PARTIAL KNEE REPLACEMENT:
MEDIAL COMPARTMENT

What Is a Medial Partial Knee Replacement?

• It is a Partial Knee Replacement performed on the medial side (inner side) of the knee joint, which is the most common of the three compartments of the knee that are replaced.
• It is done to eliminate pain (and swelling for some) on the medial side of your knee and improve your function and activity level.
• The most common reasons this procedure is performed on the medial side of a painful knee are:
  • Osteoarthritis (also known as degenerative arthritis).
  • Osteonecrosis of the medial femoral condyle.
  • Meniscus Tears & Traumatic Injuries have caused arthritis in the knee.
• Medial Partial Knee Replacement attaches new surfaces to the ends of the knee bones that restores smooth painless motion to the inner side of the knee and can last for decades.

• A Partial Knee Replacement (PKR) is also called a:
  • Partial Knee “Resurfacing” (PKR)
  • Partial Knee “Arthroplasty” (PKA)
  • Unicondylar Knee Arthroplasty” (UKA)
  • Unicondylar Knee Replacement (UKR)
• The new replaced surfaces are called “implants” or “prosthesis” and they are usually made of cobalt chrome and titanium alloy metals, and a polyethylene plastic insert. These implants replace the damaged cartilage surfaces and the meniscus.
• Dr. Buechel has performed medial partial knee replacements on patients from their late 30’s into their late 90’s with great success, and rapid return to an active lifestyle.
• Medial partial knee replacement will restore and maintain the natural tension to the 4 main ligaments (ACL, PCL, LCL, MCL), correct some or all of the bowlegged (varus) angular deformity of the leg, and allows for a return of near normal knee motion and kinematics for many.
• A well installed partial knee replacement allows patients to return to life’s normal activities, including walking, hiking, biking, swimming, dancing, running, climbing stairs, tennis, golf, deep knee bending and more.

What Are The Benefits Of Having Dr. Buechel Perform Your Medial Partial Knee Replacement?

Quality and Experience Matters!

• Dr. Frederick Buechel, Jr. M.D. has an Unparalleled Experience and has performed nearly 2,000 Partial Knee Replacements using the precision Mako Robotic System.
• You have one chance to get it right the first time.
• Having and expert like Dr. Buechel at Partial Knee Replacement perform your surgery will “Increase your chances of ending your knee pain and getting back to a healthy lifestyle.”
• You will have a predictable precision implant installation with Dr. Buechel
• He is an international advanced Mako Partial Knee Instructor
• He has been the Mako Surgeon Instructor at more than 75 Mako Bio-skills Cadaveric Courses (Knee & Hip)
• He developed the 1st Advanced Mako™ Partial Knee Bio-Skills Course in USA
• He has published on his excellent partial knee patient satisfaction and outcome results
• He uses a mini-incision leaving a beautiful cosmetic skin closure
• He cuts no muscle
• No tourniquet is used reducing your risk for blood clots
• All his partial knees are performed as an Outpatient Procedure
• You can shower the next day
• Your motion will improve with a more natural feel
• All 4 knee ligaments are preserved
• There is less pain and a rapid recovery
• Less bone is removed with the Mako system than traditional partial knees
• Performed the First Mako Surgeries in Asia in 2012 and Europe in 2013
• He was the Mako Launch Surgeon & Proctor more than 10 countries including the USA, Hong Kong, Thailand, Singapore, Greece, Turkey, Italy, Taiwan, Vietnam, China and Australia.

Who Is A Candidate For A Medial Partial Knee Replacement?

Deciding to have a medial partial knee replacement requires that your Clinical History, Physical Symptoms, Physical Exam Findings, and X-rays & Imaging all confirm that partial knee replacement is the best option for you.

