Robotic Partial Knee Replacement
Why Partial Knee Replacement Surgery?
Knees do not wear out evenly. Sometimes one part of the knee is perfectly fine while another part is completely destroyed. Depending on where the damage is in your knee, a partial knee replacement may be an option for you.
A partial, or unicondylar, joint replacement resurfaces only the worn out portion of the joint, either the inside, outside or kneecap, leaving the rest of the joint alone. To work properly, the components must be put in extremely accurately. Even a millimeter or two of tilt or rotation dramatically affects the wear patterns and longevity of the components. Think of how a car out of alignment means rapid tire wear.
Most surgeons are unable to perform partial knee replacements because of how difficult it is to achieve the required accuracy and so in many cases, even if a patient meets the criteria for a partial knee replacement, a more invasive total knee replacement will be offered.
Mako Robotic Arm Assisted Partial Knee Resurfacing (MAKOplasty® Procedure)
Mako Robotic Arm Assisted Knee Surgery is the most consistently, reproducible, precision joint replacement installation system available in the world today that allows trained surgeons to optimize knee implant sizing, tracking, and ligament balance, which enhances implant function and longevity.
Find out if you are a candidate for partial robotic knee replacement. Submit your information online for a free medical review and phone/web consultation.
As the specialist in robotic partial knee surgery, my goal is getting you back to the life you want.
Dr. Buechel’s Robotic Knee Surgery Experience
Dr. Frederick Buechel, Jr., MD is an expert in robotic-arm assisted partial knee replacement/resurfacing. He is one of the most experience Mako robotic knee surgeons in the world. He has performed nearly 1,000 procedures in the USA and around the world. He is as a Mako robotic international instructor, surgeon proctor and a educational consultant for the Mako technology and has helped launch this technology with surgeons in 7 countries. He has launched robotic programs in Asia, Australia, Europe, and the USA. He continues to be involved in the development of this system since 2010.
Dr. Buechel has been performing the procedure since 2009 has developed and taught his Mini-MAKOplasty® Technique starting at his Center of Excellence in Naples, Florida. There, he started one of the first Destination and Training Centers for patients and surgeons from around the globe. This was also the location of the first Advanced Mako Knee Training sites run by Dr. Buechel. The outpatient process with Mako robotic technology was developed here and was a teaching site for this process that allowed patients to go home the same day no matter the age of the patient. This truly minimally invasive technique & process provides rapid knee pain relief, with return to an active lifestyle within weeks for most patients.
Dr. Buechel has great experience with patients from the many cultures around the world. These differences are both anatomical differences and functional differences. Understanding these differences in people is required to achieve proper patient satisfaction, to set proper patient expectations and to plan each patient’s implant position correctly. Dr. Buechel’s experience enables him to understand the nuisances of how to customize the computer-assisted planning for each patient’s individual needs. With a vast understanding of how the computerized software manipulation can be used to optimize each patient’s outcome, patients can be confident they are getting the best use of this highly sophisticated technology. Dr. Buechel knows the system is very precise, however, it is the surgeon that is in control of the planning and use of the system and how the knee is prepared that ultimately makes the outcome a great success. It is this understanding and overall control that determines whether or not your procedure is done optimally. Experience always matters in surgery, especially in advanced surgical procedures.
Video of Robotic Partial Knee Replacement
Choosing the Right Patients for the Procedure
Dr. Buechel is an expert in properly choosing which patients can benefit from this procedure. As a knee specialist, and as a Fellowship trained Joint Replacement surgeon, Dr. Buechel has great experience with Total Knee Replacement, Partial Knee Replacement and Knee Arthroscopy. Choosing the best procedure for each patient requires proper communication between the doctor and patient. Understanding the patient’s complaints, their history, reviewing the appropriate imaging studies and properly examining each patient is paramount for the process to be a success. The proper interpretation of all this information, along with understanding what the Robotic system’s capabilities are, allows Dr. Buechel to provide the best recommendation for each individual. As is known, not every surgical procedure has the perfect outcome however, it is the ability to reduce the potential for inaccuracy and to perform the procedures a precisely as possible that will give each patient the potential to have their best outcome from the procedure they choose.
