“I work for Florida Hospital Home Care in Orlando,” says Barbara Lebert, “and I had an arthroscopic procedure done on my left knee around 2006. But then my right knee started bothering me, so I thought I really needed to have it checked out.”
An MRI and x-rays confirmed that Barbara would indeed require a surgical procedure to alleviate her knee pain.
“I love to bike ride and I couldn’t bike ride anymore,” she recalls. “I was even having difficulty walking or standing on it.”
This time, Barbara looked for a surgeon closer to her home in DeLand.
“I wanted to find a good orthopaedic doctor in Volusia County, so if I have surgery it’s closer to my home,” she explains. “I started talking to people, and everyone I talked to said, Go to Dr. Hollmann.”
Mark W. Hollmann, MD, is a board-certified, fellowship-trained orthopaedic surgeon with Florida Orthopaedic Associates.
“I went in and was very comfortable with him,” adds Barbara, “so I decided to go with him for my surgery.”
Dr. Hollmann explained to Barbara that she was actually a good candidate for a partial knee replacement, a bone-conserving, tissue-sparing procedure that compares favorably with total knee replacement for many patients.
“Total knee replacements have gotten so good, and last so long, because they are reproducible,” reflects Dr. Hollmann. “We can place total knee prostheses in the same ways time after time, and that’s why
they work.
“One of the reasons I haven’t been overly excited about partial knee replacements, however, is that they have always been a little less exact. They are not as reproducible as total knee replacements, and therefore the failure rate has been a bit higher than what we see with total knees.”
Consequently, says Dr. Hollmann, he and many of his colleagues in the field of orthopaedic surgery have been reluctant to perform partial knee replacements.
“We have done some of them in the past, but not recently, because we just didn’t feel like we could reproduce them time and time again and give patients the best results. For some time now, we have recommended that patients who might be good candidates for partial knee replacements simply hold off and treat their condition conservatively until their condition actually warrants a total
knee replacement.”
All that has changed now, thanks to a major breakthrough in partial knee replacement technology: a surgical option called MAKOplasty® Robotic-Arm-Assisted Unicompartmental Knee Resurfacing from MAKO Surgical Corporation.
“MAKOplasty is an innovative, restorative surgical solution that enables orthopaedic surgeons to treat patient-specific, early- to mid-stage osteoarthritic knee disease with consistent, reproducible precision using the MAKO Tactile Guidance System (TGS),” reports Dr. Hollmann.
“The MAKO TGS empowers surgeons and hospitals to address the needs of a large and growing yet currently underserved patient population suffering from early- to mid-stage osteoarthritis of the knee,” he continues. “Patients who desire a restoration of lifestyle, minimized surgery, reduced pain, and rapid recovery may benefit from MAKOplasty.”
Importance of precision
As Dr. Hollmann explains, the robotic technology of MAKOplasty enables the surgeon to combine the data provided by a CT (computed tomography) scan with the precision of a surgeon-interactive robotic arm.
“Basically, we take a CT scan of each patient’s knee and then that is loaded into the robot,” describes Dr. Hollmann. “The CT scan data provides us with precise preoperative planning of the implant’s size, orientation, and placement.
“The MAKOplasty engineers and I then place that prosthesis where we think it’s going to be the best fit for that particular patient. In other words, everything is driven off the patient’s own knee, so each implant will be custom fit.”
Preoperative planning with MAKOplasty enables the surgeon to have a visual reconstruction of the patient’s knee in three dimensions. The combination of technology and surgical planning and skill is the key, says Dr. Hollmann.
“Every patient gets individualized planning and treatment, as opposed to the computer-assisted surgery where it’s just the computer driving it,” he explains. “The fit is what is customized and then that is ultimately what the robot reproduces, as opposed to a computer, where it’s trying to put everybody in the same slot. With MAKOplasty, the placement of the implant is designed for each patient.
“The implants are standard sizes, but the fit is what’s unique to each patient, and this is something we have never been able to do before.”
The MAKOplasty technology basically has less tolerance for human error, adds the doctor.
“Because of the way this system is set up, there is a major benefit to patients in terms of the precision of the fit. The tolerances are less than one tenth of one millimeter. The tolerances were initially so tight with the robot, actually, that MAKO had to loosen the tolerances because they couldn’t get the trial components out. When we perform these procedures, we put in a trial implant,” explains the doctor, “which is just to make sure we have the right size and everything works fine, and it was so snug they couldn’t get it out.”
Of course, the results of partial knee replacement make this an excellent option for active patients who are not ready for total knee replacement.
“It’s a bone-conserving, tissue-sparing restoration,” reminds Dr. Hollmann. “Consequently, patients can anticipate a shorter hospital stay and faster recovery than with traditional knee replacement. That can translate to many more years of enjoying impact activities, and, of course, we haven’t burned any bridges if a patient eventually requires total knee replacement down
the road.”
Unique to area
MAKOplasty is not only unique in terms of what it can help surgeons accomplish but also in the fact that it is available only in select areas, and Central Florida is one of the few.
“One of the many reasons we are so excited about this is that Florida Orthopaedic Associates are the only ones offering the MAKOplasty solution in Central Florida currently,” says Dr. Hollmann. “No one else in Central Florida is doing this.
“In fact, the MAKOplasty machine at Florida Hospital DeLand was the second one available in Florida and is currently one of only four in the state,” adds Dr. Hollmann. “Most of the MAKOplasty machines at present are at major teaching centers in other parts of the country, such as Johns Hopkins.
“I think it’s great that active baby boomers right here in Florida can get this done without having to travel out of the area,” he concludes.
“I was actually up and walking around almost immediately after my surgery,” marvels Barbara. “It was a minor, not a major, surgery,” she emphasizes. “It was just amazing.”
Soon, she was back to her normal routine.
“I went to see Dr. Hollmann ten days after surgery, and I had no walker, no cane, nothing. I never thought I’d be back to work in three weeks, but I was.”
Barbara expresses her immense gratitude to the skilled surgeon.
“Dr. Hollmann really took the time to sit with me, explain everything, and make sure I was comfortable,” she says. “I can’t say enough about him. He’s amazing!” FHCN–Michael J. Sahno