What are the latest technology and procedures for total joint replacement?


The keys to a successful total joint replacement are muscle-sparing surgical approaches, precision of implantation and customizing the surgery to fit the patient’s anatomy and activity level. What few people know is that Wilcox Medical Center on the island of Kaua‘i is the only hospital in the state to routinely use all the advanced technologies and surgical techniques described below. Typically, this level of care has only been seen at large, university-based medical centers.


For each total-joint patient, we perform preoperative planning from hip and knee X-rays using the computer-aided design program TraumaCad® to create a custom plan for every individual. In the operating room, we build every total joint to precisely fit each individual patient’s anatomy, using more than 2,000 implant combinations for total-hip replacements and more than 3,000 implant combinations for total-knee replacements.


Advanced Total Hip Replacement


Wilcox is a leader in the Direct Anterior Approach for total-hip replacement, a surgical approach that I have been doing and teaching for more than 10 years. This advanced approach allows me to perform the surgery without cutting any muscle, enabling faster patient recovery.


For precise implant insertion, I use live C-arm imaging combined with the digital Orthogrid©. This computer software has integrated artificial intelligence that learns the patient’s anatomical landmarks during surgery to ensure precise reconstruction of leg length and offset. As I am one of the developers of Orthogrid©, Wilcox is the only center in the nation currently using this digital device.


Total-Knee Replacement


The key to our knee replacement success is our muscle-sparing approach that enables faster patient recovery with less post-operative pain. We also offer a wide variety of treatment options for total-knee replacement:


• Partial-knee resurfacing of medial compartment, lateral compartment, or patella-femoral compartment. If only part of your knee is damaged, why replace what still works well? Partial-knee resurfacing patients can expect better range of motion and function and a return to higher-level activities than total-knee replacement patients.


Total-knee resurfacing, which enables patients to return to sports such as surfing and skiing. This is a type of total knee replacement that spares the ACL and the PCL for greater stability and range of motion. As a consultant in developing this implant and instrumentation, I am the only surgeon in Hawai‘i offering the total-knee resurfacing procedure.


For precise implantation insertion, we use diverse options to best suit a patient’s individualized needs:


Robotic-assisted surgery with Navio© for total-knee replacement/resurfacing and partial-knee replacement/resurfacing. The Navio® system enables us to create a dynamic, interactive model of your knee during surgery. We then use the robot to prepare the bone for the implantation with to within a half-millimeter (1/64 of an inch) of accuracy. We are the first center to have performed these surgeries in the state of Hawai‘i!


Custom patient instrumentation utilizing preoperative MRI and X-ray to create a 3-D model of each patient’s knee. Using computer-aided design to first perform the surgery virtually and a 3-D printer to create custom instruments, we then use these anatomically matched instruments during the actual operation to execute the surgical plan with utmost accuracy. We were the first center to implement this technology in the state of Hawai‘i more than five years ago.


Open-platform computer navigation utilizing intraoperative patient registration to restore anatomical alignment to within 1/10 of one degree. We were the first center to implement this technology in the state of Hawai‘i more than 10 years ago.


State-of-the-art durable, strong and safe materials


Modern patients demand durability for their high-level activities. Every total-hip and total-knee uses OXINIUM® combined with cross-linked polyethethylene for maximum durability. These materials have been shown to have the greatest longevity in the Australian National Registry and to last up to 30 years in simulator studies. Another benefit of these materials is that they contain only trace amounts of cobalt, chromium, or nickel and thereby avoid any issues with metal sensitivity.


As a result of offering these available advances, patients have been traveling to Kaua’i from O‘ahu, Big Island, Maui and the Mainland to get their total-joint replacements done here. We also serve as a visiting-surgeon program training site and have hosted surgeons from Japan, Hawai‘i, and the Mainland to train them in the use of advanced implants, surgical approaches and technologies.


By using all these technologies, we can speed patient recovery so that many patients can go home from total joint surgery the same day! Wilcox Medical Center has the lowest length of stay of any hospital in the state, with an average length of stay of 1.84 days and an extremely high level of patient satisfaction.


I feel blessed to be able to live on Kaua’i and continue to work with Smith Nephew Orthopaedics as a consultant, helping them integrate computers and robotics into total-joint replacement and to improve surgical precision. Our beautiful community hospital in an idyllic setting enables us to offer the best of both worlds for our patients—cutting-edge technology and personalized care.


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