Big News for Bad Knees

MAKOplasty® Partial Knee Resurfacing is an innovative treatment option for adults living with early to midstage OA in either the medial (inner), patellofemoral (top), or both compartments of the knee. It is powered by the RIO® Robotic Arm Interactive Orthopedic System, which allows for consistently reproducible precision in performing partial knee resurfacing.

During the procedure, the diseased portion of the knee is resurfaced, sparing the patient's healthy bone and surrounding tissue. An implant is then secured in the joint to allow the knee to move smoothly again. MAKOplasty® Partial Knee Resurfacing can:

  • Facilitate optimal implant positioning to result in a more natural feeling knee following surgery
  • Result in a more rapid recovery and shorter hospital stay than traditional knee replacement surgery
  • Be performed on an outpatient basis
  • Promote rapid relief from pain and a quicker return to daily activities

MAKOplasty® Hip procedure

Similar to the MAKOplasty® knee procedure, the MAKOplasty® Hip procedure is performed using a highly advanced, surgeon-controlled robotic arm system. It can be a treatment option for people suffering with either non-inflammatory or inflammatory degenerative joint disease, and is designed to assist surgeons in attaining a new level of reproducible surgical precision in hip surgery.

The hip is a ball-and-socket joint consisting of the spherical head of the femur, or thighbone, which moves inside a cup-shaped hollow socket in the pelvis called the acetabulum. When cartilage in the hip wears down, bare bone is exposed. When bone-on-bone contact occurs within the joint it causes pain that can be felt in the groin, outside the hip, at the base of the spine, or radiating from the thigh to the knee. Hip implants reconstruct a bearing surface to replace lost cartilage and prevent painful bone-on-bone wear. Total hip replacement consists of removing diseased bone in the acetabulum, which is fit with a cup and liner, and replacing the femoral head with new head and stem components.

The goal of using robotic arm technology to perform hip replacement is to attain consistent precision in surgery. Accurate placement and alignment of implant components are a critical factor in hip replacement.

MAKOplasty Hip helps the surgeon place the implants in the desired location, providing a good, stable biomechanical reconstruction and acceptable leg length restoration. It is performed with the RIO® Robotic Arm Interactive Orthopedic System. RIO enables surgeons to use a 3-D anatomic reconstruction based on a CT scan of the patient's own hip to pre-surgically plan implant positioning. During the procedure, it provides real-time data for intra-operative adjustments to further enable surgeons to optimally align and position implants, and accurately reproduce the surgical plan.

The operation is performed by preparing the femur first. The surgeon removes the amount of bone required for the implant, and the femoral component's position is measured by RIO. Next the surgeon uses the robotic arm to accurately ream and shape the acetabulum to prepare it for cup placement. The RIO enables accuracy in controlling the depth of bone removal and determining the hip's center of rotation which aides in implant positioning and alignment.

When the bone preparation is complete, the surgeon uses the robotic arm to implant the cup, and the plastic liner is locked into the metal cup. The femoral stem is implanted and the correct ball size is attached to the stem to reconstruct leg length and soft tissue tension.

As total knee and hip arthroplasty procedures, MAKOplasty® is typically covered by Medicare.

Triangle Orthopaedic Associates has three physicians that are certified to perform procedures using the MAKOplasty assisted surgery technique.

Philip E. Clifford, M.D.
Brett J. Gilbert, M.D.
Ralph A. Liebelt, M.D.


MAKOplasty® Knee Surgery FAQs

 

Osteoarthritis (OA) is a form of arthritis and a degenerative joint disease characterized by the breakdown and eventual loss of joint cartilage. Cartilage is a protein substance that serves as a cushion between the bones of a joint. With OA, the top layer of cartilage breaks down and wears away, allowing bones under the cartilage to rub together.

Although the root cause of OA is unknown, the risk of developing symptomatic OA is influenced by multiple factors such as age, gender and inherited traits that can affect the shape and stability of your joints. Other factors can include:

  • A previous knee injury
  • Repetitive strain on the knee
  • Improper joint alignment
  • Being overweight
  • Exercise or sports-generated stress placed on the knee joints

Symptoms of OA of the knee include:

  • Pain while standing or walking short distances, climbing up or down stairs, or getting in and out of chairs
  • Knee pain with activity
  • Start up pain or stiffness when activities are initiated from a sitting position
  • Stiffness in your knee joint after getting out of bed
  • Swelling in one or more areas of the knee
  • A grating sensation or crunching feeling when you use your knee

Your physician will begin by reviewing your medical history and symptoms. He or she will observe the natural movement of your knee, evaluate your knee and ankle joint alignment, and check your reflexes, muscle strength, range of motion and ligament stability in the affected knee. Your physician may order x-rays to determine how much joint or bone damage has been done, how much cartilage has been lost and if there are bone spurs present. Additional medical imaging tests such as computed tomography (CT) or magnetic resonance imaging (MRI) may be ordered to determine the exact location and extent of the damage. Your physician may also order blood tests to rule out other causes of symptoms, or order a joint aspiration which involves drawing fluid from the joint through a needle and examining the fluid under a microscope.

