With more than 30 years of orthopedic surgical experience, Dr. Kris Lewonowski has observed numerous new innovations in surgical techniques, but few have excited him as much as Aquamantys technology. This system revolutionizes surgeries such as total knee replacements.
Medtronic Technology
Developed just over five years ago by healthcare pioneers Medtronic, the Aquamantys system is designed to control blood loss during surgery. It works by transmitting a combination of radio frequency energy and saline through a wand-like device. When pressed to soft tissue and bone during surgery, the device stops bleeding.
This technique is quite different from other blood control techniques currently in use. Unlike electrocauterization, which chars the target area and surrounding tissue, Aquamantys cools the surrounding area, says Dr. Kris Lewonowski, an orthopedic surgeon who specializes in total joint reconstruction for the hip and knee. This technique, called bipolar sealing, results in significantly less tissue damage, which in turn reduces recovery time.
A bloodless surgical field is imperative during surgery. Excess bleeding reduces visibility and can lead to complications. The less blood a patient loses during surgery, the easier recovery is afterward. Many surgeons currently use tourniquets to avoid excess bleeding during knee surgeries, but this lower-tech solution comes with some problems.
Reducing Tourniquet Use
Tourniquets are used in a variety of surgical procedures and can be a good solution for blood control. They are generally performed by inflating a special cuff around the limb, which creates pressure on the surrounding area. The pressure greatly reduces or eliminates bleeding, allowing for a clear surgical field and minimal blood loss.
When used for a prolonged period of time, however, tourniquets can lead to troubling complications, notes Dr. Kris Lewonowski, who currently practices with the Galichia Medical Group in Wichita, KS.
“Blood clots, nerve damage, and even tourniquet palsy are just some of the potential side effects of prolonged tourniquet use,” Dr. Lewonowski says. “If we can avoid relying on tourniquets to control blood loss, patient outcome can be improved.”
Patients who bleed a lot during surgery often require blood transfusions. Transfusions are a common cause of increased hospital costs and longer patient stays in the hospital. A recent University of Pittsburgh Medical Center study of over 3,700 patients showed that hospital bills averaged $14,000 more for patients who had joint replacement surgery that included a blood transfusion than for patients who did not need a transfusion. This extra cost reflects the additional procedures and longer stays transfusion patients required.
Aquamantys And Knee Replacement
Using the Aquamantys system in knee replacement surgery greatly reduces tourniquet use and blood loss, and results in improved patient outcome. The Aquamantys bipolar sealing technique for knee replacement is as follows: tourniquet cuff is placed and inflated, then the Aquamantys device is used to stop bleeding, after which the tourniquet can be completely deflated. This drastically reduces tourniquet use and reduces the likelihood of bad outcomes related to prolonged tourniquet use.
A 2009 study published in The Bone And Joint Journal found a 64% reduction in blood transfusions in the group who received bipolar sealing with the Aquamantys system. Patients in the group also experienced a significantly lower mean decline in hemoglobin levels after surgery.
Moreover, a 2012 study comparing bipolar sealing to electrocautery found that total knee replacement patients who received bipolar sealing showed significantly lower knee drainage output and statistically higher hematocrit levels upon discharge. Presented at the American Academy of Orthopaedic Surgeons Annual Meeting, the study also found that transfusion rates were reduced from 10% to just 3%.
“I think Aquamantys is going to be the way of the future,” says Dr. Kris Lewonowski. “Making it more available will save people money and recovery time. You will get people out of the hospital faster, they don’t hurt, it’s truly an incredible procedure.”
This is why Dr. Lewonowski will be using this procedure for his patients. He says that reducing tourniquet use also leads to much less pain after surgery. This is part of what allows a patient to recover more quickly.
“They feel better after surgery,” Dr. Lewonowski says, “This makes it easier for them to get up and walk around sooner, which is a crucial part of the recovery process.” He says patients tend to be released to go home one to two days sooner with the Aquamantys technique, which not only reduces costs to them, it also reduces their chances of secondary hospital infections such an pneumonia and MRSA.
The technique is covered by health insurance. “I recommend this technique because it results in better patient outcome,” continues Dr. Lewonowski, “But it is wonderful that the technique is also popular with health insurances because it reduces costs to them. Everyone wins.”
Considering Surgery
When considering joint replacement surgeries such as total knee replacement, it is important that patients understand how the latest surgical innovations can help reduce recovery time, reduce potentially devastating complications, and improve their overall outcome. Dr. Kris Lewonowski emphasizes the importance of discussing all options with his patients and using his vast experience to help inform them of what methods will work best for their individual situations.
Jennifer Davidson contributed to this article.