Patient Satisfaction Quite High for Unicompartmental Knee Replacement (Makoplasty)

October 2, 2017 By Stefan D. Tarlow MD

An article published in the Journal of Arthroplasty compares patient satisfaction rates at 2 years after surgery for both Total Knee Replacement and Unicompartmental Knee Replacement (also termed Makoplasty or partial knee replacement).

This study confirmed that Unicompartmental Knee Replacement patients have higher satisfaction scores (86 % vs 71 %) than Total Knee Replacement patients. The reasons for this include better range of motion, more natural feeling knee, less stiffness, and less serious complications for patients receiving a Unicompartmental Knee Replacement. Additionally, Total Knee Replacement is a more invasive surgery with longer healing times.

For many patients there can be a choice between which type of knee replacement you can have. Make a thoughtful decision based on your specific clinical information and discuss the options with your surgeon. Choose wisely.

Unicompartmental Knee Replacement

April 24, 2017 By Stefan D. Tarlow MD 2 Comments

Partial knee replacement – Medial Uni

This is an xray of a partial knee replacement. Specifically, this is a medial unicompartmental knee replacement. This fifty something year old man had pain localized to the medial aspect of his right and left knees. Carefully look at this xray and note that the lateral compartments (outside of each knee) has a well maintained joint space while the medial compartment of the untreated knee has bone on bone. The treated knee has a femoral component cemented into the femur(thigh bone), a tibial component cemented to the tibia (shin bone), and a ultra high molecular weight polyethylene component (xray invisible space) which is locked into the tibial tray. This procedure has provided the patient complete relief of his symptoms of knee arthritis. He went on to have his left knee partially replaced in the exact same manner and now functions normally without knee pain. He has returned to work and feels good. He was hospitalized only overnight in the hospital and was riding an exercycle within 10 days after surgery.

Unicompartmental Knee Replacement Has Advantages Over Total Knee Replacement

Unicompartmental knee replacement (e.g. Makoplasty partial knee replacement) offers a number of advantages over TKR including reduced risk of complications, bone and ligament preservation, and a more naturally feeling knee. One study looking at 14,000 knee joint replacement patients found the partial knee patients (compared to TKR patients) were more likely to achieve an excellent result and more likley to be highly satisfied and were less likely to have had a complication or hospital readmission.

Unicompartmental Knee Replacement : A Twenty Year Outcome Study

A study from France published by Jean-Noel Argenson, MD demonstrated impressive implant survival with good function for unicompartmental knees years after the initial surgery. Implant “survival” rate was calculated to be 83 % at 15 years after surgery and 74 % at 20 years after surgery. Age of the surviving patients was 52 – 90 years (some patients had received the partial knee replacements while in their 30’s).

Medial Makoplasty – Unicompartmental knee

Unicompartmental knee replacement is a less invasive alternative resulting in a more natural feeling knee compared to Total knee replacement in properly selected patients. This studies supports the belief that long term knee function and long term pain relief is predictably attainable with unicompartmental (partial) knee replacement. Improved precision in surgical technique available today using robotic surgical technique (Makoplasty) will likely lead to even better long term outcomes for today’s patients.

Partial Knee Replacement for Unicompartmental Knee Arthritis on the Rise

Doctors and Patients continue to seek treatment options that spare normal knee tissue and is less invasive to their body. Partial Knee Replacement (unicompartmental knee replacement) is an example of this principle.

In one select data base, from 1998 to 2005 the number of Partial Knee Replacements increased from 6570 to 44,990 procedures – a 32 % increase. In the same time period Total Knee Replacement increased by 9 %.

At this same time studies have shown Unicompartmental Knee Replacement surgery is > 90 % successful at five years and another study shows 85 % implant survival at ten years.

Partial knee replacement of any one of the three knee compartments preserves all the knee ligaments, can be done with minimally invasive techniques, feels more transparent, is less painful and results in a faster recovery compared to Total Knee Replacement. The age range for unicompartmental surgery is typically between 40-70 years of age.

New techniques for partial knee replacement are evolving and one would expect that in the future more patients will opt to have a partial rather than a total knee replacement.

