Health & Medicine
April 18, 2008, 11:05PM
New technology eliminates
guesswork in knee surgeries
By DALE ROBERTSON
Copyright 2008 Houston Chronicle
At first glance, the technology seems impossibly complicated,
something straight out of the 22nd century.
Operating with a
computer-assisted visualization guide consisting of one high-def
TV for Dr. Stefan Kreuzer and another for an associate who keeps
watch over the software, a robotic arm gently directs the
surgeon's hand as he chisels an ever-so-precise chunk from the
tip of a patient's arthritis-damaged femur. Should Kreuzer
wander off course the least little bit, the computer squawks
irritably, then locks him down cold.
Properly calibrated — using something akin to GPS
triangulation — the MAKO Tactile Guidance System has zero
tolerance for even the tiniest degree of human error. And that
means it makes partial knee-replacement surgery, a uniquely
challenging procedure because of the complexity of the joint, an
option for still-active middle-aged folks whohad been told to
just suck it up and live with around-the-clock pain.
"The partials were so technically challenging," concedes the
Swiss-born, American-trained Kreuzer, the MAKOplasty® pioneer in
the Houston area, "we'd usually say, 'Let's just do a total.' "
And total knee replacements, under the best of circumstances,
are both far more invasive and far more limiting, making them
less attractive for people who still enjoy strolling through
their neighborhoods, getting in a round of golf or arranging a
game of doubles down at the courts.
The human eye is just so
good, the hand only so steady. The guesswork in old-style
partial knee replacements made them prone to fail — often inside
of five years — and the ensuing total replacement became much
more dicey because of the bone-mass loss resulting from the
initial surgery. Doctors were reluctant to expose their patients
to such a double whammy.
The MAKOplasty® partial replacements
are expected to have a lifespan in excess of 10 years, although
because the first surgery using the system was done less than
two years ago, nobody can yet predict for certain. However, what
can be said is that, based on short-term feedback, the results
have been spectacular.
Johnny Pizzo, a 68-year-old retired cabinet maker with "a
worn-out knee," underwent the knife at Foundation Surgical
Hospital Feb. 8. Today, he says, "I'm doing great," and that's
despite his having recently wrenched it when he took a tumble in
his backyard. Come June, he'll tour Greece with his wife.
"I just wanted to walk normally again," Pizzo said. "I really
wanted to take that trip, but I knew I had to be able to keep up
with the other people."
Jerry Harris, a 65-year-old who owns
a leasing company and was once an avid runner, had gotten to
where he could barely hobble from his bedroom to the front door.
"I'm an active person, not a couch potato," Harris said. "Like
most men, I tried to force myself to take (the pain), but
something had to be done. Some of my friends had had full
replacements, but this offered the option of staying a lot more
When Harris entered the operating room Halloween morning, he
observed, "This looks like the Spaceship Enterprise. That's the
last thing I remember (before the anesthesia kicked in)."
About 1:30 the same afternoon, a therapist awakened him, saying:
"Mr. Harris, it's time for your walk down the hall."
"I told her, 'My what?' But I walked down that hall without
crutches or even a cane. I spent the night here, walked out of
the hospital the next afternoon. The next day after that, I took
my dogs out for an hour."
Harris' lone concession has been to
give up jogging, explaining that he'd prefer to prolong the life
of his "new" knee for as long as possible. But he walks and
rides an exercise bike regularly.
"I've told the world about
it," he said.
As a former college tennis player, the 41-year-old Kreuzer is
hypersensitive to his patients' desires to maintain healthy
lifestyles. Having discovered the MAKOplasty® system at a
surgical convention, he was a fan from the get-go. He pitched it
to three area hospitals, but Foundation Surgical, the upscale
newcomer on the West Loop just south of the Southwest Freeway
interchange, was the only one to bite. For the moment, it's the
only facility in the region — and one of just eight in the
country — to purchase the system, which requires an investment
of about $1 million.
Dr. Henry Blum, the chairman of the
governing board at Foundation and a staff surgeon, oversaw much
due-diligence research at Kreuzer's behest and came away
"We did a very thorough analysis – first clinical, then
financial," said Blum, who performed the operation on Pizzo. "It
made sense for us. It was a perfect fit – no pun intended –
because orthopedics is our focus."
The MAKOplasty® procedure is extremely efficient and
cost-effective, save for the initial outlay. Patients are rarely
hospitalized for more than 24 hours and many can do all of their
rehab at home. Still, because Foundation is an out-of-network
hospital, some insurance plans won't permit their policy-holders
to go there.
But Kreuzer is negotiating personally with one large
insurance company to find a solution and thinks the problem,
which impacts about 10 percent of his patients, will be resolved
as more MAKOplasty® arms come on line.
Despite the apparent
complexity of the procedure, Kreuzer insists "the learning curve
for surgeons is really pretty short. We've got a number of
general orthopedists doing it already."
He also believes the evolving MAKOplasty® technology
will be applicable for total knee replacements within
three to four years. Nonetheless, partials will always
be the preferred option, if they're an option.
more of your own anatomy you keep in place," Kreuzer
said, "the better."