Custom-built has a nice ring to it, particularly to someone who needs a total knee replacement.

Dr. Brinceton Phipps at Animas Orthopedic Associates is providing just that by using technology that produces implants designed to each patient’s anatomy.

Phipps uses a template, called a cutting block in the profession, that shows him exactly where and how much bone to resurface.

The cutting blocks and the implants that duplicate natural knee movements that Phipps uses are manufactured by Smith & Nephew, a London firm established in 1856 but which does day-to-day business from Memphis, Tenn. The technology was introduced to Durango by Mark Waller, owner of locally based Red Mountain Surgical.

The cutting blocks offer the potential of producing a better-fitting, smoother-functioning and longer-lasting joint, Phipps said in an interview last week. Longer lasting is of particular interest to younger patients, he said.

“Fifteen years ago, it was recommended that patients wait until age 65 for a knee replacement,” Phipps said. “A new knee was expected to last 10 to 12 years.

“But today people are living longer and are getting knee replacements at a younger and younger age,” Phipps said. “They refuse to give up their active lifestyles and sit on the couch.

“What are we going to tell them, ‘Wait 10 years and come back to see me?’”

Dr. Doug Bagge of Crossroads Orthopedics in Cortez has used cutting blocks for about a year. He likes the technology because it’s patient-specific.

“It saves time in the process,” Bagge said. “It eliminates some technical steps.”

Dr. Jennifer Forrest, also at Animas Orthopedic Associates, who has assisted Phipps in surgery, has embraced the approach to total knee replacement.

“It’s fantastic technology,” Forrest said. “Cutting blocks ensure that components are the exact size, rotation and fit.”

Forrest, who received her medical degree at Wayne State University and did her residency at the University of California Medical Center at Irvine, plans to use cutting blocks when she performs knee surgery.

The new knee-surgery process starts with MRI and X-ray images of the patient’s entire leg. Phipps sends the images to Smith & Nephew, where a computer generates an anatomical map of a patient’s knee that is used to manufacture custom cutting blocks and determine the precise location, depth and angle of required cuts.

With conventional measuring methods, typical femur cuts vary 5 to 7 degrees from the axis of the bone. If the true variation is greater or lesser, the joint may not be correctly aligned and may wear out prematurely.

The process doesn’t produce accurate results for patients who have metal in their knee from a previous surgery, Phipps said.

Phipps reviews the computer’s recommendations before cutting blocks – one for the femur, another for the tibia – are made. The cutting blocks, made of medical-grade nylon, have slots that accommodate the oscillating saw.

When the resurfacing is done, Phipps implants a cap of oxidized zirconium metal on the femur and a pad of a new polyethylene plastic on the tibia. The implants lock in place like a natural knee. The thigh bone component weighs 20 percent less than typical ones made of cobalt and chrome.

The Food and Drug Administration recently authorized Smith & Nephew to claim that tests of its replacement knee that simulated 30 years of use were valid.

Phipps said his procedure benefits patients in several ways.

b Precise bone cuts preserve natural bone, which allows more options in case of future knee surgery.

b The femur cap stops the bleeding associated with the traditional method of inserting a metal rod in the femur while taking initial measurements.

b Patients spend less time under anesthesia because the surgeon doesn‘t use precious time selecting the correct size of replacement parts in the operating room.

b A better-fitting knee provides more stability and flexibility.

Phipps went to medical school at the University of Texas in Houston and did his internship and residency at the University of California Medical Center at Irvine. He moved to Durango a year ago.

Experiments with cutting blocks started in 2006 on cadavers, Phipps said. FDA concerns about a first-generation template sent designers back to the drawing board. Three companies, including Smith & Nephew, then began to manufacture cutting blocks.

Phipps became interested in the templates at that time. He said he doesn’t like to be the first to try new technology but doesn’t want to be the last.

“Humans aren’t as accurate as the guy who made the original knee, but we strive to be as precise as possible,” Phipps said.

daler@durango herald.com