Advances in technology have created new levels of precision for knee replacement, Dr. Frederick Buechel told a group Tuesday at Iberia Bank’s “Health Plus” lecture series.
Buechel, an orthopedic surgeon at Physicians Regional Healthcare System, is on the cutting edge of robotic joint replacement, having performed 439 robotic knee surgeries or about 5 percent of all such surgeries worldwide. He also teaches other doctors the technique.
Buechel made no bones about his connection with MAKO Surgical Corporation, the Fort Lauderdale manufacturer producing the robotic arm he uses in his operations. He made no apology for it either.
His robotic assistant gives him advantages over traditional knee replacement that include smaller incisions, quicker recovery and virtual elimination of surgeon installation error, he said. With those claims he added that his patients are experiencing same-day turnarounds for partial knee replacements.
Errors occur with traditional partial knee replacements, Buechel said, because doctors are not as likely to place implants into the knee joint with complete accuracy. The robotic system pinpoints alignments to within one millimeter and one degree, he asserted.
More perfectly shaped resurfacing and precisely placed implants require minimal bone loss, Buechel said. They provide better range of motion and less pain. The surgery is less invasive keeping ligaments intact, and a tourniquet is not required to control blood flow. Incisions are generally less than three inches long.
The process requires pre-operative trackers to map knee joints. Trackers also are affixed to the femur and tibia. The surgery only takes one to one-and-a-half hours. Physical therapy after surgery last for two to three weeks.
Osteoarthritis is the largest cause of cartilage breakdown leading to knee distress, Buechel said. When cartilage wears away, friction develops causing joint fluids to increase to protect the area. Pain and swelling result.
“Fifty percent of people over the age of 65 have osteoarthritis,” he said.
Medicines and nutritional supplements can help relieve pain and reduce swelling, but the damage is irreversible without intervention. Arthritis is not the only source of knee pain.
Some pain is caused by meniscus tearing, Buechel said. Meniscal tears are among the most common knee injuries. The meniscus is a rubbery, C-shaped bumper that cushions the knee and distributes liquid around the cartilage, he said.
Surgical tools for repairing meniscus tears now are smaller than the tip of a pencil, Buechel said. After magnetic resonance imaging (MRI) of the injury, two tiny incisions and a 20-minute procedure can repair the damage. The incisions are so small, they only require two stitches.
Maria Waine and Lucy Thibeault, who attended the seminar, said they were on a quest to learn how to age gracefully and learn how everything is replaced.
“We want to know when old is old,” Waine said.
Buechel showed videos of patients walking immediately after surgery. After a few weeks of therapy, his patients walked normally. He also answered attendee’s questions on the best material for hip replacement and the best choice of anesthesia for irregular heartbeat patients.
When asked for his final thoughts on knee surgery, he responded: “Just know that with knee surgery, life is not limited.”