Indications for the Procedure
Office examination is used to obtain a medical history and to evaluate the location of pain and tender spots around the knee, to check the knee’s 4 ligament’s stability and function, to check blood flow, skin conditions, and overall strength and walking ability.
Patients obtain X-rays with 4 views of the knee to look for mild, moderate or severe joint space loss or destruction in one compartment from osteoarthritis, osteonecrosis or post-traumatic arthritis. If the x-rays and the exam are consistent with partial knee arthritis, and symptoms are present only in the affected side, then a patient may be a candidate for the Mako Robotic-Arm Assisted Partial Knee Resurfacing procedure.
Dr. Buechel’s Procedure (Minimally Invasive Outpatient Robotic Partial Knee Surgery)
Dr. Buechel has refined his technique using this system and all the updates since 2009, performing nearly a thousand procedures, instructing surgeons at more than 50 Mako robotic cadaveric courses, developing advanced robotic courses for the knee, and assimilating techniques learned from other surgeons he has trained and observed around the world. This has lead Dr. Buechel to the point where each and every detail has been optimized to enable highly predictable & successful outcomes.
Dr. Buechel’s skin incisions are 2-3 inches for the common medial and lateral partial knee procedures, no muscles are cut, no tourniquets are needed, and blood loss is minimal requiring no transfusions. Advanced medicines are used to reduce blood loss during and after surgery. Platelet Rich Plasma (PRP) stem cell application can be used to enhance the healing process during the closure. Skin adhesives are used on most patients to hold the skin edges together and reduce the risk of external contamination, while allowing patients to shower the next day. Patients are walking at home the day of surgery. Most are off prescription pain meds within a week or two, and feel better than before surgery often in just 2-4 weeks.
This is the initial pre-operative placement of the virtual implants onto the tibial, femoral or trochlear bone surfaces depending on the procedure. Pre-planning allows planning of the implant depth, sagittal, coronal & transverse rotation, posterior slope, coronal plane alignment, and initial tracking position of the chosen implants and multiple sizes if desired. As a critical part of the procedure, preoperative computer planning and evaluation makes a big difference in the efficiency and quality of the surgical procedure to follow. The preoperative CT scan provides enormous benefit to many patients. This scan is used to create our 3D models and allows for highly precise implant planning. Once the plan is created, the surgeon optimizes the implant positions within a millimeter and 1º, prior to the surgery based on each patient’s anatomy. The plan is then optimized during surgery based on motion data, tracking information, cartilage surface mapping, and a gap analysis to restore each patient’s individual proper tension and tracking patterns.
The preoperative CT scans often reveal important information pre-operatively. These scans reveal patients with large bone cysts that may influence a surgeon’s decision to perform the procedure, or how to plan the procedure to ensure implant stability. Large bone spurs, often not seen with imageless systems, are important to know about preoperatively, as they influence implant positioning decisions during surgery which effect proper joint tension. On the more advanced arthritis cases with lots of large bone spurs the scans help tremendously in planning their removeal. Pre-operative scans are also critical for implant planning and placement in cases of osteonecrosis, where bone loss or bone death areas are properly assess to optimize the implant position for covering the bad area.
A concern patients have with CT scans is related to the radiation dosage and its potential detrimental effects. I have been concerned as well, so our radiologists have shared with us that the special protocol for knee scans delivers a mean effective dose of only ~0.4mSv, which is equivalent to 1.5 months of natural environmental radiation, or 3 x-rays. Therefore, I strongly feel the benefit out-ways the minimal risk.
Patient & Robotic Operating Room Setup
Once the operating room is ready, the patient is brought into the operating room and properly positioned on a comfortable and well padded operating table. Once the anesthesiologist has completed their preparation of the patient with either a regional or general anesthesia, the patient is sterilely prepared and draped.
Incision & Exposure
Dr. Buechel uses a minimally invasive incisions and soft tissue techniques to perform this robotically precise procedure. The incision spares cutting any muscle, which means patients can recover quickly.
During the procedure, Dr. Buechel places temporary infrared tracking devices called “arrays”, on the femur and tibia. These allow the computer to “see” the bones moving in the operating room, and matches the precise location of the bone of the patient to the 3D scans planned on the computer. This process is called registration through navigation.
