When faced with a total joint knee replacement did you know there is an out-patient option right here in Thurston County? At Washington Orthopaedic Center, Dr. Keith Birchard uses the newest technology and equipment with the most current techniques in orthopedic surgery at the Ambulatory Surgery Center.

Washington Orthopaedic Dr Birchard WA Ortho Sign
Dr. Birchard grew up in orthopedics. His father was one of the original doctors in the practice, Dr. Carl Birchard and his mother Dee an orthopedic nurse. It was always a topic of conversation at home,” says Dr. Birchard. “I really enjoyed using my hand and tools and fixing things.” Photo credit: Krysta Carper

“In any knee replacement, it’s all about measuring, cutting and rebuilding the knee so that it’s as close to normal as possible,” says Dr. Birchard. “We can never make the knee completely normal because it’s an artificial knee but if we can get the alignment and the stability back to normal then patients should have a good outcome with relief from their pain and good function.”

The process the surgery typically involves a series of measurements. “One of the first things we have to do is drill a hole into the femur and stick a long rod into the bone which gives us access and we start to make a series of cuts after that,” says Dr. Birchard. “It’s fairly invasive.”

In the ambulatory outpatient surgery center setting, Dr. Birchard can also do the procedure in a less invasive fashion. This is so the patient has less pain and hopefully a little easier recovery, while still maintaining the accuracy of the measurements.

One option Washington Orthopaedic has is what Dr. Birchard calls a pre-navigation system. This allows them to create 3D printed models of the patient’s knee. Those models are then used to create the initial cutting blocks for the surgery.

Washington Orthopaedic Knee replacement with Dr Birchard WA Ortho
Starting at Washington Orthopaedic Center in college, Dr. Birchard first worked for a couple summers as a cast technician. “I really enjoyed that,” he says. “I also had the chance to spend some time in surgery. That really solidified my interest to be a surgeon.” Photo credit: Krysta Carper

At the time of surgery, the blocks fit to the patient’s bone perfectly, and small pins are used to stabilize them while the cuts are made. “I don’t have to drill a big hole in the femur to put the guide rod in,” says Dr. Birchard. “The blocks just slide on there where they need to be based on the patient’s own anatomy.”

The surgery requires some additional imaging after the X-rays used to diagnose knee arthritis. An MRI scan is done that is specifically designed to capture the data needed of the patient’s anatomy and alignment currently. They also use a long leg X-ray in order to set the overall leg alignment.

All that data is uploaded into a computer system from which the surgical plan is created. “It’s almost like virtual surgery,” Dr. Birchard says. “We make the cuts we want to make; we can size it to what it needs to be for that patient and once it’s all done, the patient-specific 3D models are created showing us exactly where to make that cut.”

The less invasive knee joint replacement option is one that Washington Orthopaedic has offered for the last year. “It’s pretty exciting,” Dr. Birchard says. “It is certainly an available option, that I think works really nicely in the outpatient setting.”

Washington Orthopaedic Dr Birchard
Joint replacement surgery has a significant impact on patient’s lives. Many of the patients Dr. Birchard sees are in the 50-60 age range. They are often people who will go back to work so the doctors at Washington Orthopaedic want to help get them recovered and back to work as quickly as possible. Photo credit: Krysta Carper

“It allows us to do the knee replacement surgery with the same precision but with smaller incision and a little bit less invasiveness in terms of the drilling and measurement we must do,” says Dr. Birchard. “It’s reflected in the recovery and a little less pain after surgery which is ideal in an ambulatory surgery setting.”

Recovering from any knee replacement, the first three months after surgery are the most critical. During that time, patients go through the initial healing phase and then six to eight weeks of physical therapy, gradually building up their strength. “By two to three months, patients are back to their regular activities, but I always tell people up to a year to completely recover to really get their strength and range of motion back,” says Dr. Birchard. “Most of that comes in the first three months.”

“Patients come to us because they are having pain,” he says. “We need to figure out why they are having pain and is there something we can do to help them out. The reason we do that is to improve their quality of life and have them continue to participate in their normal activities as much as possible.”

Washington Orthopaedic Sugery Center
While not every patient elects for an outpatient surgery, Dr. Birchard approaches each person as an individual and listens to his patients. Photo credit: Krysta Carper

Joint replacement is the last step in that process. The doctors at Washington Orthopaedic Center try to use the easiest, least expensive and least invasive and risky procedure first if it achieves the same goal of improving the patient’s quality of life. “We start with physical therapy, medication and injections but eventually those things aren’t as successful and we need to do something big like a knee replacement,” says Dr. Birchard.

“We care about our patients,” he says. “We want to help them improve their quality of life and give them a variety of options and choices in their treatment. If we can resolve the problem without surgery that is fantastic as well. Whether it is surgery or non-surgical treatment, we support them in those choices. I see my role as the surgeon to make the correct diagnosis, lay out the treatment options and facilitate as they move through those options.”

Washington Orthopaedic Center
704 Lilly Rd SE, Olympia


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