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Looking for a Way to Relieve Arthritis Pain? Try an Anti-inflammatory Diet

Inflammation is the body’s natural and necessary response to cell damage caused by trauma or injury, chemicals and other toxins, pathogens such as bacteria and viruses, and other irritants. It’s the way the body starts to heal itself.

But at times this response can be triggered when it shouldn’t be (as in the case of autoimmune diseases), or it can spiral out of control (as with sepsis). When this happens, instead of healing, inflammation causes more damage.

Signs of acute inflammation include:

  • Pain
  • Swelling
  • Loss of function (such as a joint)
  • Redness
  • Heat

Diagnostic tests can be useful in determining whether inflammation is causing or contributing to your joint pain. If it is, treatments are available to help control and possibly eliminate the inflammation.

First, though, you may want to try making some changes to your diet to see if that helps to relieve the pain.

Inflammation and arthritis

Although the role of inflammation is generally understood to be different in rheumatoid arthritis than in osteoarthritis, there is evidence that inflammation can be associated with both diseases.

There is also evidence to suggest that adopting an anti-inflammatory diet — one designed to reduce inflammation throughout the body — could be helpful in alleviating the joint pain associated with both types of arthritis.

It’s important to note that no diet alone can completely eliminate arthritis pain. But, when combined with other lifestyle factors such as proper sleep and exercise, an anti-inflammatory diet may be useful in reducing joint pain.

Research supports the potential benefits of this type of diet in other medical conditions as well, such as cardiovascular disease, diabetes and possibly even dementia.

The connection between diet and inflammation

Without getting too technical, here’s how researchers believe food affects inflammation:

By increasing inflammatory markers. A marker is a diagnostic sign of a disease or condition. An example is C-reactive protein, or CRP, which circulates in the blood and is produced by the liver in response to inflammation. Certain foods, such as processed sugars, appear to increase CRP levels.

By fighting oxidative stress. Oxidative stress occurs when free radicals (unstable atoms) outnumber antioxidants, leading to oxidation. Free radicals can damage fatty tissue, DNA and proteins in the body. Foods rich in antioxidants can help to remove free radicals from the body.

By “switching off” the inflammatory process. The pathway that signals the body to begin the inflammatory process can also signal it to stop the process. Omega-3 fatty acids convert into compounds called resolvins that can stop the inflammatory process.

Foods that may relieve arthritis pain

As noted above, a diet that includes foods high in antioxidants may reduce joint pain by helping to rid the body of free radicals. The following is a partial list of antioxidant-rich foods:

  • Berries – blackberries, blueberries, raspberries, strawberries
  • Cherries – tart cherries appear to be most effective for fighting inflammation
  • Citrus fruits
  • Pineapple
  • Leafy greens – arugula, broccoli, Brussels sprouts, collards, kale, mustard greens, spinach, Swiss chard
  • Red kale
  • Beets
  • Avocados
  • Beans, lentils and pulses – black beans, chickpeas, kidney beans, lentils of any color, mung beans, navy beans, peas, pintos, red beans
  • Artichokes
  • Cabbage
  • Cauliflower
  • Tomatoes
  • Carrots
  • Bell peppers
  • Mushrooms
  • Sweet potatoes
  • Onions and garlic
  • Purple or red grapes
  • Whole grains – especially brown rice, whole corn, whole oats and whole wheat
  • Almonds and pecans
  • Dark chocolate – go for at least 70% cacao, and watch the sugar content
  • Spices such as ginger, paprika and turmeric
  • Chili peppers
  • Green tea
  • Olive oil – most experts agree that olive oil has anti-inflammatory properties — just be careful not to overdo it

Foods high in omega-3 fatty acids that could help turn off the inflammatory process include:

  • Fatty fish – anchovies, herring, mackerel, salmon, sardines and tuna
  • Tree nuts – especially walnuts (and walnut oil)
  • Pecans
  • Ground flaxseed
  • Chia seeds

Foods that may exacerbate arthritis pain

Just as there are foods that may help to relieve pain from arthritis, some foods could make it worse.

