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Bend doctor to teach knee surgery in China
Dr. Knute Buehler will train doctors in a digitally aided procedure he helped design
By Kayley Mendenhall / The Bulletin
Published: May 29. 2007 4:00AM PST
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Dr. Knute Buehler, a Bend orthopedic surgeon, uses a device to tell a computer navigation system where the parts of his patient's knee are located during a knee replacement surgery at St. Charles Medical Center-Bend last week.
Pete Erickson / The Bulletin
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Dr. Knute Buehler doesn't know exactly what to expect when he visits China next month.
But, the Bend orthopedic surgeon said, he's hoping he doesn't have to sing karaoke.
"Business is interesting there. It's done at night, over dinner," Buehler said. "There is a fair amount of alcohol and karaoke."
During his 12-day trip, Buehler said, he'll be lecturing about a system he helped develop to incorporate computer-aided navigation in knee replacement surgery. He'll also be operating at several Chinese hospitals, teaching surgeons there to use the device he has a patent pending on, known as the MIS Navigation Block, that makes knee replacements less invasive, more accurate and longer lasting.
The goal of the trip for Stryker Corp., a medical device company for which Buehler is a consultant, is to expand the use of its knee navigation system throughout mainland Asia, Buehler said. He admitted to having a financial stake in the game as well, but said he has other interests in mind.
"I also want to improve the level of care in China," Buehler said. "I want to teach good techniques of doing surgery."
This trip will be Buehler's third to China in two years, but it will be his first chance to operate there and he's not certain what the hospital facilities will be like.
"It's a 3,000-year-old culture. You can learn a lot being around them," Buehler said. "One of the big things it means for here is not only do I teach, but I learn from all the people I come into contact with."
It's that sharing of information that makes the trip appealing to Mark Fairbanks, CEO of The Center: Orthopedic & Neurosurgical Care & Research, where Buehler works in Bend.
"It's an opportunity to knowledge share that goes both ways," Fairbanks said. "It's an opportunity to build great relationships with peers on the other side of the ocean. The world is getting smaller all the time."
The technology
Up until about five years ago, orthopedic surgery hadn't changed much since the 1970s, Buehler said.
Saws, drills and metal rods comprised the physician's arsenal of tools for knee replacements. The rods were hammered into the femur and the tibia to give the physician an idea of where the replacement device should go.
But that estimate wasn't always all that accurate.
"I wasn't 100 percent happy being accurate 90 percent of the time when you are talking about someone's knee," Buehler said. "I was frustrated by the lack of an ability to innovate."
Orthopedic surgeons, he said, were becoming dinosaurs in an increasingly digital world.
He came up with the idea for what he calls the "jig" that is the starting point for the Stryker knee navigation system. Pins are inserted into the tibia and femur and tracking devices that send infrared signals to a computer are attached to those anchor points.
"Those are the reference points," Buehler said. "They are locked into place so the computer always knows where the patient's leg is in space."
Once the knee is exposed, Buehler uses a metal pointer attached to another tracker to tell the computer where the parts of the joint are located. The computer turns those signals into digital data and the result is an image of the patient's knee on a screen.
When Buehler goes to make cuts, the computer tells him if he's in the right place. And when it's time to fit the replacement joint, made of highly engineered plastic and cobalt chrome, he knows if the alignment is off by even a fraction of a degree.
Working on the knee replacement of a 49-year-old woman with severe osteoarthritis last week, Buehler fitted a test knee replacement part to his cut and the computer said it was off on one side by two degrees. He noticed some soft tissue beneath the device causing it to fit incorrectly.
"Before we'd have no clue," he said. "We would never know if we were (aligned incorrectly) with the old instruments."
If a knee replacement is aligned incorrectly, Buehler said, it will wear out more quickly. If a knee replacement surgery is done well - a procedure that costs about $30,000 - the replacement will usually last between 15 and 20 years.
Buehler and his colleagues in Bend have been using the computer navigation system for about four years at St. Charles Medical Center-Bend. He has completed 1,200 knee replacements with the system. Nationwide, he said, 15 percent to 20 percent of knee replacement surgeries are being done with the navigation system.
"This particular computer-assisted navigation for knee replacement, was developed right here in Bend," Fairbanks said. "It's groundbreaking technology for people with knee trouble."
Spreading the word
On one of his last stops during the China trip, Buehler will lecture and operate at Peking University.
It's there, he said, that he has to impress an older surgeon who is considered the godfather of knee replacement surgeries in China. Because the medical system is hierarchical, where younger surgeons follow the lead of the older, more respected physicians, Buehler said convincing the Peking surgeon of the system's merits is key.
"I don't know what it will be like operating in Chinese hospitals," he said.
Buehler is interested in learning more about how the Chinese health care system works while he's there and said he'll be traveling with a guide and translator the entire time.
All of his lectures will be transcribed into Mandarin and projected on a screen behind him while he speaks.
"China is striving in every aspect of society to come up to Western standards," Buehler said. "A few Chinese surgeons in the past few months have started using the computer system, but they haven't really been trained."
Buehler will give them a hands-on demonstration and will then watch the surgeons perform a few knee replacements on their own. His schedule is packed for the less than two-week trip, but Buehler said he doesn't like to take too much time away from his practice in Central Oregon to do training in other places.
In the United States he is involved in training surgeons to use the device several times a year and, he said, he's hoping to arrange a trip to India in the near future.
"I hope to go to India toward the end of the year, but the market is not quite as developed there," Buehler said, explaining through his work with Stryker he's collaborated with physicians and software engineers from across the globe. "I like to say it's a test case in the world being flat."
Kayley Mendenhall can be reached at 383-0375 or at kmendenhall@bendbulletin.com.
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