Bellapianta Orthopedics SMinimally Invasive Surgery

Robotic-assisted hip and knee replacement is a treatment option for patients with osteoarthritis of the hip or knee that has been refractory to conservative treatments. The Mako Robotic-Arm Assisted system provides each patient with a personalized surgical plan based on each individual’s unique anatomy.

Arthroscopy is a minimally invasive procedure that allows doctors to diagnose and sometimes treat joint injuries and disease through small incisions in the skin. It is often performed to confirm a diagnosis made after a physical examination and other imaging tests such as MRI, CT or X-rays.

Robotic and Arthroscopic surgery is not appropriate for every patient. Dr. Bellapianta will discuss the diagnostic and treatment options that are best for you.

Minimall Invasive Arthroscopic Surgery

Arthroscopy is a surgical procedure that orthopaedic surgeons use to visualize and treat problems inside a joint.

The word arthroscopy comes from two Greek words, "arthro" (joint) and "skopein" (to look). The term literally means "to look within the joint."

In arthroscopic surgery, an orthopaedic surgeon makes a small incision in the patient's skin, then inserts pencil-sized instruments that contain a small lens and lighting system to magnify and illuminate the structures inside the joint. Light is transmitted through fiber optics to the end of the arthroscope that is inserted into the joint.

By attaching the arthroscope to a miniature camera, the surgeon is able to see the interior of the joint through this very small incision, rather than the larger incision needed for open surgery.

The camera attached to the arthroscope displays the image of the joint on a video monitor, allowing the surgeon to look, for example, throughout the knee. This lets the surgeon see the cartilage, ligaments, and under the kneecap. The surgeon can determine the amount or type of injury and then repair or correct the problem, if it is necessary.

When is arthroscopy used?

Your bones, cartilage, ligaments, muscles, and tendons can all be damaged by disease and injury. To diagnose your condition, your doctor will take a thorough medical history, perform a physical examination and order imaging studies — usually x-rays. For some conditions, an additional imaging study — such as a magnetic resonance imaging (MRI) scan or a computerized tomography (CT) scan — may also be needed. After making a diagnosis, your doctor will determine the most appropriate treatment choice for your condition.

Conditions

Conditions that are commonly treated with arthroscopic procedures include:

Inflammation. For example, synovitis is a condition that causes the tissues surrounding the knee, shoulder, elbow, wrist, and ankle joint to become inflamed.
Acute or chronic injuries, including:
Rotator cuff tendon tears
Shoulder impingement
Recurrent dislocation in the shoulder
Meniscal (cartilage) tears in the knee
Chondromalacia (wearing or injury of the cartilage cushion in the knee)
Anterior cruciate ligament (ACL) tears with instability in the knee
Carpal tunnel syndrome in the wrist
Loose bodies of bone and/or cartilage, particularly in the knee, shoulder, elbow, ankle, or wrist

Some problems associated with arthritis can also be treated arthroscopically.

Procedures

The procedures below are performed either with arthroscopy or with a combination of arthroscopic and open surgery:

Rotator cuff repair
Repair or resection of torn cartilage (meniscus) from the knee or shoulder
Reconstruction of the anterior cruciate ligament (ACL) in the knee
Removal of the synovium in the knee, shoulder, elbow, wrist, or ankle
Release of the carpal tunnel in the wrist
Repair of torn ligaments
Removal of loose bone or cartilage in the knee, shoulder, elbow, wrist, or ankle

Although the inside of nearly all joints can be viewed with an arthroscope, six joints are most frequently examined with this instrument. These are the knee, shoulder, elbow, ankle, hip and wrist. As advances are made in fiberoptic technology and new techniques are developed by orthopaedic surgeons, other joints may be treated more frequently in the future.

How is arthroscopy performed?

Arthroscopic surgery, although much easier in terms of recovery than open surgery, still requires the use of anesthetics and the special equipment in a hospital operating room or outpatient surgical suite. You will be given a general, spinal, or a local anesthetic, depending on the joint or suspected problem.

A small incision (about the size of a buttonhole) will be made to insert the arthroscope. Several other incisions may be made to see other parts of the joint or insert other instruments.

Corrective surgery is performed with specially designed instruments that are inserted into the joint through accessory incisions. Originally, arthroscopy was simply a diagnostic tool used for planning standard open surgery. However, with the development of better instrumentation and surgical techniques, many conditions can now be treated with arthroscopic techniques.

After arthroscopic surgery, the small incisions will be covered with a dressing. You will be moved from the operating room to a recovery room. Many patients need little or no pain medication.

