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robotic surgica l system assists in t h e p r o c e d u r e a n d p r o v i d e s immediate feed- ba c k to en s u re t h e i m p l a nt i s positioned for the best fit. "M AKOplasty i nvolves pre c i- sion surgery done t hrough a ver y sma ll incision," Dr. Petraco says. " P a r t i a l k n e e replacement has been around for many years; however, the longevity of the implants was not optimal because it was difficult to get the early implants into perfect alignment. With MAKOplasty, we incorporate preopera- tive CT scans and robotics, allowing for enhanced precision. We perform the opera- tion graphically, seeing exactly where the implant will be, telling the computer exactly where we want the implant to sit. In every case, when we look at the postoperative X-ray, the implant is exactly where we want it, and that leads to long-lasting results." "The onset of robotic surgery has changed how we perform partial knee replacements," Dr. McGinley says. "Now, we can create a preoperative plan and follow it within a millimeter. We are more comfortable that the prosthesis will not wear out." A Different Kind of Robot Since MAKOplasty is a robotic surgery, patients may associate it with da Vinci procedures. However, MAKOplasty has many features that set it apart. The relationship between the robot and the surgeon-operator is different. In the case of a robotic prostatectomy, for example, the surgeon is working at a console, not manipulating the instruments by hand. "With MAKOplasty, the surgeon removes bone using something similar to a high-speed drill," Dr. Petraco says. "The robotic component is actually a safety and precision measure. At any given time during surgery, an overhead camera looks at arrays attached to the bone. The camera and robot communicate so the robot knows where the burr is relative to the bone at all times. If the surgeon tries to remove bone from an area that wasn't indicated for removal in the preoperative plan, the burr turns off. And, if you try to push the burr outside the field of intended bone resection, the burr will not move." The result, Dr. McGinley says, is unprecedented accuracy. "I know that my surgical plan will be replicated to within 1-millimeter accuracy," he says. "The end result will be an aligned prosthesis that will not wear out." The emphasis on pinpoint precision begins with the initial CT scan. "We download the information from the CT into the computer, which constructs a graphic design of the femur and tibia surfaces," Dr. McGinley says. "With that information, we determine the size of the component we need to use and how to position it for the best alignment and stability. While we perform surgery, the computer helps us place the prosthesis correctly, assesses stability and checks the tightness of the ligaments. That way, we can position the prosthesis and adjust the ligaments as necessary during the course of the procedure." Dev ices on t he femur a nd t ibia make this tracking possible. Infrared cameras beam light to the tracking markers and report the information instantaneously to the computer, which matches the tracking data to the CT scan used to identif y the location of the bone surfaces. " We st a r t by touching t he bone surfaces with a tracking probe, which shows the computer where the surface is relative to the bone," Dr. McGinley explains. "Then, the computer knows how the bones match the surface map we have created, based on the CT scan data. If we do not pick our reference points well enough, the computer alerts us, and we make adjustments. As we perform surgery, the burr recognizes the location of the bones and bone sur- faces and, as a result, its own location." Dr. McGinley has been performing partial knee resurfacing for many years, he says, and he appreciates the extra tear in a single compartment due to the alignment of the joint," he explains. "In the cases of mild knock-knee or bowed legs, resurfacing one compartment may be a perfect option." Athletes and others who have had prior arthroscopic surger y may also benefit from partial knee resurfacing. "Of ten, these patients' meniscus was completely or partially removed," he says. "The joint will wear out at a faster rate where the meniscus is missing. If the rest of the joint is in good shape, those who have had partial meniscectomies may be good candidates for MAKOplasty." MAKOplasty Partial Knee Resurfacing At St. Charles Hospital, MAKOplasty is the preferred technique for partial knee resurfacing. This trademarked procedure starts with 3-D knee imaging, upon which a surgical plan is built. A COV ER FE AT UR E Computer graphics demonstrate the remaining area of intended bone resection (in green), as well as the area of bone that has already been prepared using the robotic burr. The burr is used to remove bone. The visual arrays identify the location of the femur and tibia. 8 | Long Island MD NEWS ■ M D N E W S . CO M

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