Orthopedist at Thompson Health discusses the use of Mako SmartRobotics System for knee and hip replacement: ‘It translates into a faster recovery for patients postoperatively.”
By Chris Motola
Q: You practice orthopedics. Do you have an area of specialty within that?
A: I’m a general orthopedist. I would say I specialize in trauma and joint replacement.
Q: Any joints in particular?
A: Primarily hip and knee replacement.
Q: And typically, what does your patient base look like? Is it mainly older people?
A: Yeah, usually older. Being at Thompson Hospital and dealing with traumas, I do a lot of geriatric fractures, operative and non-operative treatment. For my hip and knee replacements the range goes from people in their 40s with bad arthritis up to people in their late 80s and 90s.
Q: How long does a joint replacement typically last now these days?
A: I think the literature always says about 15 to 20 years, but those are based on papers. I’ve known patients that had them last even longer.
Q: Does that mean if you get one in your 40s, you might need more than one?
A: Yeah, 40s is a unique situation. And, you know, I wouldn’t even consider any type of replacement in those patients unless they’ve failed with extensive treatment and their pain is really stopping them from living their lives.
Q: OK. You’ve been using the Mako surgical robot [Mako SmartRobotics System). What advantages does it offer?
A: I use it for both the knees and hips. I think it offers optimal component positioning. It helps with planning ahead for the surgeries. So maybe templating or planning ahead, I guess it’s fine to call it. It helps us make sure we have the appropriate sizes and are able to anticipate any anomalies for patients. Also, with the robotic arm, it decreases the amount of damage to the soft tissues, so the surrounding musculature and skin. And I think that translates into a faster recovery for patients post operatively. So, for the knees, specifically, I think the Mako robotic system is a very powerful tool. It will allow really accurate balancing of the knee, comparing the replaced knee back to a patient’s native knee. And I think that it will result in a more normal feeling knee replacement for a patient. It decreases surgical time, decreases time under anesthesia, decreases soft tissue trauma. So I think all that will translate into a faster recovery as well.
Q: Does it increase the longevity of the replacements too?
A: No, that’s not reported. But in theory, you know, I could see how that’s a reasonable expectation, given that, if you have a knee that now is functioning more normally, well-adapted to the patient’s biomechanics, it could last longer.
Q: Do you make the determinations as to whether a patient needs a joint replacement or are you mainly performing the surgeries?
A: Yeah, that’s a huge part of what I do. I don’t know if you would call it primary care orthopedics, because there’s a lot of surgical treatment as well, but I see people for years for their knee or their hip pain, until they decide that they’re ready for a joint replacement. I think joint replacement is an elective procedure and so I tell people it’s quality of life, not quantity of life. So, it’s really, it’s up to them. When they feel ready for surgery, then we can discuss that. Obviously, I make sure that they have the right indications for surgery. But really, it’s not until people have more bad days than good days because of their joint pain, pain bad enough for them to consider major surgery. And the big one is pain that stops them from living the life they want. Those are the questions I ask everybody that before a joint replacement. And the other thing I ask or discuss with them is if they notice or if they or maybe a loved one has noticed that their world has gotten smaller because of their joint pain. You know, they don’t go on a walk with their spouse or they won’t go on a trip with their kids because their knee is holding them back or their hip is holding them back. I think that’s an appropriate time to discuss a joint replacement.
Q: With joints, is it usually an inevitable degeneration? Or do you see success with rehabilitation?
A: It’s a mix of both. People present to me at varying degrees of arthritic change. So, if somebody comes in and they are end-stage with erosion into the bone, I don’t think any degree of physical therapy is going to make them better. But this is something that I kind of determine with the patients when they come in and see me based on their X-rays, their amount of pain, what their lifestyle is. That kind of goes back to what I was saying before is, you know, I see people for a long time often before their joint replacement. So, we kind of follow that path together. I’m a little bit unique in that unlike a lot of people who are hyper-specialized these days I see people from the age of 2 all the way up to 102. So, it’s a different type of a practice, but I think patients appreciate that.
Q: What’s sort of the sweet spot between protecting your joints and then also exercising them to the degree that they remain strong? Because that seems like it’s a difficult zone to hit.
A: I think that that’s different for everybody. You know, it depends on your body weight, what your goals are. I think if somebody’s like, you know, an ultra-marathon runner, I can’t imagine a situation where running 100 miles at a time is good for anybody’s joints. I think that if somebody wanted to be active and they had a hard time being active because of their joint pain, I often tell people to get into the water. I mean, we live next to a beautiful Canandaigua Lake. Get into the water. If you can’t swim, do some water walking. If you can’t do that, get on a paddle board, you know, do things like that. Low-impact cardiovascular exercise is going to be hugely beneficial for basically anybody. Beyond that, I think it really just depends on the patient and their goals.
Lifelines
Name: Nicholas Valente, M.D.
Position: Orthopedist at Orthopaedics & Physical Performance and FF Thompson Hospital
Hometown: Holley, Orleans County
Education: University at Buffalo Jacobs School of Medicine, medical degree and residency
Affiliations: FF Thompson Hospital
Organizations: Board certificate through the American Academy of Orthopedic Surgeons
Family: Wife, three children
Hobbies: Farming, gardening, time with family