Sugary foods and drinks have been shown to increase CRP levels, for example, and thus could contribute to inflammation. Most baked goods and pastries, sodas and other sugar-sweetened drinks are obvious foods in this category.

Other, less obvious foods are often high in sugar, too, such as breads, crackers, granola, energy bars and even salad dressings and ketchup. It helps to check the label, particularly if a food is marketed as “low fat.” Sugar is often used to replace fat in such products.

Other foods that have been associated with inflammation:

  • Highly processed foods — this could include most foods with an ingredient list that contains hard-to-pronounce items
  • Foods high in saturated fats — red meat, full-fat dairy products, rich desserts made with cream, butter, lard, margarine and certain types of oils
  • Trans fats — hydrogenated and partially hydrogenated oils often found in fast food, fried foods, cookies and donuts
  • Processed meats — bacon, sausage, salami, hot dogs, jerky, pepperoni
  • Foods high in omega-6 fatty acids* — mayonnaise and the following oils: canola, corn, peanut, safflower and sunflower
  • Refined carbohydrates — white bread, white rice, instant mashed potatoes, semolina pasta, sugary cereals, crackers made with refined flours
  • Excessive alcohol
  • Excessive salt – more research is needed to be conclusive, but high levels of salt in the diet may cause inflammation

*Note that the body needs some omega-6 fatty acids. The goal is to achieve a healthy balance of omega-3 and omega-6 fatty acids.

Let good sense guide you

These lists are not exhaustive, and there’s no such thing as an “arthritis diet” that will magically make your joint pain disappear. With that in mind, it can’t hurt to try adding some of the “good” foods on these lists to your diet and eliminating or at least cutting back on some of the “bad” foods.

The key is to diversify your diet. For instance, it’s not a good idea to pick a food — say, salmon, or pineapple — and load up on it. That could have adverse effects you didn’t anticipate.

If you think about it, these lists, taken together, represent the usual advice for a healthy diet:

  • Eat plenty of colorful fruits and vegetables
  • Choose whole grains over processed ones
  • Opt for “healthy” fats from nuts, seeds, avocados and olive oil
  • Reduce your intake of red meat, processed meats, full-fat dairy, simple carbohydrates and sugary foods and drinks
  • Limit alcohol and salt

Also bear in mind that no two people are alike. What works for someone else might not have the same effect for you. If adding or eliminating certain foods doesn’t ease your joint pain, try some of the other options.

Gradually, you’ll find the anti-inflammatory diet that works best for you.

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5 Hip Replacement Symptoms to Watch For

It’s not unusual for people who are in their fifties or older to experience hip pain. The decades can take a toll on a person’s bones, muscles and joints, leading — in some cases — to osteoarthritis.

Younger people can also have hip pain, of course. Sometimes joint injuries can cause discomfort years later. So can extra body weight and repetitive movements (e.g., those made while training for and playing sports). Low back issues and genetic factors can play a role in hip pain. Even a difference in leg length, which may affect more than half of the population, can cause gait problems. These issues may eventually lead to the need for hip replacement.

So how do you know if your hip pain is caused by a temporary injury to the soft tissues around the joint, or an issue such as uneven hips, which might be addressed through the use of orthotics, or something longer term, like arthritis, that may warrant surgery?

Sometimes the location of the pain can help determine what’s causing it. Sharp discomfort in the groin area or on the inside of the hip is often an indication of a problem with the hip joint itself, whereas pain on the outside of the hip or in the upper thigh or outer buttock area may be associated with the soft tissues (ligaments, tendons, muscles, etc.) that surround the hip joint.

If you have persistent pain and/or stiffness in one or both of your hips, it’s a good idea to have it checked by a medical professional. Depending on the underlying cause, it may just need some extra attention. Not all hip pain calls for surgery or a joint replacement.

