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Feb. 22, 2020

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Technology improves surgical accuracy

Joint-replacement surgeries a specialty at Legacy Salmon Creek

By , Columbian Health Reporter
Published:
6 Photos
A 3-D image shows Dr. Todd Borus, an orthopedic surgeon with Rebound, where to use the MAKO surgical robot to remove bone and cartilage during a MAKOplasty hip replacement surgery Sept. 21 at Legacy Salmon Creek Medical Center. When Borus has removed enough bone and cartilage, the green area turns white. (Photos by Amanda Cowan/The Columbian)A 3-D image shows Dr. Todd Borus, an orthopedic surgeon with Rebound, where to use the MAKO surgical robot to remove bone and cartilage during a MAKOplasty hip replacement surgery Sept. 21 at Legacy Salmon Creek Medical Center. When Borus has removed enough bone and cartilage, the green area turns white. (Photos by Amanda Cowan/The Columbian)
A 3-D image shows Dr. Todd Borus, an orthopedic surgeon with Rebound, where to use the MAKO surgical robot to remove bone and cartilage during a MAKOplasty hip replacement surgery Sept. 21 at Legacy Salmon Creek Medical Center. When Borus has removed enough bone and cartilage, the green area turns white. (Photos by Amanda Cowan/The Columbian)A 3-D image shows Dr. Todd Borus, an orthopedic surgeon with Rebound, where to use the MAKO surgical robot to remove bone and cartilage during a MAKOplasty hip replacement surgery Sept. 21 at Legacy Salmon Creek Medical Center. When Borus has removed enough bone and cartilage, the green area turns white. (Photos by Amanda Cowan/The Columbian) Photo Gallery

Fifty-seven-year-old Jurita Kelley has lived with consistent hip pain for the past decade.

Kelley was in a car wreck 20 years ago that resulted in three fractured vertebrae and an injured right hip. She’s been in and out of rehab programs since. In the past six months, the pain in her hip progressed until reaching unbearable levels in June, after she returned from a vacation.

“I came back and was having trouble walking,” she said. “It progressed extremely fast.”

For years, doctors had told the Vancouver woman that X-rays showed her hip was fine. Kelley decided it was time for another opinion and made an appointment with Dr. Todd Borus, an orthopedic surgeon at Rebound Orthopedics and Neurosurgery.

Borus showed Kelley a new X-ray of her hip. She had no cartilage left. The pain she was experiencing was from bone-on-bone contact. Kelley’s right leg was 10 millimeters shorter than her left leg, and the wear on her joint was causing her to limp.

“The decision (to undergo surgery) was made within 20 minutes of my first appointment,” Kelley said.

“It has to be replaced,” she added. “There’s too much damage.”

On Sept. 21, Kelley was the 1,000th patient to undergo a MAKOplasty joint surgery at Legacy Salmon Creek Medical Center.

MAKOplasty is a robotic-assisted procedure for partial-knee and total-hip replacements. The robot provides precision and helps surgeons to accomplish three goals: position the replacement pieces accurately to lower the risk of problems, such as dislocation; optimize the longevity of the hip; and restore the leg length to help with hip alignment and recovery.

“I’m a firm believer that robotic technology improves the accuracy of what we’re trying to do,” Borus said.

Leader in procedure

Legacy Salmon Creek began offering MAKOplasty partial-knee replacements in December 2009. Three years later, the hospital added MAKOplasty hip replacements.

One hospital performing 1,000 MAKO surgeries is rare, said Jamie Ingle with Stryker/MAKO, the company behind the technology. Ingle assists surgeons during the procedures at Legacy Salmon Creek, running the computer software. He knows of only a handful of other sites in the country that have completed as many surgical procedures.

Legacy Salmon Creek is the only Southwest Washington hospital offering MAKO surgeries. And Borus is far and away the local leader in the procedures, performing 791 of the hospital’s 1,000 procedures. He has performed 581 partial-knee replacements and 210 hip replacements using the robotic technology.

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Word spread soon after the hospital began offering the procedure, Borus said. He’s had patients from as far away as Alaska, Colorado and Hawaii, and still regularly sees people from Eastern Oregon and the coast, he said.

Next year, Rebound and Legacy Salmon Creek hope to begin offering MAKOplasty full-knee replacement, which was recently approved by the U.S. Food and Drug Administration, Borus said.

Robotic precision

For a hip replacement surgery, the MAKO technology uses a CAT scan of the patient’s hip and pelvis to create a 3-D image, giving surgeons a blueprint. The computer software uses sensors placed on the patient to register the body and machine using satellite technology. The virtual image of the bone anatomy must match the actual body positioning before the procedure can begin.

“It’s sort of comforting that it won’t let you just blow through it,” Borus said. “If it’s not happy, it won’t let you proceed.”

When Borus is ready to begin the procedure, the image of the patient’s hip socket is colored in green. As he grinds away bone and cartilage in the socket to make room for the implant, the green turns white, indicating Borus has removed enough. While Borus controls the robotic arm, if he tried to move outside of the area, or tried to go too deep, the robot would stop him.

“It won’t let me color outside the lines,” Borus said.

The 3-D image also shows Borus where to cut the patient’s femur to insert the stem and attach the new femur head, the ceramic ball that will insert into the socket. The MAKO system also ensures the socket and femur head are placed at the appropriate angle and position.

“The angle of the component is really crucial to the outcome of this hip replacement,” Borus said during Kelley’s surgery. “This is how the technology proves itself.”

After the procedure, the patient’s arthritis pain should be gone immediately. The patient will, however, experience some incision pain, Borus said. Patients are usually up and walking with assistance several hours after surgery and don’t usually need a cane or crutches for more than a couple of weeks. Within four to six weeks, patients return to normal function, Borus said.

For Kelley, that would mean she could get back to gardening, a hobby she gave up long ago. But she’s most looking forward to getting her mobility back again. The lack of mobility has made simple tasks — putting on socks in the morning or shaving her legs in the shower — nearly impossible.

“You can bend, but you don’t have mobility in that area,” Kelley said. “It restricts everything. It doesn’t just restrict your hip, the pain goes up.

“I’m looking forward to getting my mobility back,” she said.

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