Robotic Knee Replacement
Please also refer to our MAKOplasty page.
Total joint replacement has evolved over the last 40 years. Initially, the focus of much research and dedication was the biomechanics of the knee and hip as well as the best materials to use in joint replacements. Once those aspects were elucidated, increased focus was placed on how the implants were fixed to the bone. Then, surgical techniques were refined to help decrease the size of skin incisions, and to decrease the rehabilitation times that patients had to endure.
The next frontier in total joint replacement is robotically-guided joint replacement. We have paired with Mako Surgical Corporation to start performing robotic
unicompartmental knee replacement in Los Angeles. By combining CT-based imaging, state-of-the-art computer analysis, and robotic precision
Uni-compartmental knee replacement is reserved for patients who have osteoarthritis of the knee that involves either the lateral or medial compartment of the knee. There must not be an inflammatory element to the arthritis (for example, rheumatoid arthritis patients are not candidates for this surgery). The patient must have near full extension of the knee and over 90 degrees of flexion (ie. bending). The ligamentous structures of the knee must be intact and functioning with rare exception. The pain pattern the patient exhibits must be focal, meaning that the pain the patient has must be localized over the damaged compartment of the knee. The "entire" knee should not be painful. Also, there should be no significant angular deformity, meaning that the patient should not be significantly "bow-legged" or "knock-kneed". If these requirements are met, in general, a patient can expect a successful surgery with moderate rehabilitation needs and decreased pain in comparison to total knee replacement.
Once you have been identified for a Makoplasty, the pre-operative process is basically same as it is for total knee or hip patients. The patient will discuss surgical times with the surgical schedulers, attend the pre-operative class, and be pre-operatively cleared for surgery by our Pulmonary/Critical Care specialist collegues. The only additional test to be done that must be done prior to surgery is a specialized CT-scan of the knee in question. This must be done at Good Samaritan Hospital in Los Angeles because the CT-scanner is specially configured to work in concert with the Mako Surgical robot software. Once the CT-scan is complete, the CT scan will be "up-loaded" into the Mako computer, and I will personally plan your up and coming surgery on the computer, aligning the components and planning the bone resections prior to surgery.
In the operating room, you will receive outstanding anesthesia, and we will then prep the affected knee and leg for surgery. There will an approximately 3-5 inch incision over the knee, and two small incisions in the middle leg, and two small incisions in the lower thigh. The small incisions are for robotic trackers that will be affixed to the tibia and femur respectively to help the computer to "visualize" your knee in space. After the surgery is started, the anatomy of the knee is registered into the computer. At that point, the robot arm engages your knee, and I guide the arm to precisely remove the amount of bone needed in order to place the components of the partial knee replacement exactly were they need to be placed as dictated by the pre-operative planning. The parts are cemented into place with a bone cement in the standard fashion.
Post-operatively, you will be seen by our committed team of physical therapists who will instruct you on your rehabilitation program that will start the same day of surgery. We expect that due to the smaller incisions, and the precise nature of this surgery that many patients may want to and are allowed to go home the same day of surgery. This will be discussed and implemented on a case by case basis.