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"New navigation endoprosthetic knee replacement technique has been used for the first time in Varna, at UMHAT 'St. Marina'," said Prof. Dr. Dimitar Raykov, Head of the Clinic of Orthopaedics and Traumatology. This method, which uses a navigation endoprosthetic technique, is a novelty for Bulgaria. So far single operations have been performed in major hospitals in Sofia and Pleven. It is being used for the first time in Varna, and the ambition of the management of the Hospital and Medical University – Varna is this method to be introduced into practice.
The operation was performed on a pilot basis in two patients – a 59-year-old man and a 62-year-old woman by a team including Prof. Dimitar Raykov, Dr. Stoyan Ivanov, Dr. Preslav Penev and Dr. Svetoslav Dobrilov, while the recovery of the patients was carried out by a team headed by Prof. Gergana Nenova.
"Hip, knee and shoulder replacement is a traditional surgery at the Clinic of Orthopaedics and Traumatology at UMHAT 'St. Marina'," said Prof. Raikov. "This is a tradition dating back many years. The joint replacement method itself is routine, it is performed at almost every major hospital in Bulgaria – municipal, state, university ones. The success of this type of surgery is already indisputable, and we have more and more patients who wish to improve their comfort of life and to forget about joint pain. This is an issue that modern medicine cannot provide a lasting solution to through painkillers. The joint replacement technique varies. The results published in our and foreign journals are quite different, and sometimes – contradictory. The most frequently replaced joint is the hip joint. It deteriorates the standard and comfort of living since the pain caused by it is intolerable. We perform knee replacement three – four times less often. This is probably so due to various reasons. It is assumed that knee pain caused by a worn joint is much more tolerable for the patient. And indeed, in life we can meet patients with serious knee distortions working in the garden, walking in the park, etc. To some extent, this is tolerated by their minds and their physics. Interesting statistics show that more and more patients worldwide wish to recover both their physical and sports activities, and in addition to hip joints, they also want to replace their knees. The results and satisfaction received by a patient whose hip joint has been replaced ranges between 80-90 %. This means that satisfied patients are almost all those who have undergone such a replacement.
On the other hand, the situation regarding knee replacement is not the same. As far as knee replacement is concerned, the frequency of replacements increases, but the results of the surgery technique, regardless of the level of competence of the team performing the operation, are far from being so high in terms of satisfaction. According to statistics worldwide between 30-40 % of patients who have had their knee replaced remain incompletely unsatisfied with the results, both in terms of joint mobility and pain. Therefore, this is a large percentage of dissatisfied patients. What are the reasons? They are different. They are both of a psychological neurological nature.
Anyway, the efforts in modern surgery are focused precisely in this direction - to eliminate as much as possible the probability of error, and the implantation of the new artificial for the body joint to be performed in such a way that it could replicate the physique of the body and the function of this limb.
The new direction in this regard is computerisation. We are all convinced of its role in our lives. In surgery, we have plenty of different systems, robots, or navigational (guiding) devices that help the surgeon to perform the intervention correctly. At our Clinic, this is a relatively new device that we, at University Hospital "St. Marina", are going to start using. It is a device that helps the surgeon to choose the right incisions – not so much on the skin as on the bone, which will ensure the best implantation of these elements of the artificial joint, which will restore the movements as much as possible. We believe that this is the future. We have plenty of information and knowledge in confirmation of the fact that the method of navigation endoprosthetic technique in the musculoskeletal system is becoming more and more popular around the world. This method is routine, and it is being used more and more in elite clinics – in the USA, in Central Europe. We know that we will succeed, and by mastering this technique we will achieve better results. My young colleagues, with whom I work in a team, are particularly enthusiastic about the opportunity to get this device and master it in application. I believe that the popularity of the Clinic of Orthopaedics and Traumatology will be enhanced, as well as the prestige of my assistants who are facing a successful career ahead of them. The role of the University Hospital and our obligation to train orthopaedic surgeons is also essential," added Prof. Raykov.
"I look forward to working with this new device," said Dr. Stoyan Ivanov, who is also a part of the surgery team. Precision is at a very high level. The risk of infectious complications, compared to the standard technique, is minimised. It is much more sparing for the patient in view of bone resections. Especially, regarding younger patients, this is a great advantage in case they need to undergo a new endoprosthesis over the time. Thanks to this device, the specific angles that we set can be seen in details. Will, good preparation and willingness to work are required in our profession," said Dr. Ivanov.
The doctor underlined that preventive examinations are essential in order to avoid or delay the need to use artificial joints in adulthood. Not only injury results in joint wear and tear, but lifestyle and hormonal problems, to a large extent, are a leading factor. "However, when the doctor gives advice on a prophylactic examination, it should be followed," said also Dr. Penev and Dr. Dobrilov – a part of the operating team as well.
"We are the next unit that takes care of the patients in their recovery," said Prof. Gergana Nenova, Head of the Department of Kinesitherapy at MU – Varna, who is a part of the team working on knee replacement applying the new technique. After the surgery, patients go through a period of recovery to resume their daily activities, to restore their work capacity in younger people, and even to start playing sports. They remain with us for a longer time, and we monitor their recovery. How the kinesitherapeutic protocol for restoring the functionality of the limb and the body will proceed depends on how the surgical intervention has been performed and what the implant is. Kinesitherapeutic programmes and their protocols correspond to the type of operational intervention. Our literature studies show that this precision in the new technique leads to faster, earlier outcomes in terms of functional recovery. The knee joint, in general, seems to be a simple joint, however, it turns out to be quite complicated. After conventional knee endoprosthesis, a large proportion of patients, especially among the elderly people, retain flexion contracture for a long time, which is a prerequisite for dissatisfaction with the surgical intervention performed. Despite the fact that it has been performed with precision. The new precision surgery would result in faster functional recovery of the volume of movement in the joint – both passive and active. This will lead to earlier ability of the patient to take care of himself, even without walking aids that would facilitate our work and will lead to earlier satisfaction of the patient," said Prof. Nenova.
Prof. Raykov emphasised that he has the support of the management of the Hospital and Medical University – Varna, the Clinic of Orthopaedics and Traumatology to become a centre where Bulgarian and foreign doctors will be trained to use this new method.
