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Knee’d To Know: Advancements in Surgery

Dr. Isaac Livshetz, Orthopedic Surgery, Adult Reconstruction, Hip and Knee Surgery

November 2, 2022

Knee’d To Know: Advancements in Surgery

While it can seem daunting, new advancements in technology have transformed the way knee replacement surgeries are performed, with improved outcomes and faster recovery.

Nothing I see on an X-ray is going to say, “You must have knee replace­ment surgery.” Instead, the patient must consider the level of pain, how it limits their function, and whether they’ve tried such other remedies as weight loss, medications, injections, and exercise.

However, studies have shown that nine out of 10 patients wait too long to have knee replacement surgery, which can prolong and complicate recovery.

Better Get MAKO

Incredible advances in knee surgery have increased the appeal of the procedure. A particular game-changer is MAKO Robotic-Arm Assisted Surgery, which allows for improved precision both preoperatively and in real time.

Knee replacement surgery involves removing the damaged cartilage and bone and resurfacing the joint with a durable implant made of metal and polyethylene. The MAKO robotic arm assists the surgeon in very precisely shaping the bone and placing latest-generation implants that effectively fuse with the bone.

Modern implants have a more biologic fixation by integrat­ing into the bone rather than being cemented in. With a traditional implant, cement is used to hold the implant in place. But that cement degrades with time, allowing the implant to loosen, which could lead to another surgery down the road.

These newer implants allow the bone to grow into the implant and form a solid bond without the need for cement. We expect that they will provide a more durable and long-lasting knee replacement.

All of this begins a few days before surgery, when my team and I review a virtual 3D model of the patient’s knee to determine the exact posi­tion and orientation of the implants. Then, with the robotic arm, we can adjust the bone cut and implant position in 0.5-degree incre­ments, to balance out the knee during surgery, which makes it feel as natural as possible.

Minimizing Meds

The robotic-assisted surgery allows us to exercise more pain control, minimize blood loss during surgery, and use fewer – if any – narcotics, which results in a much faster path to healing.

I am a proponent of a new protocol for pain management that combines various classes of medications, pain management techniques, and other palliative methods to target different pain pathways. By using multimodal analgesia, we have made great advances in managing pain after surgery. The approach provides a synergistic effect, which means we can better control pain with lower doses of medications, sometimes eliminating nar­cotic medications altogether.

Our highly tailored regimen often gives patients the confidence to walk within hours of their surgery. Because we’re getting patients up and moving so quickly, we don’t need to prescribe strong blood thinners. They take a baby aspirin rather than something stronger, like Coumadin, which has the potential for doing more harm than good.

In addition, most patients go home to recover, sometimes on the same day as the surgery. A return to “typical” activity can take four to six weeks, depending upon the patient’s adherence to a proper exercise and therapy plan.

To learn more or to make an appointment, call the Center for Orthopedic & Spine Surgery at 914-849-7897.

Dr. Isaac Livshetz

Dr. Isaac Livshetz is a fellowship trained orthopedic surgeon specializing in joint replacement of the hip and knee, including complicated initial joint replacements as well as revision surgery. To schedule an appointment in White Plains/Harrison or New Rochelle, please call 914-946-1010.