Why are so few surgeons doing MIPKR?

If this is such a great surgical technique, why aren’t all surgeons doing it? This is a question you must be asking yourself. The answer is a little complicated, but you may find it interesting. I will give you the short answer, and then go into more detail. 

The short answer: Surgeons have not learned to master the technique. It requires lots of freehand bone sculpting with high speed burrs that orthopedic surgeons aren’t used to using. 

The long answer:  This technique was first widely done and introduced by Dr. John Repicci, a dentist turned orthopedic surgeon from Buffalo, NY. He applied skills he had learned in dentistry to the knee. His work proved to be very successful and he developed quite a following of happy patients in Buffalo in the 1990’s. The Biomet corporation, maker of orthopedic implants, discovered his work and decided to work with Dr. Repicci to make more improved and durable implants for him, and then decided to let the rest of the world know about it.  Dr. Repicci travelled the world giving cadaver courses to audiences full of orthopedic surgeons wanting to duplicate his success. This is where I was introduced to the technique back in 1999.  Unfortunately it was not well taught, many surgeons had difficulty doing it, and others struggled to do it properly and had a few bad results causing them to give up on it. Biomet initially started working on tools to make it easier to do the procedure, but then abandoned that project in favor of another more invasive and more expensive style of partial knee called the Oxford. So in 2004, all efforts to promote this Repicci technique stopped, and for the last 15 years only the handful of orthopedic surgeons who mastered the technique have continued to use it. Any surgeon trained in the last 15 years probably has never even heard of it, and many surgeons who did them have retired. Meanwhile partial knees of other types have been done and many with decent success. These are called resection partial knees, they use thicker amounts of metal, are done with usually larger incisions, and look like half of a total knee. They are often difficult to revise (change to a total knee) and because of this only about 6% of knee replacements in America are partials of any type.

The future of partial knees and the Repicci technique (MIPKR)

 Many younger more recently trained surgeons are looking to robotics and computer assisted guidance systems to be able to do partial knee surgery. These are time consuming and expensive technologies. In my opinion it is not necessary, a longer operation invites more complications and we don’t need to look for more expensive ways to do things that can be done by hand. For goodness sakes, are not surgeons supposed to be skilled using their own hands?!

Because this procedure is so easy to recover from and removes so little bone, it is simple to revise to another partial knee or a primary, first time total knee. There simply is nothing else like it. Fortunately there are two other implant companies who make the same product that Repicci uses.I am presently working with one of these companies to make it easier and more reproducible to do. We plan to reintroduce this product, called the Freedom partial knee,to a whole new generation of orthopedic surgeons. My hope is that if surgeons realize how well it works and how easy it is for their patients, the percentage of partial knees done vs total knees will grow to 40 or fifty percent, which is where it should be.