Not all knee repair procedures are created equal — just ask Dennis Florit.
The 63-year-old had his left knee replaced about four years ago. He said the recovery took six months, and he cannot kneel down on his left knee.
“When you’re talking about having a full knee replaced, you go through an emotional withdrawal,” he said. “You can’t even walk. You can’t even stand. You can’t take a shower.”
Then, two and a half years later, Florit’s right leg began to give him pain. He went in and learned he would be a candidate for the new MAKO technology that Central Carolina Hospital had started using.
Dr. Andrew Bush, an orthopedic surgeon at the hospital, recently completed the hospital’s 100th partial knee replacement surgery using MAKO Surgical Corporation’s Robotic Arm Interactive Orthopedic System.
“It was unbelievable,” Florit said. “I had the MAKO done, and I was up and walking around within two weeks. It’s still fine today.”
Florit said the best part about the MAKO surgery was that it allowed him to keep most of his knee. He can kneel down on his right knee to hug his granddaughters, something that would be impossible if he’d had total knee replacements on both knees.
MAKO surgeries, which replace only the parts of the knee affected by arthritis, are an evolving alternative to total knee replacements.
Bush said that often, when a patient has a knee problem that does not respond to physical therapy or any other standard treatments, the next option is usually a total knee replacement. It involves removing most everything inside the knee between the femur and the tibia, placing metal caps on the two bones and inserting a piece of plastic to act as a bearing between them.
“Knee replacements are fantastic surgeries,” Bush said. “But they are major surgeries. They can be very painful and they have a long recovery period. People tend to be happy with the replacement, but they know that it is not their knee.”
Bush said there are three parts of the knee: the front, the back and the joint between the femur and the kneecap. Arthritis often only affects one or two of these parts.
“The best way to think about your knee,” Bush said, “is as if it is a big room with three distinct cubicles. They work together, but are also independent of one another. If the only tool in your toolbox is total knee replacement, even if the arthritis is only in one part of the knee, the whole knee gets replaced.”
Since he began using the MAKO system in late February 2013, Bush has been able to go in and replace only the parts of the knee affected by arthritis. He said partial knee replacements have been around for more than 30 years, but that there is a problem with proper alignment when it was done by hand.
“In some ways, it’s the same as carpentry,” Bush said. “You have to make sure all the cuts are straight and parallel or perpendicular to the right axis. When you’re doing a partial by hand, you really don’t know if it’s in the right place until you get the X-ray, but then it’s too late. If you’re off by even three or four millimeters, that’s enough to give the patient a bad result.”
Bush said he has had patients come in who are unhappy with partial knee replacements, and that the only option left then is a total knee replacement. Due to the risks that came with the procedure, Bush had not performed a partial knee replacement since 1995, when he finished training at the University of Medicine and Dentistry of New Jersey.
“I had never done one in private practice,” Bush said. “The very first one I did was in late February 2013. That X-ray and my 100th X-ray look identical. There’s no difference.”
Bush said that with most surgeries, the surgeon notices an improvement over time. But he said the MAKO system removes room for human error, and that his first one was just as good as his 100th.
“It’s a fantastic system,” he said. “The pre-op planning is done meticulously on a computer. Then, the robot comes in, and what’s preplanned on the computer — that’s exactly what I cut. The robot does not let me go beyond the boundaries of what I planned. If I push a little too hard, the robot pushes back and beeps to warn me. And, if I keep going, the robot turns off. It won’t let me go more than half a millimeter beyond what I planned.”
Bush said he noticed the biggest difference when talking with patients who had had a total replacement on one knee and a partial replacement on the other.
MAKO, which was bought by Stryker Orthopedics in December, is already looking to apply its robotics technology to other surgeries, according to Bush.
“In the works is shoulder replacement,” he said. “And they’re working on spine surgery and oncology, which would use this technology to cut out tumors. We would use an MRI to find the edge of where tumor is, and the robot will remove concisely just the tumor. That’s just conceptual, but they are working on it. Robotics is the future. You’ve got to be crazy not to do this.”