Robotically-Assisted Knee Replacement

This isn’t good.” - That’s what Gary Bowers said to his wife after he hit a tee shot on the fourth hole at Toscana Country Club last February and felt excruciating pain in his left knee.

“I’d never felt that kind of pain before,” the 68-year-old avid golfer relates. He cut that day’s game short and tried to play again a few days later. “I could only play two or three holes without severe pain, so I didn’t play anymore and went to see my doctor.”

Bowers’ primary care physician, Joseph Scherger, MD, MPH, referred him to Erik Schnaser, MD, at Eisenhower Desert Orthopedic Center. Fellowship-trained and Board Certified in Orthopedic Surgery, Dr. Schnaser specializes in joint replacement, performing 800 to 900 knee and hip replacements a year, including revisions.

An MRI revealed significant cartilage loss in Bowers’ left knee. Cartilage is flexible connective tissue that coats the surfaces of the bones in joints. It acts as a shock absorber that cushions the bones so they can move smoothly. With wear and tear over time, however, the cartilage can become damaged, resulting in pain from bone rubbing on bone. 

Based on the imaging results and Bowers’ symptoms, a total knee replacement was recommended. But this wasn’t going to be a traditional knee replacement operation — it was a less-invasive, robotically-assisted procedure.

“Every patient I operate on, I try to do the procedure robotically,” says Dr. Schnaser. 

“Historically, the instrumentation and implants used in conventional knee replacements are designed for the average person,” he says. “The companies that make these products calculate the average angle and size for people in a given population and design the instruments and implants to fit most people in that cohort.

But not everyone is “average.”

While a lot of people can get a standard knee replacement and do just fine, the literature says that 20 percent of knee replacement patients are not completely happy,” he continues. “That’s because some patients are outliers, and if you change their body’s biomechanics too much, the body has to relearn how to use the new joint, and that can take months, even years.”

To avoid this issue, Eisenhower Health has invested in the Mako SmartRoboticsTM system by Stryker. This technological advancement in joint replacement surgery transforms the way total knee, partial knee and total hip replacements are performed by helping surgeons know more and cut less. 

“With this robotically-assisted approach, the robot customizes the implant to give the patient a more biomechanically favorable knee,” Dr. Schnaser says. 

Prior to surgery, a CT scan of the knee joint is performed; this is used to generate a virtual 3D model or “map” of the patient’s unique anatomy. The map is integrated with the Mako system software to create a personalized operative plan. This detailed mapping guides the surgeon to remove only the diseased portions of the knee, sparing as much healthy bone and other tissue as possible — a real plus for improved recovery time and reducing the need for a future revision.  

“We also can precisely visualize where the implant goes and match it to the individual patient’s anatomy,” Dr. Schnaser says. “There’s no more accurate or precise way to do this outside of robotics.”

The robotically-assisted approach to knee replacement also yields other patient benefits when compared to traditional surgery, including less pain, a reduced need for opioid pain medication, reduced inpatient physical therapy, a shorter hospital stay, improved knee flexion and greater soft-tissue protection.

“We don’t need nearly the number of retractors with the Mako system as with traditional surgery, so we’re not manipulating the knee as much and stressing soft tissues,” Dr. Schnaser notes. 

Eisenhower Health is such a believer in the Mako technology that the organization has acquired four of Stryker’s SmartRobotics systems. In fact, Eisenhower is the first hospital in Riverside County and one of only five hospitals in the nation — including such major academic institutions as the Cleveland Clinic and New York’s Hospital for Special Surgery — to have four of these state-of-the-art orthopedic robotic systems.

After his experience, Bowers also is a believer in the technology and how it enabled him to quickly return to doing what he loves.

“I play a lot of golf,” he says. “I have a fairly low handicap and it was important to me to be able to get back to the game.

“I had surgery around 7 a.m. on April 20, my wife picked me up around noon, and I was home on a walker that afternoon,” he continues. “I don’t care to sit around and I wanted to heal as quickly as possible without damaging my knee. I was on that walker every day for three weeks. Physical therapy really helped and I did my exercises religiously.

As a result, three weeks post-op, Bowers was out chipping balls. Within another few weeks, he was playing nine holes off the ladies’ tees, gradually working up to his regular game and “hitting close to 100 percent.” He also walks two to three-and-a-half miles every day.

Bowers gives high marks to Dr. Schnaser and the entire orthopedic surgery and physical therapy team at Eisenhower. As a health care administrator — he used to own and operate skilled nursing and memory care facilities and currently owns a Nevada company that cares for developmentally disabled adults — he is uniquely positioned to assess high-quality health care.

“The doctors and staff at Eisenhower are exceptional,” he says. “The unit I was in is one of the cleanest, most modern that I’ve ever seen. My nurse…I would try to hire her if I were still in that business; all the nurses were great.”

He is especially grateful that he was able to schedule his surgery and recuperation in the desert before flying back to his home in Dallas for the summer.
 
“I don’t think I could have had a better outcome,” he adds. “If I ever had to have another surgery, there’s no question I’d do it at Eisenhower.”  

For more information or to find a physician at Eisenhower Desert Orthopedic Center, call 760.773.4545. Or visit EisenhowerHealth.org/EDOC.