The process of undergoing both full and partial knee replacements has improved in recent years due to surgical improvements and reduced hospital stays thanks to the efforts of a couple of orthopedic physicians and practices across Spokane.

Full and partial knee replacements here and nationally are the most common joint replacements performed, says Dr. Timothy Lovell, an orthopedic surgeon for Spokane-based Providence Health Care. 

At least 1 million Americans will undergo either full or partial knee-replacement surgery this year, Lovell says, adding that approximately 90 percent of all replacements performed are full-knee replacements.

About 1,300 people underwent a full or partial knee replacement surgery last year at Providence hospitals, including Providence Sacred Heart Medical Center, Providence Holy Family Hospital, and Providence Mt. Carmel Hospital in Colville.

The average length of stay in the hospital following the surgery is two days, says Nicole Stewart, Providence Health Care’s community relations director.

Meanwhile, Dr. Jonathan Keeve of Spokane-based Northwest Orthopaedic Specialists says physicians there performed more than 100 knee replacements in the last year, with 10 percent of them requiring no hospital stay following surgery.

Physicians at both Providence Orthopedics & Sports Medicine and Northwest Orthopaedics say they’re continuing to work on surgical improvements while shortening hospital time for patients.

In November 2016, Providence Orthopedics began using robotic technology to conduct some full knee replacements, while Northwest Orthopedics, also in November, began treating full and partial knee replacement surgeries as outpatient surgery for some of its patients.

Lovell is one of two doctors among Providence Orthopedics’ 11 surgeons currently trained to use what’s called the Mako robotic arm. Lovell says in September, he also trained Dr. Michael Cody, of Northwest Orthopedics, to use the device.

“The biggest thing to me is that it markedly improves our accuracy and ability to perform the patient’s surgery,” Lovell says of the technology employed by Mako.

Prior to surgery, a CT scan of a patient’s knee is taken, that scan is then uploaded into a computer allowing the physicians to have a 3-D image of the knee.

Using the robotic arm, physician can perform as many virtual surgeries as necessary on the patient’s knee until it’s time do the real thing, Lovell says.

“It allows us to get the surgical plan just right because we have a patient-specific model of the knee,” Lovell says.

Providence Orthopedics purchased the Mako robotic arm in 2014 but used it mostly for partial knee replacements. Technology upgrades made to the robotic arm last year now allow physicians to conduct full knee replacements, Lovell says.

Kalamazoo, Mich.-based Stryker Corp. manufactures the Mako robotic arm. In the U.S., most of Stryker’s products are marketed directly to doctors, hospitals and other health care facilities. Internationally, Stryker sells products in more than 100 countries.

Lovell says he frequently travels with Stryker representatives, instructing physicians around the country on how to use the robotic arm.

Arthritis is the leading reason that most people need their knees replaced. A total knee replacement is an open surgery where the diseased or worn out knee joint is replaced with artificial material, Lovell says. 

As for Keeve at Northwest Orthopaedics, he says physicians there began treating certain patients on an outpatient basis if they’re healthy and have the support at home from people who can assist in their rehabilitation.

Northwest Orthopaedics has been operating for more than 60 years. Its largest operation is located on the fourth and fifth floors of the Spokane Integrated Medical Services Plaza, at 601 W. Fifth in downtown Spokane. Its medical clinic occupies the fourth floor and an ambulatory surgery center takes up the entire fifth floor. The two floors total 41,000 square feet.

Northwest Orthopaedic also operates a Spokane Valley clinic at 12410 E. Sinto and a North Spokane clinic at 212 E. Central.

Northwest Orthopaedic has 25 physicians and 10 physician assistants, and its three clinics have a total of more than 100 employees.

One of Keeve’s recent patients is Spokane Valley resident Lori Trimmer. Over the last four years, Lori and her husband, Dave Trimmer, have had a combined total of three knee replacements.

Dave had his right knee replaced four years ago and the left knee replaced two years ago. Keeve performed all three of the Trimmers’ surgeries.

Keeve performed Lori’s surgery on Oct. 9. By the end of that week, she’d already had two visits with her physical therapist.

The Trimmers say they’re walking examples of just how much better the process of having a knee replacement has become.

“Four years ago, I was given morphine for pain, and let me tell you, that sucked,” Dave says. “Two years ago, I didn’t have to have any (morphine), and now, here comes Lori, and it’s an outpatient surgery. I was in the hospital for four days after I had my first one replaced.”

Dave adds, “It’s amazing to me that she’s doing this fabulous.”

Keeve says Lori is the perfect example of someone qualified for outpatient knee surgery.

“She’s a cooperative patient and has a cooperative coach in Dave. She’s already healthy, and in him, she’s got someone who can help her with the administering of pain medication and rehab,” Keeve says. “It’s a great thing for the right patient.”

Patients suffering from diabetes, heart conditions, and other physical challenges that need to be monitored by hospital staff aren’t suitable candidates for outpatient knee surgery, Keeve says.

Less time in the hospital also brings down the cost of knee replacement surgery. An average knee replacement surgery and two-day hospital stay costs between $110,000 and $120,000. As outpatient surgery, a knee replacement costs $16,000, Keeve says. Medicare doesn’t cover the cost of knee replacements, and neither will some insurers, he says.

Keeve says less than 10 percent of all knee surgeries Northwest Orthopaedics performed are done on an outpatient basis, but he expects to see that percentage increase in future years. 

Lori’s physical therapist, Drew Mason, of Performance Physical Therapy at 12525 E. Mission in Spokane Valley, says patients also have more prep time with therapists and physicians before the actual surgery than in previous years. 

“Lori came in and saw me before she had the surgery. We had a prior discussion about how to use the walker, getting in and out of the car, how do you navigate the stairs… how are we going to get you successfully home so that you feel comfortable there,” Mason says.