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alignment have been challenging because cutting systems have not been accurate, so many surgeons have shied away from the surgery." The preoperative plan provides patient- specific surgical direction and serves as the guiding template for the precision cutter Dr. Hartman uses to remove osteoarthritic surface from the knee. Dr. Hartman continuously assesses the plan during the procedure by moving the patient's leg through its entire range of motion. The software provides real-time data that enables him to make adjustments to optimize knee kinematics and soft-tissue balance, which significantly improves replacement component positioning. "During the operation, I can view the 3-D model of the knee on almost any plane I want," Dr. Hartman says. "If I determine the resection or component needs an adjust- ment to enhance tracking or tension on the ligaments, I can make that adjustment in the operating room. The plan can be revised and locked in to the computer in real-time, and the parameters within which the robotic arm can be guided are immediately updated." Traditional approaches to partial knee resurfacing have no safeguards to prevent resection of normal bone. MAKOplasty provides three, the first being the pre- operative master plan. The second is the real-time guide. "During surgery, I watch the computer screen, which shows the section of bone and the position of the component," Dr. Hartman explains. "The third failsafe is audi- tory feedback. If the surgeon strays less than one-half millimeter from the surgical plan, the computer warns you, and if you try to continue on an aberrant trajectory, the precision cutter will turn off. The system will not let you make a mistake." A representative from MAKO Surgical Corp. is also present in the operating room for each MAKOplasty procedure, providing additiona l techni- cal support. Improving Total Hip Replacement MAKOplasty total hip replacement is indicated for patients suffering from inflam- matory or non-inflammatory degenerative joint disease and provides orthopedic sur- geons a more accurate method for placing acetabular cups — one of the more chal- lenging aspects of total hip replacement, as surgeons often eyeball the placement. Because improper component positioning can lead to joint dislocation and implant loosening, precise placement is critical. "MAKOplasty is a valuable tool in the armamentarium for hip replace- ment because of its ability to accurately position the acetabular cup and reduce impingement on the hip and the rate of postoperative dislocation," Dr. Hartman says. "Additionally, the system helps surgeons accurately recreate leg length within 1.2 millimeters of the other leg." MAKOplasty total hip replacement follows the same planning process as partial knee resurfacing. Dr. Hartman constructs patient-specific surgical plans from uploaded preoperative CT scans and uses the plan to size the component and determine its orientation and center of rotation. To perform the procedure, the precision cutter is replaced with reamer and cup impaction instrumentation. MAKOplasty protects against hip impingement by providing more accurate and reproducible inclination and anteversion than manual procedures. The system's versatility is such that surgeons can use the approach (direct anterior, p o s t e r o l a t e r a l o r a nterolatera l) w it h w h i c h t h e y a r e most comfortable. Before leaving the operating room, the s y s t e m p r o v i d e s a results summary that confirms the proce- dure's accuracy. The Value in Outpatient Joint Replacement Although MAKOplasty is indicated for specific disease states, age is not a prohibitive factor in identifying potential candidates. "A fast-growing patient demographic for total joint replacements is the age group between 45 and 64 years old, and soon they'll be the biggest consumer for hip and knee replacements," Dr. Hartman says. "However, MAKOplasty is not a treatment for a specific age group." Dr. Hartman exclusively performs MAKOplasty total hip replacement and partial knee resurfacing opera- t ions a s out pat ient procedures at Minnesota Valley Surgery Center, a beneficial arrangement for surgeons and patients alike. "This should drive down the cost of health care," Dr. Hartman says. "Surgery centers are more cost-effective than hos- pitals, which often require inpatient care. But surgery centers provide value in other areas as well. The rate of infection is less in surgery centers because ill patients aren't staying overnight. The accuracy of MAKOplasty will also diminish the need for revision procedures, which are an increasing problem for joint-replacement surgeons across the United States." For more infor mation, please visit minnesotavalleysurgerycenter.com. ■ COV ER FE AT UR E 8 | Minnesota MD NEWS ■ M D N E W S . CO M

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