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Robotic knee surgery now at Doctors

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QUICK RECOVERY

MAKOplasty technician Scott Eller leads support staff members through an orientation in the use of the RIO robot in a simulated operation of the partial replacement of a patient’s knee in the cente...

GLENN KAHL/The Bulletin


POSTED July 25, 2013 12:30 a.m.

There’s a new $1 million computer-controlled robot at work in the operating room at Doctors Hospital of Manteca assisting orthopedic surgeons with partial knee replacement surgeries providing patients with an early range of motion, putting them back on their feet quickly following the procedures.

The Manteca hospital is the only facility offering MAKOplasty robotic knee and hip surgery from Manteca to Fresno to the south with just one other hospital in the region to the north.  Tenet purchased five of the robots to be used in their other hospitals as well.

Hospital CEO Nicholas Tejeda was pleased with the advent of the state-of-the-art equipment.

“MAKOplasty brings the precision of a robot and yet provides the skill of a surgeon,” Tejeda said. “Because of that you have faster rehabilitation and better outcomes – and, for anyone suffering knee pain – that’s great news.”

Dr. Morteza Farr performed the first surgery early last week on Mary Esparza, 71, of Manteca. She showed surprise at the ease of movement in her knee several hours after surgery when the hospital’s physical therapist Eric Rudel tested her range of movement and walked her the length of several patient rooms down the hallway.

Farr said the use of the MAKOplasty robot makes the surgery more precise and makes sure the prosthesis is centered to allow full movement of the knee.  Farr has performed three partial knee replacements in the last week in Manteca with all showing excellent results, he noted.  Two of those went home the same day, he added.

The Manteca surgeon said the shaving of the knee by the burring of the robotic arm is based on what is loaded into the computer with the pre-registration control points. 

“I’m really happy with the outcome of the patients we did right off the bat,” Farr said. “I have nearly four years of experience in (conventional) uni-compartment knee replacement surgeries.”

Esparza recalled her problems began after she had vein surgery three years ago at a Stockton hospital to address a leg condition.

“Last year I started having pain with my knee – the right knee.  They did arthroscopic surgery on it because I tore my meniscus in September and I have had nothing but problems ever since.  I’ve had injections – I have had everything.  I couldn’t even walk.  I had to sit most of the time or lay down on the sofa.  They gave me Vitamin B6 and Vitamin B12 and some pain medications for me to be able to function.  Every moment on my knee was just like torture.  So, in January they said they were going to have to do this knee replacement, and then the doctor calls me in and says, ‘Oh, we have something new.’”

What was new was the MAKOplasty (trade name) surgeon-controlled RIO Robotic Arm Interactive Orthopedic System which makes possible accurate alignment and positioning of the implant.

Esparza has four children, six grandchildren, three step grandchildren and nine great grandchildren. She hopes to be able to once again go dancing like she has in the past and travel to the Oregon Coast as she has in many of her past years before her knee gave out. 

“It’s very exciting,” she said before the procedure.  “The doctor told me he did the same procedure in San Jose and the patient walked right out.”

The robotic procedure targets the parts of the knee that have been damaged by Osoteo-arthritis with the MAKOplasty performed through a four to six inch incision over the center of the knee with several small incisions made in both the femur and the tibia.  The procedure preserves more of the patient’s natural bone and tissue than in conventional surgery.

On Monday of last week MAKOplasty Surgical Co. technician Scott Eller provided an orientation for hospital support staff members, providing them with a first-hand look at a simulation of the procedure in one of the operating rooms.

The first step in the surgery is to order an X-ray to determine if the patient is a candidate for the procedure. Those needing full knee replacements are not eligible.  The patient will then be given a CT scan providing a three dimensional picture of the knee.

In the actual surgery, computer navigation is used in what relates to a GPS positioning of the knee, informing the computer of the anatomy of the knee and the leg, indicating just how the knee is going to function when all is completed.

The X-ray and CT scan information is fed into the robot’s computer program showing exactly how the implant is going to fit in the procedure and showing how much bone has to be buffered off.  The robot has a burring drill rather than a saw to allow the implant to fit precisely in place. 

The procedure takes about an hour and a half in most cases, doctors said.

The hospital is hosting an open house in the DHM Conference Center on Wednesday, July 31, from 2 to 5 p.m. for members of the public to learn more about their “exciting new equipment” for knee and hip surgery.  The center is located at the corner of North Street and Cottage Avenue in Manteca. Please RSVP to Kathy McKenzie at (209) 239-8721.

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