• Dr. Buechel, is an expert partial knee surgeon and will listen to your situation, ask you the right questions, exam your knee and review your x-rays and MRIs.
• When Dr. Buechel reviews your case, he will confirm your diagnosis and let you know if you’re a candidate and meet the indications for a medial partial knee replacement.
• Quality and Experience Matters! If you are a candidate, this is your knee, and you have one chance to get a partial knee right the first time.
• Choosing an Expert in Partial Knee replacement will, “Increase your chances of ending your knee pain and getting back to a healthy lifestyle.”

The Indications

1. Clinical History

The clinical history indicating a person is a candidate for a medial partial knee replacement can include one or several of the following:

• Younger active adults, generally in the later 30s and beyond, that want to remain very active who have painful weightbearing knee arthritis or osteonecrosis.
• Active older adults into their 90’s who have painful weightbearing knee arthritis or osteonecrosis.
• Adults that have had a prior medial meniscus tear, with or without surgical repair that have gone on to degenerative arthritis in the medial compartment.
• Adults with a prior ACL reconstruction that have gone on to develop arthritis in the medial compartment.
• Patients that have failed one of the cartilage repairing operations on the medial side of their knee joint.
• Adults who have had a prior knee fracture/break on the medial side of their knee, such as a tibial plateau fracture, that now have arthritis pain.
• Older patients with mostly medial knee arthritis pain that are too unhealthy to undergo the stress of a total knee replacement and its recovery.

2. Patient’s Symptoms

The symptoms many people experience indicating they are a candidate for a medial partial knee replacement are:

• Pain Medially when walking (on the inner side of the knee joint)
• Pain getting up from seated position
• Pain walking stairs
• Dull aching pain, Sharp Pain
• Swelling of the knee Joint
• Stiffness in knee
• Loss of motion in the knee
• Walking distance has decreased
• Limping
• Reduction in fun activities due to medial knee pain
• When people decrease or stop playing their sports due to pain
• Failed Injection Therapy (Cortisone, HA, Ozone)

3. Physical Exam Findings

The physical exam findings people have indicating they are a candidate for a medial partial knee replacement are:

• Pain on examination with pressure on the medial (inner) compartment of the knee
• No pain or tenderness in the lateral or kneecap compartments
• The ACL and PCL ligaments should be stable on exam.
• The collateral ligaments must be intact and have stable end points when corrective tension is applied to the knee on exam.
• Range of motion for best candidates should have no more than 15 degrees loss of extension (straightening), and at least 90 degrees of flexion (bending).
• Varus (bowlegged) limb alignment deformities should be less that 15 to 20 degrees.
• Opening up of the medial side of the knee space when a stress is applied to the knee joint.

4. X-Rays and Imaging

The x-ray findings people have indicating they are a candidate for a medial partial knee replacement are:

• A decrease or total loss in the medial joint space of the knee on the Anterior Posterior (AP) View.
• A decrease or total loss in the medial joint space of the knee on the Flexion Weightbearing View (Rosenberg View).
• The lateral compartment joint space is preserved.
• There may be some small bone spurs in the lateral compartment.
• The patellofemoral joint space is normal, or mild to moderate space loss with no pain.
• There may be bone spurs around the kneecap edges.
• The kneecap is tracking centrally or only slightly deviated in the groove of the femur.

When do we order an MRI?

If there is any question regarding the health of the lateral compartment or patellofemoral compartments and ligaments that will remain after medial partial knee replacement, an MRI can be obtained to objectively evaluate these areas and provide more guidance. If you already have and MRI, this will be reviewed to help in your decision making.

How Does Dr Buechel Perform His Medial Partial Knee Replacement?

“Outpatient, Mini-Incision, Tourniquet-Free,
Mako Robotic Assisted Medial Partial Knee Replacement.”

Dr. Frederick Buechel, Jr. MD has been performing his Medial Robotic Partial Knee Replacements as an Outpatient for more than a decade. He utilizes one of the smallest incisions possible and a plastic surgery closure. He uses a Mako Robot for all his partial knees to ensure precision implant placement.