Whether your OA is mild or severe, your physician will most likely recommend certain lifestyle changes to reduce stress on your knee joints. Additional disease and pain management strategies may include: physical therapy, steroid injections, over-the-counter pain medications such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) or topical pain relieving creams. Please speak with your physician if your symptoms do not respond to non-surgical solutions, or if your pain is no longer controlled by medication. You could be a candidate for surgery. The most common surgical knee intervention performed for OA is a total knee replacement. During this procedure, the natural joint is removed and replaced with an artificial implant. This treatment option is usually offered to patients with advanced osteoarthritis of the knee. Total knee replacement is not always optimal for patients with early to mid-stage osteoarthritis in just one or two compartments of the knee. For patients with partial OA of the knee, MAKOplasty Partial Knee Resurfacing may be the more appropriate solution.

MAKOplasty Partial Knee Resurfacing is an innovative treatment option for adults living with early to midstage OA in either the medial (inner), patellofemoral (top), or both compartments of the knee. It is powered by the RIO Robotic Arm Interactive Orthopedic System, which allows for consistently reproducible precision in performing partial knee resurfacing. During the procedure, the diseased portion of the knee is resurfaced, sparing the patient's healthy bone and surrounding tissue. An implant is then secured in the joint to allow the knee to move smoothly again. MAKOplasty Partial Knee Resurfacing can:

  • Facilitate optimal implant positioning to result in a more natural feeling knee following surgery
  • Result in a more rapid recovery and shorter hospital stay than traditional knee replacement surgery
  • Be performed on an outpatient basis
  • Promote rapid relief from pain and a quicker return to daily activities

The MAKOplasty Partial Knee Resurfacing procedure is designed to relieve the pain caused by joint degeneration and potentially offers the following benefits:

  • Improved surgical outcomes
  • Less implant wear and loosening
  • Joint resurfacing
  • Bone sparing
  • Smaller incision
  • Less scarring
  • Reduced blood loss
  • Minimal hospitalization
  • Rapid recovery

The RIO Robotic Arm Interactive Orthopedic System features three dimensional pre-surgical planning. During surgery, the RIO provides the surgeon with real-time visual, tactile and auditory feedback to facilitate optimal joint resurfacing and implant positioning. It is this optimal placement that can result in more natural knee motion following surgery.

Typically, MAKOplasty patients share the following characteristics:

  • Knee pain with activity, usually on the inner knee and/or under the knee cap
  • Start up knee pain or stiffness when activities are initiated from a sitting position
  • Failure to respond to non-surgical treatments or nonsteroidal anti-inflammatory medication

MAKOplasty can be performed as either an inpatient procedure or on an outpatient basis depending on what your orthopedic surgeon determines is right for you. Hospital stays average anywhere from one to three days; ambulatory patients return home the same day. In many cases, patients are permitted to walk soon after surgery, drive a car within two weeks and return to normal daily activities shortly thereafter.

All implants have a life expectancy that depends on several factors including the patient's weight, activity level, quality of bone stock and compliance with their physician's orders. Proper implant alignment and precise positioning during surgery are also very important actors that can improve the life expectancy of an implant. Through the use of RIO, implants can be optimally aligned and positioned to ensure the longest benefit. RESTORIS MCK implants enable the treatment of one or two compartments with OA disease. With single compartment disease, a second compartment may be treated in the future if OA spreads. In addition, because very little bone is actually removed during a MAKOplasty procedure, the implants can be replaced with another procedure such as a total knee replacement, if necessary.

 


MAKOplasty® Total Hip FAQs

 

MAKOplasty® Total Hip Arthroplasty (THA), is a procedure known as total hip replacement that is made more precise by utilizing the RIO® Robotic Arm Interactive Orthopedic System. It is indicated for patients who suffer from non-inflammatory or inflammatory degenerative joint disease. RIO® Robotic Arm Interactive Orthopedic System, allows surgeons to achieve a new level of precision with the newest techniques in hip replacement surgery.