Before being discharged, you will be given instructions on caring for your incisions, what activities to avoid, and which exercises you should do to aid your recovery. During the follow-up visit, the surgeon will inspect your incisions; remove sutures, if present; and discuss your rehabilitation program.

The amount of surgery required and recovery time will depend on the complexity of your problem. Occasionally, during arthroscopy, the surgeon may discover that the injury or disease cannot be treated adequately with arthroscopy alone. More extensive open surgery may be performed while you are still anesthetized, or at a later date after you have discussed the findings with your surgeon.

What are the possible complications?

Although uncommon, complications do occur occasionally during or after arthroscopy. Infection, blood clots of a vein (also called deep vein thrombosis or DVT), excessive swelling or bleeding, damage to blood vessels or nerves, and instrument breakage are the most common complications; however, these occur in far less than 1 percent of all arthroscopic procedures.

What are the advantages?

Although arthroscopic surgery has received a lot of public attention because it is often used to treat well-known athletes, it is an extremely valuable tool for all orthopaedic patients and is generally easier on the patient than open surgery. Most patients have their arthroscopic surgery as outpatients and are home several hours after the surgery.

What is recovery like after arthroscopy?

The small puncture wounds take several days to heal. The operative dressing can usually be removed the morning after surgery and adhesive strips can be applied to cover the small healing incisions.

Although the puncture wounds are small and pain in the joint that underwent arthroscopy is minimal, it takes several weeks for the joint to maximally recover. A specific activity and rehabilitation program may be suggested to speed your recover and protect future joint function.

It is not unusual for patients to go back to work or school or resume daily activities within a few days. Athletes and others who are in good physical condition may, in some cases, return to athletic activities within a few weeks. Remember, though, that people who have arthroscopy can have many different diagnoses and preexisting conditions, so each patient's arthroscopic surgery is unique to that person. Recovery time will reflect that individuality.

Robotic Surgery with MAKO by Stryker

Mako SmartRobotics is an innovative solution for many suffering from painful arthritis of the knee or hip. Mako uses a 3D CT-based planning software so your surgeon can know more about your anatomy to create a personalized joint replacement surgical plan.

By guiding your doctor during surgery, Mako’s AccuStop technology allows your surgeon to cut less by cutting precisely what’s planned to help protect your healthy bone.

What is Mako robotic-arm assisted surgery?

Mako robotic-arm assisted surgery is a technology developed for hip and knee replacement surgeries. It allows your orthopedic surgeon to pre-plan your surgery using Mako’s software and then perform the operation by guiding the robotic arm to precisely remove bone and cartilage.

Why is it used?

This technology allows your surgeon to use a CT scan to create a 3D virtual model of your unique anatomy. The uniquely detailed and personalized view enables him or her to create a surgery plan that can be adjusted if necessary during the surgery.

In addition, when your surgeon prepares the bone for the implant, the robotic arm guides the surgeon within the predefined area, allowing for a more accurate and better-aligned joint replacement.

What does the procedure involve?

Your surgeon will use Mako to make a 3-D virtual model of your joint. He or she will then virtually put the implant in place, and once it’s in the proper position, this plan can be implemented during surgery.

As you’re under general anesthesia, Mako’s robot arm, along with the doctor, will hold the surgical instrument. Your surgeon will be able to see the pre-surgical plan overlaid on the real-time surgery to use as a guide, and the instruments are under his or her control the entire time.

The robotic instrument has tracking eyes and can adjust for very small movements of the joint if they occur. It precisely prepares the bone according to visual boundaries that protect the essential structure of the joint and removes only the part that’s been affected. The implant is placed, the joint is properly balanced, and if necessary, your surgeon can make adjustments if needed.

What are the benefits of Mako robotic-arm assisted surgery?

This type of technology provides the following benefits:

Can be used for partial or total replacements
Helps create a personalized surgical plan
Gives your surgeon real-time sensory feedback
Makes your surgeon in complete control
Helps ensure proper preparation of the bone
Allows for precise placement of the implant
Produces minimal blood loss and a smaller scar
Helps preserve healthy bone and soft tissue
Results in less post-operative pain than manual techniques
Provides a quicker recovery and shorter hospital stay

What is recovery like?

Recovery is usually quicker than it is with traditional joint replacement methods. You may be able to walk just hours after your surgery, and you’ll probably be able to return to your everyday activities in 1-4 weeks. The exact amount of time depends on your health and the extent of your surgery.

Who makes a good candidate for Mako robotic-assisted knee replacement?

If the following apply to you, you may want to talk to your doctor about this technology:

Osteoarthritis
Pain or stiffness with activity or when getting up from a sitting position
Inadequate response to non-surgical treatments such as anti-inflammatory medication

How long has the Mako procedure been available?

