total knee replacement at the Indiana Orthopaedic Surgery Center, an outpatient facility with 23 hour stay capabilities, located in our 5255 East Stop 11 Road building. In healthy patients, it is possible to have your total knee replacement in our state of the art surgery center and return home the next day to recuperate in the comfort of your own home. This is made possible by the use of a special catheter, attached to a pump containing pain medicine, that is placed in the femoral nerve sheath, located on the front of your thigh near the groin. This catheter delivers pain medicine directly to the nerve, providing pain relief while diminishing the risk of side effects often associated with other types of anesthesia, such as nausea, itching, urinary retention, and constipation. These catheters can stay in place for 3-5 days. In most cases, the need for oral pain medication is greatly reduced. A home nurse and physical therapist will come to your home for the first few days after surgery to help monitor your progress and assist you with exercise. Because these types of blocks both lessen the pain after surgery and temporarily weaken the leg, you will need to wear a simple brace when walking for the first few days after surgery. Our experience to date with over 60 total knees, has shown that this is a safe and more enjoyable experience for the patient.
New Surgical Pain Management Techniques for Knee and Hip Replacement
Always looking for ways to improve the postoperative experience and improve patient outcomes, Dr. Monesmith utilizes a "mulitmodal" pain management protocol for all knee and hip replacement patients. This protocol begins with preoperative medications taken 1-2 days prior to surgery to help stop pain before it begins. On the day of surgery, our talented team of anesthesiologists will use nerve blocks specifically designed for either a hip or knee replacement to keep you comfortable. Then, medicines to limit postoperative nausea and vomiting, and multi-modal pain medications are used to treat different pain pathways after surgery. Put together, this protocol is helping patients feel better and have less pain at the same time.
Indiana Orthopaedic Hospital
The Indiana Orthopaedic Hospital was recently named a 5-Star Joint Replacement Hospital by Healthgrades. The IOH, as we call it, is a true orthopaedic specialty hospital, devoted solely to the care of orthopaedic patients. Private rooms, state of the art operating rooms, electronic medical records, digital xray technology, dedicated orthopaedic nursing, and terrific food are just some of things that the Indiana Orthopaedic Hospital unique. Dr. Monesmith operates at both the IOH and The Indiana Orthopaedic Surgery Center.
Mobile Bearing Unicondylar Knee Replacement (UKR):
When only a single compartment of the knee joint is arthritic, it may not be necessary to have a complete total joint replacement. UKR can provide durable pain relief, can be performed in a MINIMALLY INVASIVE fashion, and allows the patient to go home from the surgery center or hospital the day after surgery. Mobile bearing partial knee replacement has an excellent long term track record, equivalent to total knee replacement in several studies. UKR involves replacing only the one compartment affected by arthritis, while leaving the remaining healthy areas of the knee alone. One of the more common indications for UKR is in the younger patient who has developed arthritis after having the meniscus surgically removed many years ago. The mobile bearing partial replacement can allow for a rapid recovery and quick return to activity in the appropriate patient. For more information on this procedure, you can link to www.oxfordknee.net.
Minimally Invasive Hip and Knee Replacement
There has been intense patient interest regarding "minimally invasive" joint replacement surgery recently, much of it media generated. While there is no universally agreed upon definition of what "minimally invasive" means, many surgeons claim to be using it! Both Dr.'s Monesmith and Kolisek have worked to reduce incision length and tissue trauma during joint replacement, making these operations less invasive to the body. The goal is to hasten short term recovery, while maintaining longevity and long term success of these operations. Studies are ongoing to determine whether these minimally invasive techniques produce better outcomes or are simply cosmetic.
Computer Assisted Orthopaedic Surgical Navigation
For years, orthopaedic surgeons have used guides and jigs to aid them in placing knee and hip implants in the appropriate position during a joint replacement operation. Furthermore, early failure of a total joint replacement can result from improperly positioned knee and hip implants during surgery. The recent development of computer navigation may help reduce this complication.
Navigation utilizes a PC based program that helps the surgeon make accurate decisions regarding alignment and orientation of joint replacement implants. New technology introduced in 2007 allows us to avoid placing additional pins in the bones outside the operative field and simply mount the device right on the joint surface. This surface mounted technology is now available and in use at the Indiana Orthopaedic Hospital by Dr. Monesmith.
Both Dr.'s Monesmith and Kolisek have been leaders in bringing this technology to use. In Indiana, Dr. Monesmith was the first to use it for a total knee replacement and Dr. Kolisek was the first to use it with a minimally invasive hip replacement. Both surgeons continue to refine its use to benefit patients who have joint replacement surgery. Alternative Bearings for Hip Replacement
Traditionally, the bearing surface for a total hip replacement consisted of a metal ball and polyethylene(plastic) cup. While this has worked extraordinarly well for many years, there is wear associated with this bearing couple, which can lead to loosening and ultimately failure of the hip replacement over many years. Because of this, the goal has been to develop bearing couples that have less wear.
Ceramic on ceramic bearings are one such development. Ceramic bearings are extraordinarily hard and have very low friction. Utilizing a ceramic ball on the femoral stem, and a ceramic liner in the socket, there is a dramatic reduction in the amount of wear created by a hip replacement. Hopefully, this will provide greater longevity and reduce the potential need for revision hip replacement in the future.
However, not everyone needs a ceramic hip. These are generally reserved for very young and highly active patients. Fortunately, the plastics used in hip replacement have been improved as well. Because of recent developments in technology, the plastics used in modern hip replacement have improved durability, and are nearly equal to hard bearings such as ceramic.
Overall, we believe that a well done total hip with an appropriate bearing should last 20-25 years.