Dr. Buechel has developed a comprehensive process to achieve high levels of patient satisfaction and great outcomes for his mini-incision medial partial knee replacement patients for over a decade.

Dr. Buechel educates his patients in the office, provides meticulous world-class surgical technique and uses the most advanced and precise surgical robotic technology. He and his outstanding staff are there for you before and after your surgery to help you regain your highest level of function and satisfaction possible.

6 weeks after Medial Partial Knee Replacement with a Mini-Incision

Major Steps And Protocol Items In Dr. Buechel’s Medial Partial Knee Replacement Process Ensuring Precision And Patient Satisfaction

• Dr. Buechel is a master pre-operative and intra-operative software planner on the Mako Partial Knee software which allows him to optimize your implant size and initial positioning.
• He uses an leg holder that allows him to optimally position the knee during each part of the surgery.
• He uses a small 2-3-inch skin incision over the medial compartment to provide direct access to the area.
• He does not cut into the vastus medialis quadriceps muscle during the exposure.
• He does not use a tourniquet during surgery which reduces pain and dramatically reduces the chance of a blood clot.
• He uses the medication Tranexamic acid (TXA) to reduce blood loss, and none of his patients require transfusion.
• He uses custom instruments and retractors to be gentle on the skin and provide excellent visibility.
• He is very detailed about cauterizing any bleeding during the surgery to reduce swelling and pain.
• Once the Robotic system is setup and connected, Dr. Buechel properly inputs all the kinematic data from your knee motions and ligament tensions, and then makes the final implant positioning adjustments in the software.
• The Robotic arm is then brought into the field where it is controlled by Dr. Buechel’s hands to prepare the bone surfaces to receive the implants.
• The trial implants are installed and then all the bone edges are trimmed and smoothed around the implants.
• Stability is checked and the computer data is evaluated to help make the final choice on insert thickness to provide the optimal tension on your medial compartment.
• The final implants are then opened and attached to the bone surfaces with a bone cement. This is a critical step to ensure optimal fixation of the implants.
• The knee is irrigated with bacteriostatic and antibiotic solutions prior to closure to reduce infection risk.
• The final skin closure is done with a skin adhesive Dermabond that acts as a barrier for 3 weeks over your skin incision. This allows for daily showering and results in a pleasing final scar.
• A light dressing and ACE wrap cover the knee to go home.
• A Cryotherapy machine is started immediately to reduce pain and swelling and is taken home with you.
• The next day a Reparel compression leg sleeve is provided in the office.
• A Nutritional support program is recommended as part of the protocol to ensure optimal healing.

WHEN IS THE RIGHT TIME TO HAVE A MEDIAL PARTIAL KNEE REPLACEMENT?

• The decision when to have your partial knee replacement performed starts by having a proper exam and imaging that confirms you’re a candidate for the procedure.
• Once you know you’re a good candidate, the timing is really up to you and it’s not an emergency.
• Your decision to proceed with a partial knee replacement should occur when,
  • The pain is no longer tolerable
  • When your quality-of-life decreases
  • When you can’t enjoy the things you like to because of your knee pain.
• These would be issues I would consider determining how soon to have my partial knee.
• When you decide to proceed, make sure to have an expert, like Dr. Buechel, perform your partial knee replacement to ensure an optimal outcome. Quality and Experience Matters!

RECOVERY TIME FOR DR. BUECHEL’S MEDIAL PARTIAL KNEE REPLACEMENT SURGERY?

