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VOL. 127 | NO. 223 | Wednesday, November 14, 2012

Saint Francis Introduces MAKO Knee Treatment


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Saint Francis Hospital-Memphis this week becomes the first hospital in the city to offer the MAKOplasty partial knee resurfacing treatment.

John Lefever, a regional MAKOplasty specialist, leads a demonstration at the “Meet the MAKO Robot” open house held on November 7 at Saint Francis-Memphis.

(Photo Courtesy of Wiley Henry of The Carter Malone Group)

The treatment uses a highly advanced, surgeon-controlled robotic arm system to correct early to mid-stage osteoarthritis that has not yet progressed to all three compartments of the knee. Saint Francis spent $1.5 million to acquire the new technology, and the first surgery is scheduled to take place Thursday, Nov. 15.

Dr. Apurva Dalal of Tri-State Orthopedics is the only joint replacement surgeon in Memphis who will use the technology.

“It’s the most amazing technology that I have ever seen. It’s a huge leap forward in my opinion from what we had been doing and what this new technology brings to us,” said Dalal, who has been performing knee surgeries since 1995. “I’m glad that Saint Francis has taken a step forward to invest money into this technology. The whole advantage is that we are giving patients better surgeries than we have ever been able to give them.”

So far this year there have been 54 conventional partial knee replacement surgeries done at Saint Francis-Memphis.

In preparation for Thursday, Dalal spent the past weekend in Fort Lauderdale, Fla., getting some tips and insight from a surgeon who has completed more than 3,000 surgeries using the MAKOplasty robot since 2008.

The first MAKOplasty surgery was performed in 2006, and there have been more than 10,000 procedures completed nationwide since then.

Benefits of MAKOplasty include reduced pain, minimal hospitalization, more rapid recovery, less implant wear and loosening, less scarring, better motion, and a more natural feeling knee.

“There are an enormous amount of advantages to doing this surgery,” said Dalal, who explained the new surgery is very different from traditional knee replacement because the incision is small, blood loss is less, and only a minimal amount of bone is removed. “I can get more precise patient outcomes than ever before. We can re-create the patient’s knee like it was before he or she had arthritis.”

“It’s the most amazing technology that I have ever seen. It’s a huge leap forward in my opinion from what we had been doing and what this new technology brings to us.”

–Dr. Apurva Dalal

Prior to the surgery, the Robotic Arm Interactive Orthopedic System (RIO) takes a CT scan of the patient’s knee, and then the MAKO Tactile Guidance System creates a three-dimensional model of the bone surface that the surgeons can use to plan the procedure. During the surgery, special cameras and sensors feed real-time data into the computer, which then looks for a match between the programmed surgical plan and the real-time data. Once a match is found, the robotic arm locks in place and makes the needed cuts.

“The robotic arm is extremely precise, allowing us to fine tune surgeries in ways that we could not during conventional procedures,” Dalal said. “I can sense the exact amount of tension, gap, angle or slope involved.”

The procedure could even be done on an outpatient basis, but Dalal expects to keep patients at the hospital for one night to evaluate their condition. The next day they will be able to walk on their new knee.

MAKOplasty is especially effective for active adults who might play golf or tennis, but patients with very bad knee conditions will still need a total knee replacement surgery. Qualified patients must have a normal ACL ligament. The same MAKOplasty treatment is being researched for total knee replacement, but Dalal feels that advancement is still probably three years away.

The MAKOplasty treatment also can be used for hip surgeries, but Dalal explains that knee pathologies are far more common so he will start with knees and possibly expand to hips in six months.

Procedures involving robotics for other types of surgery are becoming more common.

“In the past five years, we are seeing more and more robots in medicine in general,” Dalal said.

Saint Francis currently uses robotics for urologic, gynecological and general surgeries.

“We also use the CyberKnife in radiation oncology to treat tumors that are difficult to treat,” said Marilynn S. Robinson, senior vice president for Saint Francis Healthcare.

Saint Francis is looking into future robotic applications for thoracic and cardiac surgeries.

“We are beginning single-site surgery, and the literature is predicting no-site surgery, where patients will have no scars because the surgery will be done through naturally recurring orifices,” Robinson said.

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