Makoplasty Partial Knee Replacement: A Primer

February 15, 2017 By Stefan D. Tarlow MD 3 Comments

What Is a Makoplasty Partial Knee?

Dr. Tarlow utilizes the world’s most advanced orthopedic robotic arm and computer software system at HonorHealth’s Scottsdale Healthcare Thompson Peak. Each implant is customized to precisely optimize your knee alignment, tracking, and ligament tensioning to extend the life of your implant. Makoplasty Robotic partial knee resurfacing is a less invasive solution designed to restore the feeling of a natural knee. Every patient is unique. Every result is precisely beautiful. Walk away from your knee pain today!

Advanced Knee Care, P.C. and Scottsdale Healthcare Thompson Peak is one of a few locations worldwide to offer partial knee resurfacing with MAKOplasty®, a technique that resurfaces the damaged area of the knee without compromising the healthy bone, ligaments and tissue surrounding it. The robotic-arm assisted, minimally invasive procedure may offer a smaller incision and a faster, less painful recovery than traditional joint replacement surgery, with many patients back on their feet in just days.

The process begins with a detailed evaluation including an office visit with Dr. Tarlow for specific knee history, detailed physical exam and standing 4 view knee x-ray series. Other special imaging tests might be required. After the decision to perform Makoplasty is finalized, three main steps are completed to assure accurate sizing, precise implant alignment, and proper balancing of the knee.

Step One: CT Scan of the knee done at Scottsdale Healthcare Thompson Peak (must be done at this facility – CT machine is specifically calibrated for Makoplasty procedure). The CT provides precise, unique anatomic detail of your knee. This data is entered into the Makoplasty computer and is used both before and during the procedure to accurately plan implant size, orientation and alignment utilizing CT-derived 3-D modeling. A provisional sizing and positioning of components is done before surgical implantation.

Step Two: Intra operative placement of Computer Navigation. This “tells the computer” exactly where the knee bones are in space and provides kinematic detail about knee motion and balance. This information is used to refine exact placement of the implant, still in the virtual realm at this point in time.

Step Three: Integration of step one and two allow precise virtual placement of the implant through real-time intra-operative adjustments for correct knee kinematics and soft-tissue balance.

Makoplasty Partial Knee Replacement Recovery

Makoplasty is an inpatient procedure with a usual one-night hospital stay. Typical recovery includes using a walker for a week and return to driving within 2 weeks. As a knee arthroplasty procedure, MAKOplasty® is typically covered by most health insurers.

The Robotic Arm Interactive Orthopedic System is now introduced into the knee using
minimally invasive exposure and bone sparing removal of damaged tissue to form a shallow trough to allow the Restoris implants to be permanently placed into the knee replicating the precise sizing and location derived from CT scan, Computer Navigation, and virtual kinematics. RIO® assists the surgeon in achieving natural knee kinematics and optimal results at a level of precision previously unattainable with conventional instrumentation.

Commonly Identified Benefits of Robotic Knee Resurfacing

Less Pain vs. Total Knee has been observed
Rapid Recovery is commonly seen
Minimal Rehab
Minimally invasive incision
Precision Implant Position
One Night Stay is usual
Easier Recovery Than Total Knee has been observed
Preservation of Healthy Tissues
Patient Specific, Custom Fit for Men and Women
Return to Activity including Golf ,Tennis, Hiking, Biking, Work

Factors That Favor A Successful Partial Knee Replacement (Makoplasty)

Implant Design, Surgeon Experience, and Patient Age greater than 65 years are associated with improved outcomes for unicompartmental knee replacement. This is sometimes termed Makoplasty or partial knee replacement. In Dr. Tarlow’s opinion, precise implant placement using computer navigation and virtual modeling and robotic arm guided resection will be shown further improve outcomes.

In a report from Kaiser Permanente California from 2013 the following factors are associated with better patient outcomes.

1. Implant design Zimmer

Unicompartmental Knee arthroplasty (ZUKA) had a 1 % revision rate, the Oxford Mobile Bearing 1.7 % revision rate and all others tested were 6 % or greater. The Restoris implant used for Makoplasty incorporates all the important design characteristics of the ZUKA implant.

