Health Care

Personalized, Precision Knee Replacement

John Heple

Chatsworth resident John Heple is no stranger to surgery. “I originally broke my back when I was 18,” he said. “They had to rebuild everything again when I was 50.”

By the time he was in his mid-60s, the retired Nevada forest firefighter and EMT needed to have knee replacement surgery.

“Both knees hurt, but my left hurt the most,” he said. “I went in and got the left one done.”

He had plans to replace the other knee, but he postponed the procedure when the pandemic hit. In October 2020, he and his wife relocated to Chatsworth.

“I got here, and my knee was uncomfortable, but I was dealing with it,” he said.

But steroid shots only relieved his pain temporarily. He wasn’t walking the way he should. So, he made an appointment to see Adam Land, MD, an orthopedic surgeon with AdventHealth Medical Group Orthopedics & Sports Medicine.

He said Dr. Land told him he would further damage his knee if he kept trying to modify the way he was walking.

“He said I’m going to mess it up so bad I was not going to be able to fix it,” Heple said.

Then Dr. Land told Heple about new robotic equipment AdventHealth Gordon had purchased in December that would allow him to replace the knee more precisely than the traditional methods.

“It’s the evolution of joint replacement,” said Stephen King, MD, an orthopedic surgeon who works in the same practice with Dr. Land. “As the technology has evolved, it’s reached the point where it can be disseminated to guys like us in smaller communities.”

Dr. Land performed Heple’s surgery using the new Mako® SmartRobotics™ System the first week of March 2021.

“He was a great surgical candidate,” Dr. Land said.

Previous injuries and surgeries had led Heple to not being able to fully extend his knee.

But the Mako® system accounts for a patient’s unique anatomy, the surgeons said. Before the procedure, a CT scan of the patient’s leg is taken, and the technology creates a 3D model of their bone structure. The surgeon then reviews the model to determine the best size, placement and positioning of the replacement joint.

“We’ve never been able to do this before,” Dr. Land said. “Before I cut the skin, I already know what potential challenges I may face.”

Once in the operating room, the robotic equipment provides real-time visual and tactile information to the surgeon operating the instruments.

“It allows you to make more precise cuts of the bone for a more balanced knee, which improves functionality and longevity of the knee replacement,” Dr. King said.

Before, the surgeons said, they had to use their best judgment about the joint’s placement, which could be complicated if a patient suffered from arthritis, had a bowed leg or otherwise had a bone structure that deviated from the norm.

“As a surgeon, this allows me to feel very confident in what I’m doing for the patient,” Dr. King said. “This allows you to be extremely accurate and when you leave the operating room, you now know they’ll have a balanced knee, and the forces will be evenly distributed. It allows for a less painful knee in the long-term for patients, as well as a more functional knee they can flex and extend better.”

Dr. Land said the technology also plans the procedure down to the millimeter, which means less bone and soft tissue damage during the surgery.

“The technology has eliminated a lot of those variables we’ve never been able to control before,” Dr. Land said. “Once the computer maps out the knee, it will not let that saw go anywhere it’s not supposed to. I can’t force it into a position that would put an artery at risk or a ligament at risk, and that’s a huge benefit.”

Dr. Land said he’s hopeful the Mako® system’s ability to tailor the new knee to the patient’s unique physiology and needs will also improve patient satisfaction with their replacements.

“The goal is ultimately to have a knee that lasts for that person’s whole life,” he said. “My prediction is, if you have fewer outliers, you will have more patients who are happier. If you put the knee in precisely, they’ll have a smoother, quicker recovery. The knee is better balanced and more consistently balanced, so patients should like it and be happier with it.”

Heple had a complicated medical history that needed to be taken into account before and during the surgery. He said he survived a
near-fatal accident when he was a teenager that required him to learn how to walk again, as well as a spinal Staph infection following a surgery in his 50s that took two years and a round of chemotherapy to heal.

“I liked the fact that they didn’t know me from Adam, but they listened to me,” Heple said. “Dr. Land was pretty thorough.”

He also appreciated being able to have the surgery done in Calhoun, which is about a half-hour drive from his home.

The staff also arranged for him to do his post-surgical physical therapy at PT Solutions in Chatsworth, a partner of AdventHealth.

“I went three days a week for an hour each time,” he said. “By the second week, they got me on the pedal bike. Into my third week, [the physical therapist] said, ‘You’ve already passed what I would expect to see for somebody at four weeks.’”

Dr. King and Dr. Land said they’ve always focused on providing top-quality orthopedic care to their patients.

“But this allows us to even go one step further without patients having to leave the community,” Dr. Land said. “I think it shows a tremendous commitment to the community in making sure we have the same level of equipment and everything else the big academic centers have.”

He also commended hospital leaders with investing capital funds and working with physicians to bring cutting-edge technologies to their patients, as well as ensuring the proper training for those incorporating them into their practices.

“When you look at Christ’s earthly ministry, it’s obvious that He was excellent at everything He did,” said Mike Murrill, president and CEO of AdventHealth Gordon. “I believe that one of the best ways we can honor our mission statement of Extending the Healing Ministry of Christ is to not only be compassionate, inclusive and intentional but to also be excellent at everything we do.”

For more information on Mako® SmartRobotics™ surgery, please call AdventHealth Medical Group Orthopedics & Sports Medicine at 706-695-4825.

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