The first Mako procedure was a partial knee replacement performed in June of 2006. Since that time, over 83,000 Mako hip and knee replacement procedures have been performed around the world. The Mako total knee replacement was first performed in 2016.

Does the Mako robotic-arm actually perform surgery?

No, the robotic-arm doesn’t perform surgery, nor can it make decisions on its own or move without the surgeon guiding it.

How long do knee implants last?

The robotic arm is a tool that is used to place implants accurately and precisely. The implants used for hip and knee replacement have been in the market for decades and have good long term survivorship data. For most patients, the implants should last for the rest of their lives.

Is Mako covered by health insurance providers?

Most insurances, including Medicare and Worker’s Compensation plans, cover the use of the robotic arm. We pre-authorize the Mako surgery with your insurance just like we would a standard hip or knee replacement and then our billing team provides the patient with estimates in terms of cost and out of pocket expenses. Feel free to reach out to our office if you would like to inquire about your specific insurance.

MAKO Robotically Assisted Knee Replacement

What is Mako robotic-assisted knee replacement?

Specialty Orthopaedics is pleased to offer Makoplasty, or robotic-assisted partial or total knee replacement surgery performed with Mako technology. Robotic-assisted knee surgery may be suitable for patients who are suffering from knee arthritis affecting one, two or three compartments of the knee. Mako technology allows our surgeons to selectively target the part of your knee damaged by arthritis, and when possible, replace the diseased part of your knee while sparing the healthy bone and ligaments surrounding it.

Makoplasty robotic knee replacement was developed by Stryker, a leader in the advancement of robot-assisted orthopedic technologies. The technology helps improve the precision and accuracy of joint replacement surgery.

The Mako system has proven its ability to recover patient joint functionality and pain, with a high patient satisfaction level after surgery.

Why is Mako robotic-assisted knee replacement used?

Conservative treatment options may be sufficient for certain patients suffering from knee arthritis. However, as the disease and your discomfort progress, conservative options may not be enough. In this case, Makoplasty, or robotic-assisted partial or total knee replacement, may be a good option for you.

What does Mako robotic-assisted knee replacement involve?

A unicompartmental (partial) or total knee replacement surgery with Mako begins with a pre-surgical evaluation of your knee using a CT scan or other imaging test. This helps your orthopedic surgeon develop a precise plan for surgery. This information is then scanned into the Mako machine creating a 3-dimensional template or model which enables pinpoint precision during the procedure.

During robotic knee surgery, your surgeon will use the Mako robotic arm to assist in removing the damaged portion of the bone and tissue, leaving healthy bone and cartilage intact. Then, with assistance from the robotic arm, your surgeon will insert artificial components to replace the old, damaged portions of the joint.

Mako SmartRobotics™ for Total Hip replacement

Each patient is unique and can experience joint pain for different reasons. It’s important to talk to us about the reason for your hip pain so you can understand the treatment options available to you. Pain from arthritis and joint degeneration can be constant or come and go, occur with movement or after a period of rest, or be located in one spot or many parts of the body. It is common for patients to try medication and other conservative treatments to treat their hip pain. If you haven’t experienced adequate relief with those treatment options, you may be a candidate for Mako Total Hip replacement, which may provide you with relief from your hip pain.

How does it work?

Mako SmartRobotics™ is an innovative solution for many suffering from painful arthritis of the hip. Mako uses 3D CT-based planning software so your surgeon can know more about your anatomy to create a personalized joint replacement surgical plan. This 3D model is used to preplan and assist your surgeon in performing your total hip replacement.

In the operating room, your surgeon follows your personalized surgical plan while preparing the bone for the implant. The surgeon guides Mako’s robotic arm within the predefined area, and Mako’s AccuStop™ technology helps the surgeon stay within the planned boundaries that were defined when the personalized preoperative plan was created. By guiding your doctor during surgery, Mako’s AccuStop™ technology allows your surgeon to cut less by cutting precisely what’s planned1 to help protect your healthy bone.2

Mako SmartRobotics™ for Total Hip replacement is a surgical procedure intended for patients who suffer from noninflammatory or inflammatory degenerative joint disease (DJD). Some forms of DJD include osteoarthritis (OA), post-traumatic arthritis, rheumatoid arthritis (RA), avascular necrosis (AVN) and hip dysplasia.

It’s important to understand that the surgery is performed by an orthopaedic surgeon, who guides Mako’s robotic arm during the surgery to position the implant in the hip joint. Mako SmartRobotics™ does not perform surgery, make decisions on its own or move without the surgeon guiding it. Mako SmartRobotics™ also allows your surgeon to make adjustments to your plan during surgery as needed.