A candidate for MAKOplasty® Total Hip Replacement may experience the following:

  • Pain while putting weight on the affected hip
  • Limping to lessen the weight-bearing pressure on the affected hip
  • Pain that may radiate to the groin, lower back, or down the thigh to the knee
  • Hip pain or stiffness during walking or other impact activities
  • Failure to respond to non-surgical treatments or nonsteroidal anti-inflammatory medication.

Only your surgeon can determine if you are a candidate for MAKOplasty® Total Hip Replacement.

Source: Centers for Disease Control (CDC). www.cdc.gov

This technology offers the potential for a higher level of patient–specific implant alignment and positioning to accurately reproduce the surgical plan, an aspect not consistently achieved in manual techniques.

Accurate alignment and positioning of hip implants are important factors affecting surgical outcomes and the lifespan of implants.

The robotic arm technology enables a new level of accuracy in implant alignment and positioning – that may mean restored mobility and a return to your active lifestyle.

Individual results may vary. There are risks associated with any hip surgical procedure, including MAKOplasty® Total Hip Replacement. Your doctor can explain these risks and help determine if MAKOplasty® Total Hip Replacement is right for you.

A typical hospital stay for a total hip replacement is determined by your MAKOplasty® surgeon. Your surgeon will also determine what physical therapy may be prescribed for you.

All implants have a life expectancy that depends on several factors, including the patient's weight, activity level, quality of bone, and compliance with his/her physician's orders. Proper implant alignment and accurate positioning during surgery are also very important factors that can improve the life expectancy of an implant. Through the use of the RIO® robotic arm system, implants may be more optimally aligned and positioned.

There are three surgeons at Triangle Orthopaedic Associates who perform MAKOplasty® Total Hip Replacement surgery. Dr. Phillip Clifford, Dr. Brett Gilbert and Dr. Ralph Liebelt are total joint surgeons who have experience with this type of procedure. Click on their photos at the bottom of this webpage to view their biographies.

MAKOplasty® Total Hip Replacement is typically covered by Medicare. Check with your private health insurance company to verify coverage.

 


About Degenerative Joint Disease

 

There are different types of DJD that may cause hip pain. These include but are not limited to:

  • Osteoarthritis (OA), also called "wear and tear arthritis", in which cartilage wears down over time1
  • Post-traumatic arthritis, which results from a severe fracture or dislocation of the hip1
  • Rheumatoid arthritis (RA), an inflammatory arthritis of the joints1
  • Avascular necrosis (AVN), a condition where the "ball" or femoral head has lost its healthy supply of blood flow causing the bone to die and the femoral head to become misshapen2
  • Hip dysplasia, a condition where bones around the hip did not form properly, which may cause misalignment of the hip joint3

The risk of developing symptomatic DJD is influenced by multiple factors such as age, gender, and inherited traits that can affect the shape and stability of your joints4. Other factors can include:

  • A previous hip injury
  • Repetitive strain on the hip
  • Improper joint alignment
  • Being overweight
  • Exercise or sports-generated stress placed on the hip joint

Source: American Association of Orthopedic Surgeons. www.aaos.org

  • Pain while standing or walking short distances, climbing up or down stairs, or getting in and out of chairs
  • Pain in the groin, thigh, or buttock area
  • The affected hip feeling stiff or tight due to a loss in its range of motion
  • Joint stiffness after getting out of bed
  • Any signs of limping and/or favoring the opposite leg as to not put any weight on the affected hip joint
  1. American Association of Orthopedic Surgeons. Total hip replacement. Retrieved September 20, 2011, from: http://orthoinfo.aaos.org/topic.cfm?topic=A00404
  2. American Association of Orthopedic Surgeons. Osteonecrosis of the hip. Retrieved September 20, 2011, from: http://orthoinfo.aaos.org/topic.cfm?topic=A00216
  3. American Association of Orthopedic Surgeons. Developmental Dislocation (Dysplasia) of the hip (ddh). Retrieved September 20, 2011, from: http://orthoinfo.aaos.org/topic.cfm?topic=A00347
  4. American Association of Orthopedic Surgeons. Osteoarthritis of the hip. Retrieved September 20, 2011 from: http://orthoinfo.aaos.org/topic.cfm?topic=A00213#Symptoms
  5. Centers of Disease Control. Arthritis basic faq's. Retrieved September 20, 2011, from: http://www.cdc.gov/arthritis/resources/spotlights/lifetime-risk.htm
  6. http://www.makoplasty.com/
 


MAKOplasty Seminar Series

New 2014 dates to be added soon.

To RSVP for a seminar, please contact Stephanie Bridges by e-mail: sbridges@triangleortho.com or at 919-281-1958.

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