Tonawanda News

August 18, 2013

Robot technology aids in hip, knee replacements

By Danielle Haynes
The Tonawanda News

KENMORE — For Lewiston resident Betty Rienzo, the ability to be up and about on her feet was pretty important to her. 

Up until last November, the now-70-year-old, worked as a certified medical assistant for a podiatrist, which, like for many in the medical industry, involved lots of walking around and long hours on her feet.

”I very rarely sat,” she said.

That was, until she had a fall while on the job that injured her right knee. The once-active woman was now walking with the assistance of a walker and receiving regular cortisone shots to relieve inflammation. 

She told her employer that fall it was time for her to retire ... the pain was just too much.

Rienzo’s orthopedic surgeon, Dr. Peter Shields, told her she needed a full knee-replacement. During the scans and X-rays required for that surgery in March, Shields discovered the injury to her knee had subsequently caused strain on her hip, chewing away at the ball in the joint.

She would also need hip-replacement surgery, but this time Shields wanted to use a less-traditional procedure that used technology unique in Western New York.

Shields has pioneered the use of the MAKOplasty robotic-assisted hip-replacement surgery in the Buffalo area at Kenmore Mercy Hospital. The surgery makes use of a robotic device, the RIO Robotic Arm Interactive Orthopedic System, which allows surgeons to input a CT scan of the patient’s hip into the robot, which then guides the surgeon in the replacement process.

”In hip-replacement surgeries, especially, we’ve always had some problems with the position of the components. Even though we do hundreds of these, everybody’s anatomy is a little different,” which can lead to post-operative hip dislocation and impingement, and uneven leg length, Shields said. “Those are things we try to minimize as best we can by preemptive planning.”

”The robot allows us to go one step beyond that because we can predictably postition the ball and socket so we can have positioning as accurate as possible,” he added.

A recent study by Dr. Henrik Malchau, of Massachusetts General Hospital, found that of 77 total hip-replacement surgeries done by three surgeons with the robot, 84 percent were correctly positioned within an acceptable range. That compares to a 47 percent acceptable range among 1,823 traditional hip-replacement surgeries at the hospital, MAKO Surgical Corp. says on its website.

Shields said he underwent extensive training in Miami, Fla., to learn to make use of the MAKO robot, which Kenmore Mercy Hospital purchased for $750,000 in 2008. Kenmore Mercy’s MAKO robot is one of 164 commercially used in the United States and one of 171 worldwide.

Walt Ludwig, Kenmore Mercy’s chief operating officer, said the technology wasn’t initially even offered to hospitals in Western New York because a hospital would have to have a high volume of orthopedic surgery to make it worth its while. He said more orthopedic surgeons have come to the hospital because of its continued investment in its orthopedic program, resulting in more orthopedic surgeries. 

Up until March, the only surgeon using the device at Kenmore Mercy was Dr. John Repicci, who helped MAKO develop the technology.

”Since one of our local orthopedic surgeons was very instrumental in helping this company develop this robot and how it works, it made sense for us to obtain it,” Ludwig said.

Repicci uses the technology to perform partial knee-replacement surgeries, the only procedure Kenmore Mercy’s robot was used for until Shields began using it for hips in March.

Shields has completed 13 surgeries as of the first week of August. 

Rienzo’s was done July 15, just three weeks before her interview. She said she was initially hesitant about the surgery, convinced it would be more complicated and painful than her knee surgery.

”I thought I would be laid up a long time,” she said, but she was up on her feet the same day as her surgery and was released from the hospital three days later. 

Rienzo spent a week at a rehabilitation center and was sent home.  

”When I came home it was not even two weeks after surgery and I cooked dinner,” she said, adding that her recovery was not nearly as quick with her knee-replacement surgery.

Three weeks after her surgery she described her pain as somewhere between a one or a two on a 10-point scale and though she’s still using a walker, expected to make the switch to a cane in a few days. She hoped to be walking implement-free within a month.

Her recovery has gone so well, Rienzo said, her former employer has asked her if she’d return to work. While she wasn’t willing to confirm whether she would or not, she said she’s not shy to tell people robotic hip-replacement surgery is best way to go.

”The hip replacement really was nothing,” she said of the pain and recovery.

”When I was in the (rehabilitation) home a lot of the nurses asked about it because their mothers needed hip replacement,” she said, adding she gave them a positive review of her procedure with Shields.

Shields said the only con to using the MAKO robot is that the surgery takes between 20 and 30 minutes longer than a traditional procedure, which typically lasts 3 to 3 1/2 hours.

”If I had somebody who may have an exceptional risk to surgery, I may do a traditional (hip-replacement procedure) to just go faster,” he said. “My experience so far, I think, is this is the one I’m going to stick with,” he said of MAKOplasty.

Traditional surgery is also a better option for patients with hip fractures, Shields added.

Ludwig said the addition of the MAKO robot in 2008 is part of the hospital’s long-term plan to stay ahead in the field of orthopedic surgery in Western New York.

”We’re opening up a new nursing unit that’s going to be an orthopedic unit,” he said. “It’s something we do very well. We’re proud of what we do and we’re just going to contine pushing forward.

”We look at Kenmore Mercy Hospital as a leader in orthopedic surgery in the community. This is really part of our whole orthopedic strategy. We want to have the best services and the best technology.”

Contact Sunday Lifestyle editor Danielle Haynes at 693-1000, ext. 4116 or follow her on Twitter at @DanielleHaynes1.