• Recovery for a Medial Compartment Robotic Partial Knee Replacement surgery by Dr. Buechel is significantly less difficult than patients expect.
• Day One, you are full weight bearing, right from the operating room.
• Within a few weeks you should be walking unassisted and back to basic activities of daily living.
• Within just a few months, you should be back into your regular daily routine without the knee pain you had before.
• Your full recovery comes over the next 12-18 months with your commitment to exercise and improve your physical conditioning.
• A walking aid is provided for you at the surgical center as you start off with a cane, crutches or walker. You can eliminate any or all of these devices once you feel stable and confident with your balance. This is generally within the first week. There is no rush, you should feel safe and use these devices until you feel confident and ready to discontinue them.
• Mild to moderate pain is generally limited to the first week starting day 2 or 3 when your surgery pain blocks start to wear off.
• Swelling control is the main goal in the first 2 to 3 weeks.
• Once the swelling has resolved, the range of motion generally returns to the pre-op motion. Most patients by 6 weeks have all their pre-op motion back. By 3-6 months, many patients have increased their motion by 8-10 degrees.
• Physical therapy for robotic partial knee replacement surgery is not an aggressive painful process like most total knee replacement therapy can be. I start with simple patient home exercises the first week to allow for wound stabilization and swelling reduction. Then I begin formal physical therapy the second week focused on improving the quadriceps strength and proper return of a normal, or near-normal gait cycle.
• Stationary bike exercise can begin right away using the non-operative leg only, to get your cardiac conditioning going and release the good endorphins into your system.
• At the end of the second week, you can use both legs on the bicycle if the swelling has subsided and the wound has stabilized.
• Driving is generally okay by the end of the first week for most patients with the understanding that you are not allowed to drive ever if you are taking narcotic pain medication.
• I limit high impact exercises like jumping or running, and high torque twisting like a strong golf swings and singles tennis until the 8-week mark. This allows the bone to stabilize where the tracking pins were inserted during your surgery, to reduce the risk of a bone fracture at the pin sites.
• Return to most activities is common by 12 weeks. However, the knee improves for 18-24 months which means you have lots of time to get it great.

PAIN MANAGEMENT FOR MEDIAL PARTIAL KNEE REPLACEMENT

A Medial Partial Knee Replacement Surgery performed by Dr. Buechel using the Mako Robotic System is significantly less painful. Dr. Buechel has developed a comprehensive process to control and manage pain from over a decade of robotic partial knee experience in the USA and Internationally.

Dr Buechel’s techniques and protocols are designed to make the recovery process as comfortable as possible. An important part of managing pain is communication, and Dr. Buechel and his staff are always available for our patients directly by mobile phone or text.

Dr. Buechel’s multi-modal approach to pain control and swelling reduction includes medications, supplements, surgical techniques, mini-incisions, no tourniquets, no muscle cutting, layered skin closures and skin adhesives, personalized software enhanced ligament balance restoration, robotic bone preparation & tissue protection, cryotherapy during recovery, personal leg compression sleeves and rapid mobilization.

• Dr. Buechel has developed several techniques and uses special instruments that allows him to make a very small incision, put little tension on your skin and tissues, and have great visibility to precisely install your implants.
• His anesthesiologists provide you with a spinal anesthesia or general anesthesia, along with two nerve blocks (1. Adductor Canal Block, 2. IPACK block) that give you great pain control after the surgery for 36 to 48 hours.
• The anesthesia team uses IV steroids to reduce swelling after surgery which provides increased pain control and comfort.
• Dr. Buechel injects a local anesthetic mixture into the wound to provide you with even more immediate pain control that allows you to walk out of the surgery facility and back into your home or hotel that day.
• Dr. Buechel does not use a tourniquet to stop blood flow while operating. This eliminates the thigh pain after and during surgery, allows for better bleeding control, reducing swelling and lessening pain after surgery. This also dramatically reduces your chance of a blood clot from knee surgery.
• A Breg Polar Care Kodiak Cryotherapy cool wrap is provided after surgery. It is simple to use and critical in making you comfortable, reducing pain and reducing swelling.
• A Reparel sports compression leg sleeve will be placed on your operative leg in the office the day after surgery to reduce swelling and pain.
• Elevation after surgery when you’re not walking is part the protocol to reduce swelling, which reduces pain and improves healing.
• Avoiding aggressive physical therapy early in the first week allows the wound to seal and swelling to reduce. Simple walking and home exercises are all that are needed for the first week for most.
• With this regimen, most patients only require ibuprofen and acetaminophen after surgery. Some patients will take a few low-level narcotic pills for a few days the first week after surgery.

