Over fifteen million Americans suffer from osteoarthritis of the knee.
In fact, our American Academy of Orthopedic surgeons has indicated that it's one of the
leading causes of disability world-wide.
The reason that people develop osteoarthritis of the knee is multifold.
Probably the most critical factor is family history.
One of the other factors could be lifestyle and activities.
A lot of people that are, enjoy active lifestyles may have a propensity to develop arthritis
in their knee joint, particularly if they have had prior injuries.
Partial knee replacement has been out for a long time, so the topic that we're discussing
is not anything that is new, it's just this treatment option is more revolutionary or
forward thinking in terms of the technology that we're using, and that's MAKOplasty.
MAKOplasty is robotic-assisted partial knee replacement surgery that utilizes a robotic
arm in conjunction with a surgeon interactive technology to accomplish partial knee replacements.
One of the great features of this is that we can use smaller incisions and less soft
tissue damage, in order to facilitate a quicker recovery and quicker return to recreational
activities and work even.
The difference is, with partial knee replacement surgery, we can selectively replace one or
more of the different compartments inside the knee joint.
So, one of the ones I see most typically is a medial partial knee replacement, where just
this compartment is replaced.
It's also possible to just replace, underneath the kneecap, this articulation, vis-à-vis
a patellofemoral arthroplasty, or, the lateral compartment, which is the outside here.
That's unique from total knee replacement, which replaces all three compartments, and
one of the biggest features about that is that with partial knee replacement surgery,
is you can retain the cruciate ligaments.
So in total knee replacement, at least most of the time, the anterior cruciate ligament
is always removed or sacrificed, in addition to which the posterior cruciate, which is
another supporting structure of the knee, is removed as well.
One of the main benefits of MAKOplasty or partial knee replacement surgery is those
main ligaments are preserved.
What our hope is that by preserving the ligaments, and less soft tissue damage, less soft tissue
exposure, less boney resections, is that the outcome will be a knee replacement, a partial
knee replacement that feels more like a natural knee.
When a patient arrives for surgery, they are greeted at the patient intake area and they
are brought into the staging area where they are prepared for surgery.
Each one of these rooms is individual, and it is there that you will greet your anesthesiologist,
your circulating nurse in the O.R., and your surgeon.
The average time of surgery is about an hour and a half to two hours.
The goal is, if at all possible, the patient will have physical therapy the same day of
surgery at least once if not twice, and then once or twice again the following day before
being discharged home.
The average person is able to return to work within a short, relatively short period of
time, I would average between two to four weeks.
I would say ninety percent of people are back to work by about the four week period after
partial knee replacement.
So the way this happens is for patients that are candidates for partial knee replacement
surgery, part of their preoperative work up is that we refer them for a CT scan, and that
CT scan actually catches imaging involving the femoral head, the knee, and the ankle
joint.
So this technology actually allows us to create a three dimensional model on a computer, and
then figure out the sizing, the orientation, and position of placement for the implants
to try to insure as good of result as possible.
One of the key features about this technology is that it uses this new science called haptics,
which is the ability to use sensation or touch to form a boundary.
And what this means is that the cuts are defined in a set boundary of allowable space.
So the burr on the tip of the robotic arm can only cut where it's supposed to.
If you reach the edge of the boundary, it will stop.
One of the ways I think that this technology has enhanced my practice and ability to take
care of patients is again, to reproducibly get excellent or precise results, to be able
to position the implants where I want them, with a high degree of certainty, on a reproducible
basis.
So, this is the MAKO robot, as I said, it weighs over one thousand pounds, and this
is the robotic arm which has very fluid movement as you can see, it's controlled or anchored
to the robot.
At the end of it is the six millimeter burr, and this burr is what we do all the cutting
with.
We position it adjacent to the table where the patient is on, and we use information
about the robot’s locations and the arm location.
Now the way this information is conveyed, is through these arrays which are attached
to the robot.
This appendage has these arrays which beam information to the infrared camera.
We attach to the patient, two sets of arrays as well, using pins.
In this fashion, we are able to send information that's fixed to the patient up to the infrared
camera which then inputs it into the computer, and that way we are able to know where the
leg is and where the knee is in three dimensions in space as well as the robot to know where
the knee is in three dimensions is space.
I have these specialized probes which I use during the surgery, and these probes have
a very defined tip and they also have arrays attached to the probe, which is allowed for
me to beam information from here to the infrared camera which is then put into the computer.
All this data is compiled in the computer, so it gives me real time feed in three different
dimensions about where the knee is in space and where I'm going to position the implants.
So in depth, angles, all that that can be confirmed real time, right here in surgery,
using this instrumentation.