There are some warning signs, though, that could indicate a hip replacement may be necessary. We’ve compiled a list of five common hip replacement symptoms to be on the lookout for.

1. Stiffness in your hip limits your normal range of motion

Your hip doesn’t move as freely as it used to, and the stiffness is bad enough that it keeps you from engaging in regular everyday activities — like going for a walk, or squatting down to pick up something. One leg might feel as though it’s dragging, compared with the other leg, and you might have an actual limp. Maybe you wobble when you walk.

Your hip joint might feel as though it sticks, or locks up, especially when you start to stand up after sitting for a while. The stiffness might be worse in the morning, when you first wake up. You may also have a dull ache in your hip or groin, along with the stiffness.

Stiffness can come on gradually, and you might not notice it much in the beginning. These are common signs that you have stiffness in one or both of your hips:

  • It’s harder to put on your shoes and socks.
  • You can’t walk the same distance you normally would, or it takes you considerably longer.
  • Getting out of a car is a challenge.
  • It’s difficult to lift your leg in front of you, to the side, or behind you.
  • You have to use your hands to push against something or pull yourself up when getting up from the floor.

2.  Recommended treatments don’t relieve the pain

You’ve tried a variety of treatments to eliminate the pain — including medications such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen, and injections of cortisone or hyaluronic acid. You may also have tried physical and/or occupational therapy, at-home remedies, transcutaneous electrical nerve stimulation (TENS) and even minor surgery.

Although these methods may provide some level of short-term relief, steadily returning pain is a hip replacement symptom to be aware of.

3. You have difficulty sleeping

Pain in your hip may make it hard to get in a comfortable position so you can fall asleep, particularly if you’re accustomed to sleeping on the side that is hurting.

Once you do go to sleep, the pain may cause you to toss and turn. The disruption in your sleep cycle can leave you feeling tired when you wake up and throughout the day.

4. Tests show that you have arthritis or joint damage

The hip is a ball-and-socket joint where the femur (thigh bone) joins the pelvis. The “ball” is the femoral head (the upper end of the femur), and the “socket” is the acetabulum, an area on the outer edge of the pelvis that is formed by three bones. The joint capsule, which is a connective tissue that attaches to the bones, and the muscles and ligaments that surround the hip joint stabilize the hip and provide support.

Cartilage separates the bones from each other and helps to cushion them as they glide back and forth across each other. The surface of the joint has a thin lining called the synovium, which produces synovial fluid that lubricates the cartilage and helps ease movement. Over time, the cartilage can break down, and as it wears away, the bones are left rubbing against each other. This is how osteoarthritis develops.

In people who have rheumatoid arthritis, an inflammatory disease can develop at any age, the synovium swells and becomes thicker, and as that occurs, chemical substances are produced that destroy the cartilage.

Soft tissues like cartilage don’t show up on an X-ray, but an X-ray can still be useful in diagnosing osteoarthritis. That’s because it will show hip arthritis symptoms such as narrowing of the space between the bones in the hip joint, as well as any bone spurs that might have formed around the joint.

For cases that are more complex, magnetic resonance imaging (MRI) may be appropriate. An MRI is a more detailed image that does show soft tissues, including cartilage.

5. You’re feeling emotional distress

Persistent pain can be debilitating. It can keep you from doing activities you enjoy and make it hard to get through the day. As the pain continues, you may start feeling frustrated, impatient and perhaps even a little hopeless.

Know that there is help. If it turns out that your symptoms do warrant a hip replacement, the surgery can rid you of the pain you’ve been experiencing and get you back to your normal activities. Depending on the type of surgery, you could be back in full swing in a matter of weeks.

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Explaining Knee Pain When Sitting or Squatting

If you’re experiencing knee pain from squatting motions, sitting, or knee flexion, there is a possibility that your knee’s ligaments, tendons, or cartilage have been damaged or degraded.

To put scientific jargon into layman’s terms, if you’re experiencing front, back, inner, or outer knee pains, here is a break-down of what it could be.

