Using robotic surgery to treat knee pain

by: Heather Salerno September 3, 2015
Innovative surgery

(Photo: Joe Larese/The Journal News)

The problem

Adolfo Calenda, 71, worked in construction for decades before retiring in 2006, and he knew that the job had taken a toll on his body.

“I used to do tiles and marble, so I would be on my knees a lot,” he says. “It got to a point where it was very painful.”

But Calenda didn’t use that as an excuse to be sedentary. Until his late 60s, he played tennis with friends about twice a week, and enjoyed gardening on the one-acre property he owns with his wife, Joy. And he would often start the day with a walk around a local lake, “to keep the muscles loose.”

All that changed two years ago, when the frequent pain in his left knee got worse. He had to quit his regular tennis game, because his knee would ache for days afterward. “It wasn’t worth it,” he says.

Gardening also became impossible, and he had to cut back on his morning strolls. The final, frustrating straw came late last summer while visiting relatives in Italy. Calenda’s sister lives in Trieste, a seaport on the Adriatic Coast, and he’d always liked to walk down the hill from her home to a nearby piazza. On this trip, he had to take the bus instead.

“This was holding me back,” he says of his knee pain. “It was time to do something.” Calenda was familiar with joint replacement surgery; Joy previously had operations on both hips and knees.

But unlike his wife, who needed to have those joints fully replaced, Calenda qualified for a partial knee replacement.

What he had done

MAKOplasty

Dr. Joel Buchalter, co-director of the Orthopaedic Institute at Putnam Hospital Center, performed a procedure in July on Calenda called MAKOplasty, a state-of-the-art treatment that uses a surgeon-controlled robotic arm.

It’s a quicker, less painful and less invasive operation than a total knee replacement, which typically requires a three- to five-day stay in the hospital. The robot also helps surgeons achieve a higher level of precision, since they must carefully secure the artificial implant in a way that lets the joint swing smoothly.

“A partial replacement is like doing an inlay in a mosaic,” says Buchalter. “You have to put it in perfectly.” With MAKOplasty, a CT scan of the patient’s knee is taken before the operation and fed into a specialized computer system, which creates a customized, 3D anatomical model – in other words, a kind of surgical map. Then in the operating room, the system guides the doctor in prepping the damaged bone for an implant, ensuring that no tissue or bone can be removed outside the previously planned area.

Buchalter says that the conventional style of partial knee replacement, which uses less exact X-rays and relies on a surgeon’s visual estimate, has fallen out of favor over the years because they don’t have the same success rate as complete replacements.

With MAKOplasty’s greater accuracy, patients like Calenda have another option. But this procedure isn’t for everyone. For instance, Buchalter says he likely would not recommend it for someone with rheumatoid arthritis, an inflammatory condition that tends to affect the entire joint. Yet, he adds, “this adds to the tool chest to help patients with various ailments.”

How it helped

Calenda went home from the hospital the day after surgery. By then, he was already able to go up and down stairs. Two weeks later, he could drive a car. A physical therapist came to his house until last month to help him exercise, and he now continues those sessions as an outpatient. To aid his progress, Calenda is thinking about taking up swimming, a low impact sport. But he does hope to get back to tennis later this year. “I’m taking it slowly, slowly, trying not to overdo it,” he says. Most significantly, though, he now has no pain at all when he walks. But the operation has made more than a physical difference in Calenda’s life. “Mentally, it makes you feel better,” he says. “Getting back to the things you love to do, it makes you feel younger.”

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