2. Surgeon Experience

A surgeon case volume of less than 12 cases per year had double the revision rate compared to surgeons with greater than 12 cases per year. Dr. Tarlow performs greater than 75 cases per year.

3. Patients younger than 55 are in most cases more physically active than patients older than 65 years of age

The revision rate in the Kaiser report observed a 5 times higher revision rate in patients under 55 years of age. This is not a universal finding and other studies can be found showing similar revision rates in patients of all ages.

Optimizing Makoplasty Partial Knee Replacement for Our Patients

Advanced Knee Care and Stefan D. Tarlow, MD have had the Makoplasty robot for use at Scottsdale Healthcare Thompson Peak since January 2011. Our team has continued to refine the delivery of this service to our patients. “State of the Art” is an Outpatient surgical procedure with minimally invasive techniques, multimodal pain management and faster recovery.

An office visit with Stefan D. Tarlow, MD at his Scottsdale location starts the process. In most cases the decision for Makoplasty can be made on the initial visit including Patient History, Comprehensive Knee examination, and orthopedic quality “4 view” standing xray done in his office.

On arrival at the hospital our RN team prepares the patient for the procedure including our 13 Steps to help prevent surgical site infections and initiation of multimodal pain control. Saphenous Nerve Block, a quick and painless anesthesia procedure performed in the Pre operative area, is one of the keys to Outpatient Makoplasty.

The Makoplasty Partial Knee replacement is done in our operating room with our hand-picked team of anesthesiologist, nurses and physician assistants. The procedure duration is 90 minutes in most cases.

Once awake, a Physical Therapist consult in the recovery room is the last step before heading home, leaving the hospital on a walker.

Three Pain medications are used in combination to keep our patients comfortable as they recover from their surgery. The three include oxycodone (sometimes hydrocodone) are narcotics that works by binding to receptors in the brain and blocking the feeling of pain. Lyrica is thought to work by blocking pain in the brain and spinal cord. Acetaminophen is thought to block pain receptors in the brain.

VenaFlow Elite is a home sequential compression device to lower DVT
risk during our patient’s first 2 weeks at home. In addition, Aspirin in used twice daily for 2 weeks.

Finally, Outpatient Physical Therapy is initiated the week after surgery and continues for 3-4 weeks.

These are the keys as to how we optimize recovery for our Makoplasty patients.

Is Makoplasty Partial Knee Replacement Right for You?

February 13, 2017 By Stefan D. Tarlow MD Leave a Comment

Makoplasty Robotic Partial Knee Replacement Best for One Compartment Disease

While Makoplasty parts can be combined in several different configurations, by far the most common is to resurface only one compartment. The one compartment most commonly resurfaced is the medial compartment of the knee.

Medial knee is the time tested application with predictably great outcomes. This procedure has been dramatically improved upon using Robotic Technology.

In my opinion, lateral uni compartmental application works well when your surgeon is able to incorporate accurate implant placement using Makoplasty Robotics and Computer Balancing and CT mapping technology.

Xray of Medial Mako (most common construct)

Bicompartmental Mako Components for Tibial Resurfacing

Bicompartmental Mako components (No patellar button shown and 2 options for tibial resurfacing shown)

Bicompartmental Mako with no patellar button

Cartoon of Bicompartmental Mako (no patellar button)

Bicompartmental Knee Resurfacing:

In my hands, bicompartmental use is a less desirable construct. If two or more compartments are arthritic Dr. T. will usually recommend Total Knee Replacement. Another bicompartmental construct is to resurface the medial and lateral compartments, leaving healthy patella. This is rarely done and no xray image was able to be found on line to even demonstrate the appearance of this.

Xray of Bicompartmental Mako (patellofemoral + medial uni)

Makoplasty Unicompartmental Knee Mimics Natural Knee

Dr. Tarlow attended a course titled “Update on Unicondylar Knee Replacement” this past week at the annual meeting of the American Academy of Orthopedic Surgeons.

