Aspen surgeon Thomas Pevny, rear, performs a partial knee replacement using an instrument attached to a robotic arm. A computer monitor displays the area of bone to be cut away in green. (Janet Urquhart, Aspen Times)
ASPEN — Orthopedic surgeons at Aspen Valley Hospital have teamed up with a new player in the operating room, one that's making them better at what they do.
The local hospital is one of two in Colorado to offer MAKOplasty, a procedure that employs a robotic arm to assist surgeons in performing hip and partial knee replacements.
Or, as Dr. Tomas Pevny of Aspen Orthopaedic Associates, suggested, perhaps the surgeons are assisting the robot. Either way, local surgeons say the robotic tool has increased the accuracy of the procedures, made the surgeries less invasive and sometimes made partial knee replacements possible when a total knee replacement was previously the only option.
"I don't get excited about much in orthopedics, but this is very cool," said Dr. LeeLee von Stade, also a surgeon with Aspen Orthopaedics.
The $1.25 million system was installed in August, purchased with the hospital's capital funds. The hospital anticipates 60 MAKOplasty cases per year and has seen about 20 operations make use of the equipment so far, according to Ginny Dyche, community relations director at the hospital.
"With only two in the state (the other is in Denver), we do anticipate we'll be getting patients from outlying areas," she said.
The technology allows the creation of a virtual, three-dimensional image of a patient's joint, with the replacement parts inserted, before the surgeon sets foot in the operating room.
"Even before surgery, I know what size components I'm putting in and where I'm going to put them," Pevny explained before performing a partial knee replacement on a Carbondale man last week.
Not only does the technology sometimes make a partial knee replacement possible when a total replacement was previously necessary, it takes some guesswork out of the operation, according to Pevny.
The partial surgery leaves all the knee ligaments in place, which is good because the joint retains its natural movement. However, placing the components for a partial knee replacement previously required a degree of subjectivity on the surgeon's part, and if the positioning wasn't perfect, an eventual loosening and failure could result, Pevny said.
MAKOplasty allows a surgeon to place the implants precisely in the joint. In the operating room, the patient's knee is synchronized to a three-dimensional scan of the joint, displayed on a computer screen, and the surgeon wields a tool connected to a robotic arm to make the necessary cuts to the bone to accommodate the implants. As bone is carved away, the image on a computer screen suspended above the operating table displays the progress.
The system is not unlike Nintendo Wii video-game technology, which detects the three-dimensional movements of a player grasping a hand-held controller and translates them to the image on a television screen.
"The robot, when we decide that's where we want to cut the bone, does it precisely every time," Pevny said. "It takes the subjectivity out of it."
The robotic arm won't let the surgeon make a cut beyond the pre-established parameters.