HOW DOES THE MAKO ROBOTIC PARTIAL KNEE SYSTEM WORK?

Dr. Buechel is an expert at Outpatient, Mini-incision Medial Partial Knee Replacement. He uses the Mako Robotic Partial Knee Replacement System to provide every patient with an optimal result from a consistently, reproducible, precision installation.

Dr. Buechel has been a pioneer using and developing the Mako Partial Knee System by Stryker since he began using the system in 2009. As one of the early adopters of this revolutionary technology, Dr. Buechel has been a part of the development team and training team since the beginning. Dr. Buechel is a super user of the technology and uses all the features available to optimize each of his patient’s knee replacements.

Dr. Buechel has used the Mako Robotic Partial Knee System to install all his partial knees for more than 12 years and nearly 2,000 cases in the USA and internationally. Most surgeons who perform partial knees perform less than 10 partial knees replacements annually.

WHAT ARE MAKO ROBOTS:

• Mako™ Robots are computer programmable machines that help surgeons accurately prepare bone surfaces for implants
• They provide Tactile Feedback to the surgeon during bone preparation
• They create virtual boundaries or walls that the surgeon cannot violate with the cutting tool.
• They Provide Precision, Safety & Accuracy During Bone Preparation

WHAT ARE THE STEPS TO PERFORM A MAKO ROBOTIC PARTIAL KNEE REPLACEMENT

CT SCAN:

• The process starts by obtaining a low dose CT Scan of the operative leg from the hip to the ankle. This scan is then digitally sent to our team and loaded into the Mako software.

PRE- OPERATIVE PLANNING:

• Dr. Buechel then reviews and optimizes the plan on the computer prior to surgery, choosing the initial size & setting the initial position of the knee implants.

INTRA-OPERATIVE PLANNING:

• During the surgery, tracking devices called “arrays” are temporarily attached to the thigh bone and shin bone to allow for real time communication between the computer, the robot and the patient.
• Dr. Buechel then collects live knee motion data correcting the knee deformity manually by applying proper tension back to the medial ligaments while bending the knee through a full range of motion.
• Intra-operative functional planning adjusts the implant position to optimize ligament tension, implant tracking and implant to cartilage transitions from live motion data collected.
• This customizes the implant placement in your knee to optimize your fit, feel, and comfort after surgery.
• Collecting and utilizing the intra-operative data to optimize each person’s best implant position becomes the “Surgical-Art” of robotic knee replacement”.

ROBOTIC-ARM ASSISTED PRECISION BONE PREPARATION:

• The robot is brought next to the patient and communication is verified.
• Accu-Stop™ Technology: The robotic arm communicates with the computer plan which creates virtual boundaries, providing safety and precision during the bone preparation.
• The Mako Robot prepares the bone surfaces for the implants exactly to the final plan within 1mm and 1 degree, ensuring optimal implant placement.

Dr. Buechel’s Outpatient, Mini-incision Medial Partial Knee Replacement using Mako Robotic Technology will help you
“End your knee pain and get you back to an active lifestyle”

Contact Us

The simplest way to schedule an appointment with Dr. Buechel is to call us directly at 1-212-308-3089. We will schedule an In-Office Appointment or Virtual Consultation for your first encounter. Our practice hours are Monday through Friday, 9:00 AM to 5:00 PM.

If you don’t have the time to call or it is just easier, you can contact our staff with a quick email at info@RoboticJointCenter.com and we will email you back within 24-48 hours. If you wish, let us know in your email and we can also call you back at a designated phone number you provide.