The best surgical outcomes are in unicompartmental knee patients. Uni patients have a higher satisfaction score, lower chance of infection, stroke, heart attack, blood transfusion, blood clot and death rate compared to total knee replacement patients.

The appeal of the unicompartmental or partial knee replacement also known as Makoplasty can be summarized in the following thoughts.

Makoplasty replaced knees compared to Total Knee Replacement:

Retain more normal knee tissue – including the ACL and PCL ligaments
There is less bone resection
Smaller incisions
Less pain/quicker recovery
improved, often times normal knee motion
Less expensive

2014 study from Germany showed unicompartmental knee closely preserves natural knee kinematics in vitro.

2015 study from New York showed Unicompartmental knee arthroplasty is an economically attractive alternative in patients sixty-five years of age or older, and modest improvements in implant survivorship could make it a cost-effective alternative in younger patients.

Most studies comparing unicompartmental knee replacement versus total knee replacement find a slight preference in favor of unicompartmental knee.

Makoplasty Partial Knee Resurfacing Shown To Be Best Surgical Method

Study finds MAKOplasty® Partial Knee Resurfacing Offers Lower Post-Op Pain, Improved Knee Function

The content for this blog post comes from the work by Blyth MJ, Smith J, Jones B, MacLean III AB, Anthony, Rose P entillted Does robotic surgical assistance improve the accuracy of implant placement in unicompartmental knee arthroplasty?

Comments from Dr. Tarlow: Common sense would lead me to conclude that precise implant placement will result in the best patient outcomes from partial knee replacement surgery. Makoplasty allows the surgeon to optimize implant size, knee alignment, implant tracking and limp alignment. My observation is that many patients return to close to normal knee function after this procedure. Scientific research is lacking to validate my observation. This is the first in hopefully many studies that corroborate my clinical observations.

Summary of Study: Results of an ongoing study on partial knee replacement surgery provide early clinical evidence that robotic arm assisted MAKOplasty Partial Knee Resurfacing results in improved knee function and less pain when compared to manual procedures using Oxford® implants.1 The study, which started in October 2010, is being conducted in Scotland and will be ongoing for ten years. The initial results looked at early outcomes of 100 partial knee replacement procedures – 50 robotic arm assisted MAKOplasty procedures and 50 manual procedures performed with Oxford® implants. All surgeries were unicompartmental knee arthroplasty (UKA) procedures, which involve only one compartment of the knee.

The researchers found that when compared with conventional procedures MAKOplasty resulted in:

Lower post-operative pain from day one up to 8 weeks after surgery
More accurate implant placement
Twice as many patients with improved knee functionality (57% vs. 26%) based on American Knee Society Scores

This study was presented at the 2013 Annual Meeting of the American Academy of Orthopaedic Surgeons.

Makoplasty Knee Surgery and Home In One Day-Outpatient Partial Knee Replacement

Makoplasty knee surgery with Dr. Stefan Tarlow and his team

Dr. Tarlow team performing Makoplasty

Stefan D. Tarlow, M.D., Knee Surgeon with Advanced Knee Care, P.C. has posted a new video with an overview showing how Makoplasty, a partial knee replacement procedure using robotic technology can be performed as an outpatient. Click here to watch the 4 minute video.

Makoplasty – Partial Knee Replacement – Home the Same Day

Scottsdale Healthcare Thompson Peak acquired a Mako RIO system in Janaury, 2011. Since that time Dr. Stefan Tarlow has performed over 180 procedures, more than any other orthopedic surgeon in Arizona. Dr. Tarlow is Arizona’a most practiced and well-versed Makoplasty surgeon. Not content with status quo, he and his team continue to innovate and improve on the technique.Our team of Surgeons, Nurses and Anesthesiologists have continued to refine our delivery of care for our surgical patients. This is particularly evident in the patients undergoing partial knee replacement using the robotic technology known as Makoplasty.

Today’s standard delivery of care has evolved to outpatient day surgery
due to improved surgical efficiency, saphenous nerve block (little to no motor weakness compared to femoral nerve block), and recovery room pain management with short acting opiods (Fentanyl). Together these modifications allow many patients to go home directly from recovery room.

Makoplasty Specialist Brian Fighting Irish