Data Collection (Pose Captures) & Intra-Operative Adjustment of Implants
Once the communication is verified in the operating room, the surgeon places the knee through an arc of motion, correcting angular deformity, and re-tensioning the ligaments of the knee. This allows the computer software to present the surgeon with tracking information and an implant gap analysis, along with cartilage surface mapping so the surgeon can make virtual adjustments of the implants to optimize their position.
Understanding how to optimize this data collection process and adjust for different deformities is where surgeon experience using the system can make a significant difference, especially in the more advanced cases. Once Dr. Buechel has adjusted the implant in the virtual computer software, he can then use the robotic-arm cutting tool to precisely & safely prepare the bone.
Robotic Bone Preparation
With the intraoperative plan optimized, Dr. Buechel guides a 6mm round cutting tool connected to the end of a robotic-arm across the bone surface removing the planned volume of bone resection. The robotic system provides visual, audible and tactile feedback limiting the area of resection to only the planned surface within a millimeter and one degree of the plan. The robotic system creates virtual boundaries like an “invisible wall”, safely and precisely limiting the movement of the cutting tool.
Implant Installation and Validation
Once the bone surface is prepared by the robotic cutting tool, Dr. Buechel then trims and prepares the remaining soft tissues in the space in preparation to install the trial, and then final implants.
Trial implants are installed without cement to test the tracking, tension and stability of the knee joint. Then the final implants are installed with the use of bone cement attaching the femoral and tibial implants. Probes are used to verify the precise seating of the implants to the desired location in the cement bed. A final check of stability is made with a trial bearing before the final bearing is chosen and locked into the tibial base implant.
Dr. Buechel is very focused on the management of the soft tissues while opening and closing the knee joint for these procedures. By meticulously caring for the health of the skin and deep tissues throughout the procedure, healing is optimized and the chance of wound healing problems is reduced.
Most patients will have sutures that dissolve placed under the skin, and a skin adhesive glue is used on the surface to eliminate the need for suture removal.
Immediate Post Operative Recommendations
Patients will be discharged from the surgical facility once they are awake, alert, medically stable, and have had a chance to walk around the facility with their assistive devices.
Sterile dressings are placed on the knee with compression when leaving the operating room. Cooling devices to be used at home should be ready for your arrival back at your home or temporary housing location. Patients are recommended to walk each hour while awake for short distances as instructed. When not walking, the leg should be elevated to heart level or above for swelling reduction along with the use of the cooling device. Pain medications should be taken only as necessary and is lessoned by the use of the cooling device and elevation. Although blood clots are extremely rare with this procedure, the use of an anticoagulant medication is generally recommended for most patients for 3 weeks, with the specific choice determined for each patient based on their risk factors. A compression stocking is recommended to help control swelling and a specific type will be recommended.
A rehabilitation program is recommended before and after surgery to optimize your outcomes and optimize your quality of life. Patients can begin their progressive exercise program the day of surgery. Dr. Buechel’s comprehensive Mini-MAKOplasty® Program is designed to enhance patient outcomes, allowing patients the greatest chance of success with the least risk of complications.
The Benefits of Dr. Buechel’s Mako Robotic Partial Knee Procedure
Less Painful & Quicker Recovery
- Recovery to daily activity function is rapid
- 2 – 3 weeks of gentle Physical therapy
- No Forceful Painful therapy sessions to get motion
- Faster Return to Work
- Narcotic use is minimal in most
Precision Implant Installation
- Less likely chance of early failure
- Maximized potential articulation lifespan
- Reduction of Surgeon related Bone Resection Errors
- Same Day Discharge or 1 Night Stay
Less invasive surgery
- 2-3” incisions for most patients
- No Muscle cutting for Medial or Lateral procedures
- Minimal blood loss (No Transfusions)
- No Tourniquet
- Minimal Blood Clot Risk
- Minimal Bone Removal
- No staples or sutures will need to be removed
- You can shower the next day
More Natural Feeling Knee
- Increased Range of Motion
- Pre-op Motion returns in 2-3 weeks
- Keeping the stability of your ACL & PCL maintains natural stability