IU Health Saxony seeks to improve knee replacement outcomes with new gait laboratory

Writer / Jon Shoulders

Dr. R. Michael Meneghini, director of orthopedics and joint replacement at IU Health Saxony Hospital in Fishers, says the completion of the hospital’s new Kinematics Gait Laboratory represents a substantial step in the right direction toward improving the quality and effectiveness of knee replacement surgery – not only for local patients, but also throughout the world.

“Kinematics is a fancy word for how the knee moves, and its normal and abnormal motions,” Meneghini says. “We’re going to watch people walk, and how their gait and their walking patterns change before and after knee replacements.”

Meneghini and his colleagues will observe patients’ pre- and postoperative movement in the lab via treadmill and leg sensors and gather data each step of the way with the goal of better approximating normal, natural gait after surgery through improved implants and surgical techniques.

“The working hypothesis is to look at the implant types, the alignment of the knee and the way we put the implants in, and see if we can change or modify those parameters of knee replacement to better suit the individual patient,” Meneghini explains. “If you and I were walking down the street we would have different gait patterns potentially, and we may need our knee replacements put in just a little bit different.”

Meneghini says knee replacement surgery remains one of the most successful procedures in medicine across the country according to registry studies, but 20 percent of patients nationwide are not completely satisfied with their knee replacement.

“The reasons for that, we think, are that the knee is a complicated joint,” he says. “It moves in a combination of rolling, sliding and translating patterns that is complicated due to the complexity of the ligaments and the bony anatomy. The reason we are undertaking this work is to try and take that 20 percent of patients who are unsatisfied and be leaders in the United States and even the world to minimize that amount.”

IU Health Saxony is currently in the final stages of obtaining institutional review board approval for the Gait Laboratory, which will allow lab physicians to enlist patients for participation and collect their data. Patients interested in contributing can expect to spend 15-20 minutes in the lab during their preoperative appointment and additional 15-20 minute sessions during one or two postoperative visits. Meneghini says it will likely take several years of data collection and analysis to yield significant research results.

“Our goal here is to correlate the preoperative kinematic patterns of patients to what we do with surgery, and then finally to ask patients how they feel about their knee replacement and correlate all those together,” he says. “This will be pioneering and innovative research and hopefully movement forward that we can then tell other orthopedic surgeons what we’ve learned and make things better for patients across the globe. We take a lot of pride in knowing that hopefully we’re one of the innovative entities that helps bring patients from all over the world to Fishers.”

Since opening its doors in 2011, IU Health Saxony’s staff has published in several medical journals on research areas like blood conservation in knee replacement, how surgical approaches affect patient outcomes and surgery complications. Meneghini says Saxony was third in the nation among all hospitals according to 2016 data for length-of-stay index, which refers to the time between patient admission and discharge.

“We publish at least every month or every other month in peer-reviewed journals because we do have a commitment to innovation here at Saxony and to help moving our profession forward,” he says. “We have visitors from all over the world come to Fishers to learn about how to do hip and knee replacement well, and that’s pretty exciting. We want to take great care of patients and we do, but we also have another mission, which is to make things better for future generations.”

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