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Custom Implants can Improve Healing for Knee-Replacement Patients, Especially Athletes

Victory comes in many forms. For Art Auwaerter, victory was being able to participate in an Olympic-style weightlifting competition after undergoing a double knee replacement 12 weeks earlier.

Mr. Auwaerter, 72, is one of the oldest, if not the oldest, competitive weightlifters in Florida. The recent local contest in Miramar was the first time he was able to compete since being sidelined about 18 months earlier by significant knee pain due to osteoarthritis.

Total knee replacement surgery changed that, although Mr. Auwaerter’s quick recovery and comeback impressed even his doctor, orthopedic surgeon Carlos Alvarado, M.D [1]., of Miami Orthopedics & Sports Medicine Institute [2].

(Watch now: The Baptist Health News Team hears from patient Art Auwaerter and orthopedic surgeon Carlos Alvarado, M.D [1]., of Miami Orthopedics & Sports Medicine Institute [2]. Video by Steve Pipho and Connor Pipho.)

“The typical patient does not go back to Olympic weightlifting, so that was unusual,” Dr. Alvarado said.

The majority of knee replacement patients do one knee at a time, since the first few weeks of recovery can be tough. But Mr. Auwaerter was determined to have both of his knees operated on at once. Because he was extremely fit and in excellent health, he was a good candidate for a bilateral procedure. “Doing a double knee replacement is not easy. It’s hard. But I am glad I did it that way,” Mr. Auwaerter said. “I got it over with.”

Mr. Auwaerter, an avid sailor, had been experiencing pain for a while from osteoarthritis, in which the cartilage that cushions the bones wears away. Known as the “wear and tear” type of arthritis that often comes with age, it allows the bones to rub against one another, causing pain and stiffness. “My knees got so bad I couldn’t do the things I wanted to do anymore. I had a problem getting around the deck of a boat. I had to stop weightlifting,” said Mr. Auwaerter. “At that point, I said I really have to do something about this.”

The deterioration of his knees was so advanced, Mr. Auwaerter said, the only option was surgery.

He began working almost immediately after his operation in hopes of participating in a local competition sanctioned by the Florida Weightlifting Federation [3] that would qualify him for the state championships in Orlando. He credits his recovery to the outstanding care he received at Miami Orthopedics & Sports Medicine Institute [2] before, during and after his surgery.

Important to his success were the custom prosthesis Dr. Alvarado used to replace his knees.

Using CT scans, Dr. Alvarado and his staff can create personalized implants that mimic an individual’s natural anatomy, following the original shape and curves of their bones. Algorithms convert the scans to a 3D model by mapping the contours of the joint and correcting areas damaged by disease. The model then becomes the basis of the new, made-to-fit joint that allows the surgeon to preserve as much as possible of the natural bone.

A knee replacement (also called knee arthroplasty [4]) might be more accurately termed a knee “resurfacing” because only the surface of the bones are actually replaced.

“We just take enough so we can remove the damaged part and replace it with a cap of surgical stainless steel over the damaged bone. In between the two bones we use a plastic insert that functions as the cartilage,” Dr. Alvarado explained.

Custom Implants Provide Faster Recovery
Since no two people are exactly alike, custom implants can provide quicker healing and better recovery over the more traditional off-the-shelf prosthesis for people who need a new knee — or two. There is less disruption of the tendons and ligaments, and the model assists the surgeon in planning the most effective approach and angle to replace the knee.

“We can restore it. We restore it by 3D printing an implant for each and every patient,” Dr. Alvarado said.  “We’ve done more of these than just about anyone in the country.”

Custom knee implants are not appropriate for every patient, especially if the knee has degenerated to a point where it can no longer provide a good scan of the person’s natural anatomy. However, for patients who require the greatest range of motion in order to return to an active lifestyle, they are often the best option. “The custom-made implants have more of a natural feel and potential for faster return to normal function,” Dr. Alvarado said.

Although his knees still felt a little stiff less than three months post-surgery, Mr. Auwaerter was able to lift almost 183 pounds to qualify for the state competition.  “He was awesome,” said Andres Forero, who organized the Jacked Classic competition in Miramar. “It was really inspiring. His whole body was impressive.”

Mr. Auwaerter, considered by the Florida Weightlifting Federation to be one of South Florida’s weightlifting pioneers, is excited to be back to the sport he loves. Because of that, he felt like a winner even before the Miramar competition began — the medal he earned for his age group was a bonus.

Although he is still building back his strength, he hopes to participate in national competitions in the future. “It feels good to be a part of this,” he said as he surveyed the crowded gym in Miramar. In the background, the regular boom of other competitors releasing their weights after their lifts was like music to his ears. “I’ll be weightlifting until I can’t do it anymore… I just don’t see that happening for a long time. Weightlifting builds up your body and keeps you strong,” he said. There are guys who do this into their 80s. I want to be one of those guys.”