Total Knee Replacement with Dr. Miranda

What is a knee replacement? Knee replacement is when we’re cutting resecting portions of the bone that are arthritic and putting in an artificial joint. Artificial joint is made up essentially three or four components here. We replaced the metal, goes onto the femur metal, goes on top of the tibia, and then the bearing surface in between is a hard polyethylene plastic. The patella is not in the kneecaps, not in this picture, but that’s kind of the backside of it is resected off. And a a plastic button is a similar to this kind of plastic is placed on the back of the patella.
So what are goals of knee replacements? Now, goal knee replacement this is not like you’re getting a 20 year old knee done here. Like we’re not, it’s not the fountain of youth, right? It’s an artificial knee. So the goal is to have the patient’s pain reduced, restore motion, and restore your ability to be able to do normal things. Okay? So if you didn’t run before and you have a knee replacement, you can’t then run. But it is a very, very successful surgery to alleviate pain, increase motion and have the patient get back to a more normal state of affairs, so to say in their ability to do normal things. So if they golf before they got an arthritic knee and couldn’t golf, then likely they will return to golf. Most everyone does that now. It’s just if you’ve done an activity in the past, I think that you’d be able to do that most likely after you’ve had the joint.
Cause your body is used to doing that. So this is the kind of a patient we like to see in the office here. Very active, probably 89 year old that smokes a cigar. It’s wonderful. All right. Joint replacement. According to the healthcare research and quality in agency in the United States, there’s over 600,000 joint replacements done each year. So it’s super common surgery. This is kind of an older picture here of what joint replacement looked at, used to look like. You can see back in the background, there’s the actually printed out x-rays. I haven’t seen one of these for several years. Now they’re all digitized. And on the computer we’re able to, um, they don’t even have light boxes like this in some of the rooms anymore. Uh, here there’s multiple sets of instrument trays, trials, cutting blocks. Over here, this is a old fashion bone cement mixer. The gowns that the staff is wearing here, these are cloth gowns, green, ugly looking kind of, it’s just personal preference, but it’s a older style. Here we have one, two, three, four, five, six sets of instrument trays. Okay. So the instrument trays are used in replacements.
And what we do is the bone is kind of sized. We pin blocks to it to make the bone resections. And then there’s trial components that we make sure that we got the right fit and size for each patient. Okay. So this is all those different trays that are required when doing a knee replaced. I mean, kind of the standard or standard or manual with methods.
This is kind of a more, I guess, 2017 operating room. Nice blue colors, a clean kind of a know it has a more sleek appearance to me. We have, it’s not just one tray. There’s multiple trays, but these are stacked. You don’t have to have multiple tables in the room. So it’s kind of a more, um, a simpler system. Okay. So the setup here, actually you couldn’t see it in the other picture, but this, this is one of the representatives that helps run the, uh, Mako robot. We need an assistant to be able to run through the computer software here. And he was you know, posing for the picture. There’s a modern knee holder here, so the, uh, patient’s leg is strapped into this foot boot here and then you’re able to slide the heel up and down to position the leg where it needs to be. Uh, this is the robotic sensor up here. And then the erase that communicate where the leg is in space to the actual robotic system.
We have eliminated with this technique, the robotic portion, because we’re making the bone cuts with the robotic saw. We’ve eliminated the jigs. So it actually is very efficient method because the, there’s less trays to sterilize and process and to transport from, um, you know, per case. So it’s actually in a sense it’s from that standpoint, cost, uh, re re reduced because we don’t have to sterilize as many trays for this procedure, but this is kind of the, so this is, um, the trial periods for the femur or the trial components for the femur. And then these are the plastic pieces that go in between the, uh, the femur and the tibia. I don’t have a picture of the tibial trials, but it’s a lot less, um, instrumentation per case because we’re able to kind of, I’ll get into it a little bit later, but look at the patient’s anatomy and have an idea more so than we did before, of what sizes we’re going to be using.
So this is actually the Mako robot. Okay. So kind of consists of three parts here. This is the robotic arm here. There’s a bar or a saw attached to this portion right here. This is kind of the computer station that the representative use has the keyboard and the mouse there and they can scroll through the different screens. And then this is the screen that the surgeon uses to visualize, uh, what is, uh, being actively being done. So in, in general, the dilemma with joint replacements is that it’s predicted that there’s going to be an exponential increase in the number of joint replacements in the next 20 to 25 years. So with it becoming a more popular surgery, uh, how do we, we would have estimate that more being done. How do we make it last longer for patients? So patients, a life expectancy has been increasing, uh, their demand for, uh, returning to normal activity quicker.
Returning to work is up. Um, and, and we want these, these procedures to be very effective for patients, reduce their pain and kind of get them back on with their life. So how do we achieve this? This is our main goal of what we do. Why do, how do we get, how do we get there? Well, in the past then currently I think that there’s some tools that we use to get us to that point and navigation, kind of a way of doing the procedure. Um, it’s a little different than robotics, but it’s a tool that we utilize to try to get that perfect knee component. Design components have been around for 20, 30 plus years, but they keep evolving to make that the goal is always to have that knee that restores the normal function, normal mechanics, very, very difficult task.
But there’s a lot of different co component designs, types of knee replacements and they all seem to work pretty well in the past. Gender specific knee replacements have been available. This is kind of gone out of favor recently, but very popular in the late nineties, early 2000 when there was a male knee and a female knee was very good marketing campaign by one of the bigger companies. But uh, needless to say, there is certainly difference between a male and female anatomy as well as individual anatomy. So there’s certainly kind of a role for these different sizes of implants. And then patient specific implants are also available. So you map a patient’s need with a CT scan or an MRI, and then the component is actually built for that patient. So that’s another interesting concept. But I, I personally believe that a lot of this is in robotics. I think that if we look back in the history, whatever robotics done for us in the past, you know, assembly lines, manufacturing. In healthcare world, you know, almost every place that you go now is on some type of computerized medical record system. The X rays are no longer available , for printout. Really. It’s all, it’s all on a pack system. So I think that using technology and robot robotics is a, is the future of a lot of this in hip and knee replacements.