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To knee or not to knee?
by Jessica Carner
Jan 15, 2011 | 2838 views | 0 0 comments | 4 4 recommendations | email to a friend | print
Tribune/Nathan Orme - With the new MAKO RIO (Robotic Arm Interactive Orthopadic System), doctors at Northern Nevada Medical Center (NNMC) use a burr to remove parts of bone in partial knee replacement surgery. The machine in use at NNMC is the first of its kind in Nevada.
Tribune/Nathan Orme - With the new MAKO RIO (Robotic Arm Interactive Orthopadic System), doctors at Northern Nevada Medical Center (NNMC) use a burr to remove parts of bone in partial knee replacement surgery. The machine in use at NNMC is the first of its kind in Nevada.
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SPARKS — Northern Nevada Medical Center is the first in Nevada to provide a robot-assisted partial knee replacement surgery option for patients suffering from osteoarthritis.

Osteoarthritis is a degenerative bone disease that causes cartilage between healthy joints to break down, removing the buffer between bones.

Through a procedure called MAKOplasty, patients who are not in need of a total knee replacement can have only the arthritic portion of the knee removed so healthy bone and surrounding tissue can be spared.

John Zebrack, an orthopaedic surgeon with the Reno Orthopaedic Clinic (ROC), said the outcome of partial knee replacement surgeries is highly dependent upon implant positioning and alignment, which is challenging using the manual technique. The new robot-assisted method allows surgeons to remove a precise amount of bone and place an implant in the optimal position.

The MAKOplasty procedure is less invasive, because it is performed through a smaller incision than is required for a traditional total knee replacement surgery, Zebrack said. Patients also can benefit from less implant wear and loosening, less scarring, reduced blood loss, minimal hospitalization, rapid recovery and a more natural feeling knee.

“In all the (MAKOplasty procedures) I have done, the patients have spent one night in the hospital,” Zebrack said. “And they are rehabbing quicker.”

David Tompkins, physical therapist with ROC, said patients can usually return to full weight bearing activity within a month of having a partial knee replacement. Of course, that amount of time varies from patient to patient, he said.

Zebrack said he believes the attitude of the patient plays a key role in the amount of time it takes to recover. People who have a positive attitude and are willing to work through a little bit of pain will rehabilitate faster, he said.

Prior to a MAKOplasty procedure, a Computerized Axial Tomography (CAT) scan is done on the knee and the images are uploaded to a computer where the pieces of bone that need to be removed are mapped out. With the assistance of a robotic arm, the surgeon removes precise portions of bone and then replaces the bone with implants composed of metal and plastic.

“MAKOplasty is a robot-assisted partial knee replacement,” Zebrack said. “The surgeon is still doing it, but the computer and robot allow us to be more precise.”

Partial knee replacements are not for everybody, but can be an option for patients who have knee pain during activity on the inner knee, under the knee cap or the outer knee, who fail to respond to non-surgical treatment such as rest, weight loss, physical therapy and/or non-steroidal anti-inflammatory medication, Zebrack said.

Partial knee replacements last up to 15 years for 90 to 95 percent of patients, depending upon variables such as level of physical activity and weight, he said. Total knee replacements can last about 30 years.

Zebrack said he usually advises patients over the age of 75 to have a total knee replacement versus a partial in order to lower the risk of having to undergo a second surgery when they are older.

Total knee replacement, Zebrack said, is one of the most successful procedures in orthopaedic medicine. The total replacement, however, is highly invasive, requires extensive rehabilitation and removes healthy cartilage and tissue.

According to the American Academy of Orthopaedic Surgeons, osteoarthritis (OA) of the knee is the most common form of arthritis. Forty-six percent of people will develop OA of the knee over their lifetime.

Five surgeons in Nevada are trained to perform MAKOplasty procedures: Zebrack, Eric Boyden, Ryan Dobbs, Lex Simpson and Renny Uppal. Call 796-3040 to schedule a consultation.
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