Dr. Bartlett Comments

Visit our MAKOplasty Facebook page, where patients share their stories.

Patient Information for MAKOplasty
(Robotic Assisted Partial Knee Resurfacing)

Introduction

As you consider whether MAKOplasty may be right for you, this information will help you understand the procedure and recovery.

The surgery begins with a good visual examination of the inside of your knee. If arthritis is affecting both sides of your knee, you will receive a total knee replacement.

If the arthritis is affecting only one side of your knee, and the other side is normal, you will undergo MAKOplasty or robotic assisted partial knee resurfacing as planned.

Prior to Surgery

A CT scan of the affected knee will be obtained. The digitized CT scan information is then used by the computer for both preoperative planning and for intraoperative bone preparation.

I would recommend a couple sessions of physical therapy prior to surgery. This is called "pre-hab" and will strengthen your knee and prepare you to use crutches immediately after surgery.

Your Surgery

Your incision will be shorter than the ones used for total knee replacement, only about 4 inches long.

Dr. Bartlett performs the surgery with the robot's role being limited to planning and guiding bone preparation. Dr. Bartlett will use your CT scan and a computer to plan your knee resurfacing. Dr. Bartlett will make your incision, examine the knee, expose the part of the joint to be replaced, and operate the high speed burr that removes damaged bone.

During this phase, the robot will guide the burr so that just the right amount of bone is removed and from just the right location. Then Dr. Bartlett will insert the implants and close the knee.

The robotic arm greatly increases the accuracy of bone preparation, implant positioning, ligament balancing and final lower extremity alignment. The normal side of your knee, with its normal joint cartilage and normal meniscus, will be preserved. Also, the important anterior and posterior cruciate ligaments will be preserved. Knee kinematics or knee function will be much more normal than with total knee replacement. In addition, your recovery will be substantially faster.

After surgery

Since there is less pain with MAKOplasty than with total knee replacement surgery, your hospital stay will be only 1 - 2 days. It will be permissible for you to get up in a chair the evening of surgery (unless you have elected to receive a femoral nerve block) and you may begin full weight bearing immediately, although you must use crutches or a walker for balance support. You begin physical therapy the morning after surgery. If you are comfortable and confident in your ability to get around with crutches and/or walker, you may go home that afternoon. If not, you may stay in the hospital and receive more physical therapy the following day.

If you have elected to receive a femoral nerve block for increased pain control, your thigh muscles will be weak and your knee will feel wobbly for 8 - 24 hours after surgery.

If you have received a femoral nerve block, you will need to put only partial weight on your leg until your strength returns. Your hospital stay will probably be an additional day. Whether or not you choose to receive a femoral nerve block, you will have much less pain with MAKOplasty than you would with total knee replacement.

Because your recovery is so swift, when you leave the hospital, you may already have full knee motion. It will not be necessary to use a continuous passive motion machine (CPM) while in the hospital. (This is a machine that rests on your bed and moves your knee for you).

Since your surgical incision is smaller than with knee replacement, and since no bone saws are used, blood loss is very minimal. It is unlikely that you will require a blood transfusion.

Discharge Medications

You will be discharged on the following medications:

1. Celebrex 200 mg, one tablet orally daily for 3 weeks (anti-inflammatory/pain killer).
2. Percocet 5/325, 1 -2 tablets every 4 -6 hours for pain. (Each tablet contains 325 mg acetaminophen (the active ingredient in Tylenol). Do not exceed 4000 mg acetaminophen during any 24 hour period).
3. Aspirin 325 mg, (5 grain), one tablet twice a day for 2 months. (Blood thinner/prevent blood clots).

If you are at a high risk for blood clots (DVT - deep venous thrombosis or PE - pulmonary embolism), you will not use aspirin, but rather a stronger blood thinner will be recommended.

Physical Therapy

You should begin outpatient physical therapy the day after you return home from the hospital. You will need someone to drive you to therapy. You will be given a prescription for therapy. Be sure that you have made an appointment for outpatient physical therapy prior to undergoing your surgery as it can often take 1 - 2 weeks to get an appointment scheduled with physical therapy.

Use of Crutches

You may discontinue crutches or walker when your leg feels strong and stable. This is usually 1 - 2 weeks.

Your First Postop Visit

Please see Dr. Bartlett or his assistant 10 - 12 days after surgery for wound examination and staple removal. You will see Dr. Bartlett again one month, two months, and three months from surgery.

Resuming Activities

Most patients find that by 2 weeks they are able to walk without crutches and they are able to return to light work activities. Most patients are able to drive 3 weeks from surgery and are able to return to relatively normal activity levels 6 weeks from surgery.