Excerpt from Philly Style Magazine (summer 2013)
Philly Physicians Move Medicine Forward
... While breakthroughs in cancer treatment continue to garner national attention, there is cutting-edge work being done elsewhere in the city that is impacting lives right now—such as a knee replacement procedure that has patients leaving the hospital the same day—or will in the near future, like a stem cell therapy to minimize and possibly restore vision loss. Although only a few people become the public faces of these advancements, there is always a small army working behind the scenes, sometimes for decades, to turn treatment dreams into reality for the millions of people who desperately need help...
Orthopedic surgeon Scott Schoifet, MD, of Virtua Health, the largest health provider in South Jersey, doesn’t expect thank-you letters. So he was surprised to get one from a patient who wrote, “This was a wonderful experience.” Says Dr. Schoifet, “A wonderful experience! I just cut them open and they’re telling me it’s a wonderful experience!” He has developed a technique for reducing the postoperative pain and recovery time from total knee replacement surgery. In the past, knee replacements usually meant significant pain and roughly six months of rehabilitation to restore strength and mobility. But Dr. Schoifet has performed some 4,000 total knee replacements, and afterward many patients have walked out of the hospital under their own power the same day.
The breakthrough? Not cutting the quadriceps, the tendon that attaches the knee to the large muscle group in the thigh. To replace the knee, the surgeon needs access to the whole joint, and previous approaches had cut the tendon to enable that. Afterward, the patient would need to rehabilitate not only the knee but also the tendon.
Dr. Schoifet knew that some surgeons were trying to develop a tendon-sparing surgery, so he observed a few procedures. “I watched and I thought, We can do this better.”
He developed new instruments for the surgery. Then, in late 2003, he operated on some patients without cutting the quadriceps tendon. “My very first patient I went to see was raising her leg in the air and bending without pain the day of surgery,” Dr. Schoifet reports. “Even though my early cases took twice as long, the patients got better twice as fast. There was no turning back from there.”
The new technique revolutionizes postoperative care, he says. “Ninety percent of our patients go home and not to a rehabilitation center after their surgery. While some patients are able to go home on the day of surgery, the majority spend, on average, one night in the Joint Replacement Institute recuperating and participating in physical therapy.”
Dr. Schoifet, who lives in Medford, New Jersey, with his wife and three sons, hopes his technique will be widely adopted. He acknowledges that it’s easier for a surgeon to cut the tendon, but the improved patient outcome and reduced hospital stay with his procedure should outweigh that consideration—and joint replacements are becoming more common as the population ages.
“When I was finishing my training, I loved joint replacement,” he says. “My fellow students wanted to work with younger patients. But I thought, There is going to be a lot of joint replacement needed, and it needs to be done well. I thought there was a lot of opportunity to try to improve it. And now I can get patients off the cane and back to sports and golf and exercise in six weeks.”