GRAND FORKS – Since the age of 17, Debbie Mickelson has spent decades working jobs that had her constantly on her feet – waitressing, bartending and running a 14-room motel with her husband in Cooperstown, North Dakota.
“I was always on my feet," she said.
About three years ago, that wear and tear – and arthritis – had begun to take a toll. Mickelson was experiencing pain in her left knee.
After reading positive reviews on the Altru Health System website, she randomly chose Dr. Jeremy Gardner, an orthopedic surgeon, for her knee replacement surgery.
She was pleased with the surgery and care she received, she said. So in December, after a cyst in the back of her right knee burst and rendered her unable to walk, she again sought joint replacement treatment surgery from Gardner.
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“I just think he is really good at his job,” said Mickelson, 60. “I would recommend him to anybody.”
As she recovers from knee surgery at home in Cooperstown, she said, “I feel good.” It’s just a matter now to get the knee to bend to the 120 degrees that Gardner recommends.
After surgery, enduring weeks of physical therapy “is no fun,” she said, “but you feel so much better afterward.”
Robotic-assisted surgery
Under Gardner’s care, Mickelson and thousands of Altru patients have benefited from MAKO robotic-assisted technology.
Since MAKO was introduced at Altru in 2016, more than 3,000 robotic hip and knee joint replacement surgeries have been performed with this technology – the vast majority by Gardner, according to Altru officials. That figure places Altru near the top of the list for the entire upper Midwest, according to Ken Harvey, communications strategist with Altru Health System.
The MAKO technology represents an investment “in the $800,000 to $900,000 range,” said Gardner, a leading expert in MAKO surgeries who joined Altru in 2010. “Whatever it costs, it has been well worth the investment. We’ve seen a significant increase in the number of joint replacements that we’ve done, and the outcomes of those have been dramatically better.”
Gardner’s partner, Dr. Reed Lambert, who joined Altru’s orthopedics and sports medicine team last year, also performs surgeries with the MAKO robot.
The technology also is used for joint replacement in the Twin Cities and Duluth, said Gardner, who joined Altru in 2010.
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In preparing his patients for surgery, Gardner sometimes has to clarify that he does not conduct “robotic surgery,” whereby the surgeon is not in direct contact with the patient but operates instruments at a distance.
“Some robotic surgery is done that way, but not orthopedic surgery,” he said.
Gardner performs robotic-assisted surgery, using instruments he controls in surgery with the patient on the operating table.
Important advantages
The technology provides many advantages for patients who qualify for joint replacement surgery, Gardner said. Among them is the length of the incision, which is smaller than previously was necessary.
The surgery “is far less invasive than 15 years ago,” he said. A smaller incision also means less trauma to the body, and therefore less pain and a shorter recovery period.
Among other most important benefits is that the surgeon is able to more precisely fit the implant to the patient’s anatomy, which improves early recovery and patient satisfaction with the joint replacement.
“We can really customize the surgery to the patient,” Gardner said.
Pre-operatively, the surgeon uses a computerized technology-based robotic system that produces a 3D image of the patient’s anatomy. It allows him to properly plan for the implant size and match points on the bone to points on the implant model, lining them up symmetrically.
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The technology, which sets parameters for implant placement, “doesn’t allow me to go beyond” the parameters; MAKO will stop the surgical saw if it goes outside the parameters, he said. “The cuts are more refined, more accurate.”
About two-thirds of MAKO surgeries at Altru are knee replacements, with the remainder being hip replacements, he said. Hip replacement surgery is done on the front, not the back, of the body and the surgical incision is about 75% smaller than it used to be.
That approach allows for “easier recovery time, and you also get a more stable hip; it’s less likely to dislocate or pop out,” Gardner said.
The vast majority of joint replacement surgeries are needed for treatment of the negative effects of arthritis, he said. His patients have ranged in age from 30s to 80s.
Patients benefit
“The benefits (of MAKO robotic-assisted surgery) come in the long term, how (the implant) feels and functions,” Gardner said. Newer implants are “more balanced and wear more evenly.”
Another improvement with joint replacement in general, early on, “is our ability to get people moving quicker,” Gardner said. “So within a couple of hours we want you up, moving around that day, putting weight on it and walking.
“Several patients have been able to go home that same day. I would say 98% of patients go home within 24 hours – so, often, a very short stay in the hospital if not home that day,” he said.
“It wasn’t too long ago, maybe seven or eight years ago, that people would stay three or four days in the hospital,” he said, “and now they’re down to less than a day.”
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After joint replacement surgery, the recovery is “surprisingly smooth for patients,” Gardner said, adding that improvements in pain management techniques – such as injections and nerve-blocking agents – have played an important role in the patient’s post-surgery progress.
“They’re often surprised how comfortable they feel,” he said.
Gardner also credits his surgical team, including his nurse Kacie Capp, for providing consistently highly-rated patient care. Capp is responsible for coordinating care and getting patients ready for surgery, he said.
Summing up the impact of the MAKO robotic-assisted surgery since its introduction seven years ago, Gardner said, “It has been a great advancement for Altru.”
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