Not much could keep Amy Frenz and Darrell Fields off the basketball court.
Both have officiated high school games for the Colorado Springs Basketball Officials Association for more than two decades . But when knee pain grew worse over time, they sought answers.
“I’m not fun anyways, but when I’m in pain ... well, I’m really not fun,” Fields said.
Fields, who officiates more than 50 games a season, reached his breaking point last year after trying pain medications and cortisone shots.
“My meniscus was shredded so I was pretty much bone on bone in my knee,” he said.
That’s when he reached out to Frenz, who two years earlier had undergone a specialized knee replacement with a custom-made implant designed from a 3D-printed mold.
Fields consulted with Dr. Ronald Royce, the Colorado Springs orthopedic surgeon who performed Frenz’s knee replacement, and decided to pursue the same procedure with a unique implant made by a company called Conformis.
“We design an implant based on a 3D image of a patient’s knee from a CT scan (which combines X-ray images from hip to knee to ankle),” said Scott Colby, territory manager for Conformis in the Springs and Pueblo. “Then we have a 3D mold, an image of the patient’s knee. It’s not so much the size, but more the shape of the knee that’s important.”
Conformis implants are designed to “mimic the distinct shape and curves of each patient’s knee, which creates an increased potential for a more natural-feeling knee,” the company says.
“It’s kind of like getting custom shoes made, getting a custom fit. When you get the shape right, it’s going to let the tissues move more naturally, more normally,” said Royce, who practices with Centura Orthopedics in Colorado Springs.
Royce trained with Drs. Tom Minas and Wolfgang Fitz, who designed the Conformis joints, at Boston’s Brigham and Women’s Hospital in 2004 as they were developing the idea, and again in 2014 to witness surgeries using the joints.
“I came back to Colorado Springs convinced that I wanted to do Conformis knee replacements,” he said. “They’re designed for the ‘young’ athletic knee, which is great for Colorado because we have so many athletes.”
The replacement proved successful for Fields. Now 10 months post-surgery, he’s back in the game with “no pain,” he said.
A quicker recovery
Knee replacements are common in the Springs. Royce performs about 100 each year, and was one of the first surgeons in the region to use custom 3D Conformis implants. He said he uses the specialized joints 90 percent of the time.
“It’s a tremendous technology advance. You’re involving the computer to help you do a better surgery,” he said.
Frenz and Fields agreed that recovery time was shorter for their knee replacements than previous surgeries to their respective ACL tears . Royce said that’s because the knee replacement involves a less invasive procedure, and patients have less blood loss with a Conformis knee replacement and can return to natural movement more quickly.
“We’ll soon be at 500 Conformis knees here in Colorado Springs,” he said, noting four partners in his practice also use the 3D implants. “I think people do better with this surgery than without it.”
It’s not for everyone, however. Patients who have metal allergies can’t get the Conformis, which contains some chrome alloy and nickel. And those who don’t want to wait the roughly six weeks it takes to prepare the replacement joint may go a different route, Royce said.
The game plan
After a CT scan is sent to Conformis in Boston, the company develops “a 3D ‘map’ of the patient’s diseased or damaged knee. Those maps are then sent to a 3D printer and exact wax replicas of their knees are printed. Metal components of each knee replacement are then formed around the replicas — ensuring the proper fit for each patient’s unique anatomy,” Penrose-St. Francis Health Services states in a release.
A few days before surgery, a rep such as Colby will hand-deliver a box to the operating room containing all of the Conformis pieces and will lay out those pieces in the order they’ll be used during the operation.
“The computer calculates exactly what we need to do. We have a game plan. All we have to do in the operating room is perform that plan,” Royce said.
During a knee replacement, the surgeon makes cuts in the bone and builds the artificial knee inside a patient’s leg one component at a time.
The new Conformis femur “fits just perfectly on the patient’s bone,” Royce said. There are markings and holes on it that “guide where I put my instrument and show where I put the pins in to receive the cutting block. The angle of where the saw goes is created by the computer.”
Royce said that unlike with standard knee replacement joints, he’s able to make small adjustments. “You can fine-tune it to the millimeter,” he said. “One millimeter can make a difference in the way a knee feels. This gives you all these options you wouldn’t have in a traditional setting. ”
It’s called “microbalancing,” Colby added.
By comparison, an “off-the-shelf” knee replacement comes in standard sizes that don’t account for high variations of shape, such as a larger, taller man or a petite female, Colby said. The metal of the standard implant can overhang the bone and rub on the surrounding tissue, causing pain.
The thinner Conformis implant, which fits the unique size of each patient’s femur and tibia, also allows for less bone and healthy tissue removal, he said. Better fit leads to less pain.
“Orthopedic surgeons are starting to get a lot of pressure to do more outpatient surgeries. I think this type of knee would do better in that situation. It will happen more as Medicare bundles patients,” Royce said.
The technology has advanced the standard of care, he said.
Frenz was 58 and very active when she got her Conformis knee replacement. She first injured her knee playing rugby as a teenager. Three knee surgeries to repair torn ligaments and meniscus in the intervening years were stop-gaps for the time when the former University of Northern Colorado basketball player would need a new knee to be able to keep up with the action on the court.
“It just got harder and harder. Every single step was painful. I couldn’t recover as quickly as I used to,” said Frenz, now 60. “It got to the point where I was having constant swelling and pain. It impacted everything I did. I had to take so many pills each day for the pain.”
Frenz knew she wanted to keep up her active lifestyle — officiating about 30 games per year — after surgery.
“I wanted to do a cruciate-retaining surgery, to keep one of my ligaments in place during the surgery, which requires less recovery time,” she said. “I found Conformis before I found Dr. Royce. I saw his name and that he specialized in it. You’ve got to really shop around.”
Now two years post-surgery, she says, “It was the best fit for me. Now I don’t have any repercussions after I do a game. I couldn’t be happier. I recently did three games in four days and I had no pain.”
She added, “It’s amazing that when you don’t have pain you’re so much more fun to be around.”
Contact the writer, 476-1602.