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The Ci System provides a digital model that serves

To see the difference perfect alignment can make in parts’ wear-and-tear, look no further than your car’s four wheels — or to the knees that Dr. Walter Shelton rebuilds.

With the introduction of computer navigation in his practice of total knee replacement at River Oaks Hospital in Flowood, the orthopedic surgeon has added three-dimensional joint mapping and visualization to his tools in the operating room. A study completed last year by a fellowship-program member at the Mississippi Sports Medicine and Orthopaedic Center showed significant improvement in alignment of knee components through computer navigation over methods used in the past, Shelton said.

“This allows your cuts to be perfect as far as perpendicular to the long axis of the leg,” Shelton said. “You can get them pretty close without it, but this gets them to within a tenth of a degree. That should increase the knee’s longevity because the wear is much less, just like when the wheels on your car are properly aligned.”

Shelton employs the Ci™ System from DePuy, a Johnson & Johnson company, in the operating room at River Oaks. Since introducing the technology about two years ago, he’s used it in more than 100 total-knee procedures and includes it in the majority of them these days.

The process adds about 12 minutes to each procedure with the extra step of mapping out the knee by adding markers for the computer to read.

“If you added 10 to 12 years to the life of that prosthesis, 12 minutes in the operating room is a small price to pay,” he said.

While some of the instruments Shelton uses in the operating room are the same as with the old method, he employs different cutting-alignment blocks. The instruments he places on the bone to guide the saw cuts are connected to the computer.

In orthopedics, the computer has arrived in the operating room for good, Shelton says.

“I think we’re going to take computerized navigation in surgery to the next level in the coming years,” he said. “It will get easier and more user-friendly, and we will wind up doing a lot of things with it.”

Also on the horizon is the development of biological implants — restoring tissues rather than replacing them. The team at Mississippi Sports Medicine is already doing some work in that area, using platelets as a source of growth factors for ACL repair.

“I think we will be regenerating ligaments, whereas today we’re reconstructing them,” he said. “In 15 to 20 years, they’ll look back and say, ‘I can’t believe you were doing things like that.’”

Staying on the cutting edge is important at the center, where the fellowship program is hosting four new members this year. The medical staff of 10 sub-specialized orthopedists works with the fellows to hone their skills through 800 to 1,000 procedures during the year. The center also recently opened a wet lab and auditorium for education and has begun hosting courses on new techniques for surgeons around the area. It hopes to host two or three such sessions each year.

Since he began his practice in orthopedics in 1980, Shelton has seen the arrival of landmark changes every decade — from total joint surgery in the 1980s, to arthroscopy in the 1990s, and computer navigation today.

For perspective, he thinks back to his training days during the 1970s at Campbell Clinic in Memphis, Tenn., under renowned surgeon Dr. Harold Boyd, who was in his seventies at the time.

“He had seen orthopedics come from the 1930s into the ‘60s and ‘70s,” Shelton said. “So we asked him that question, ‘What has been the major advance?’ His answer was, ‘The availability of excellent anesthesia.’”




October 2007

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