Oxford Knee Replacement

Harvey Black reminisces: “20 years ago, I tore cartilage in my knee playing tennis. I had arthroscopy and I was playing tennis again a few days later. It was great, but nobody told me it was just a long-term band-aid. It swelled constantly. I had to ice it and take anti-inflammatories. Eventually, I had to abandon tennis.”

“I was a teaching pro. That’s how I got through university. Tennis was part of my life. Giving up tennis was difficult. Now I might play again!”

Black says this last sentence exuberantly. Dr. James Rathbun, orthopaedic surgeon at The Scarborough Hospital (TSH), told Black he will recover from his upcoming Oxford unicompartmental knee replacement in six weeks, not the six months it takes for a full knee replacement.

Rathbun, the doctor who brought this procedure to The Scarborough Hospital, where he performed North America’s first Oxford knee replacement, understands Black’s hopes. “I’ve had people with arthritic knees go back to activities like hockey and tennis pain-free,” he says. (please clarify that Rathbun performed North America’s first Oxford knee surgery at TSH)

“When I heard about the Oxford knee, I was impressed,” Rathbun continues. “I went to England, did the course and started doing Oxfords when I got back.” TSH staff now do more Oxford knee replacements than any other hospital in Canada.

Rathbun explains the procedure he’s done more than 500 times. “We add three pieces to one side of the knee joint. We fit a rounded convex alloy plate to the base of the femur (thighbone) and a flat plate to the top of the tibia (shinbone). Between the two, we insert a plastic mobile bearing to replace the worn meniscus. The top of the bearing is concave so it fits with the convex upper (femoral) plate. The whole assembly lets the bearing slide between the two plates.”

Rathbun pulls out a container full of broken metal and worn plastic to make a point.

“Unlike these broken prostheses, the Oxford pieces hardly wear over time,” Rathbun says, “since the bearing slides between the two bones, not just one. That’s a lot less friction on the bearing.”

The Oxford University designers of this procedure have refined it over time. Today’s patients get the Oxford Phase 3. Key upgrades include different sizes of plates and bearings for different-size knees. “We can put this into a gorilla or a minute little lady,” Rathbun says.

Rathbun lauds the whole operation, not just the pieces. “I can tell from X-rays whether a patient needs this procedure – I don’t need to do arthroscopy. It’s a one-hour operation, there’s a much smaller cut and we don’t move the kneecap out of the way. Patients wake up with less, if any, pain, they’re out of the hospital in half the time, and rehabilitation is much quicker.”

“The Brits have been putting these things in people for 15 to 20 years,” Rathbun says. “After long-term follow-up with 130 patients, they recorded a 98 per cent success rate.”

That’s music to Black’s ears. “I might just hit a few balls in Florida this fall!” Rathbun adds: “The vast majority of patients are very happy. They can walk normally again.”

(For pictures and further explanations, click here.)

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