Common Knee Pain Diagnoses

The anatomy of the knee is complex and interconnected in many ways.

Whether the pain resides with the back, front, or medial/ lateral (side) parts of the knee, the damage may originate from any part of the knee’s anatomy.

It is difficult to decipher where the pain may be coming from, which is why diagnosing the specific area of pain can help you understand which part of your knee has been affected.

Here are a few common questions you can ask yourself when experiencing knee pain when sitting or squatting.

  1. Is the pain coming from the front, sides, or back of my knee?
  2. Is my knee pain coming from standing, sitting, flexing, all of the above? Not sure?
  3. How active am I?
  4. Have I started new activities? 
  5. Am I wearing different footwear than normal? 

Answering these questions can help you pinpoint the possible cause of your pain and help give your doctor a better idea of where your knee pain is coming from.

With this knowledge in mind, there are four common diagnoses that are associated with acute knee pain. 

1. Jumper’s Knee (Patellar Tendonitis)

Jumper’s Knee is usually a result of the overuse of the Patellar tendon (refer to the picture above).

Oftentimes jumper’s knee is symptomatic of overload and overuse of your quadriceps (quad) muscle group.

The quad muscles are involved in a variety of movements which include jumping, kicking, squatting, running, or any generally explosive movement involving the legs.

Energy and the pressure of impact are often distributed among the Quad muscle. After extended use, however, the pressure begins to cause inflammation in the tendon.

Repeated use especially after sustaining the injury can lead to tears. 

Inflammation is usually a result of microscopic tears in the tendon.

This triggers a healing response from your body, flooding the damaged area with blood, nutrients, antioxidants, and other fluids that are designed to help the healing process. 

For the old, but young at heart, the cause of Jumper’s Knee is usually due to repetitive microdamage and degradation.

While resting the knee seems like the best method of healing, small and steady movements and use of your affected knee is also a vital part of the recovery process.

Here are a few symptoms to determine if you have Jumper’s Knee.

  1. Tenderness and pain originating from the front of your knee (beneath your knee knee cap)
  2. Pain with sudden movements
  3. Pain with extending your knee

2. Runner’s Knee 

Runner’s Knee is usually the result of irritating the lining and soft tissues in the knee. It is known as Runner’s Knee because the repetitive movements of running can easily cause pain and inflammation. These repeated movements are usually felt with knee pain when squatting.

Runner’s knee is a common term used to describe a group of conditions that create pain behind and around the patella or kneecap.

The conditions can include anterior knee pain syndrome, patellofemoral malalignment, chondromalacia patella, and iliotibial band syndrome.

For patients with runner’s knee the pain is often most acute when the knee sits in a flexed position. While there are many different diagnoses for Runner’s Knee, it is usually a series of linings and soft tissues that have become irritated due to consistent pressure.

Runner’s Knee is usually more common in women, particularly middle-aged women. Weight can also be a contributing factor to the development of Runner’s Knee along with failure to stretch/ warm-up. 

As the name of the condition suggests, Runner’s Knee is a common injury in people who enjoy recreational or professional running.

However, this is a problem that is not exclusive to runners. As previously mentioned, there are a number of reasons that one may develop Runner’s Knee including biking, hiking, and impact sports.

Here are a few indicators that you may have Runner’s Knee.

  1. Pain coming from the sides of your knee
  2. A grinding originating from your knee after a period rest
  3. Popping and pain from knee loading (walking up stairs or squatting)
  4. Pain or snapping along the outside of the knee 

3. Baker’s Cyst (Popliteal Cyst)

The popliteal area refers to the area behind the knee. Most symptoms of a Baker’s Cyst include general stiffness, a mass in the back of the knee, and pain in the back of the knee.

The injury is a result of cartilage or soft tissue damage which, in turn, causes a build-up of what is known as synovial fluid (a lubricant that greases the joint for movement).

After continued movement, the body produces a large amount to help cushion the knee, but the fluid pushes out the back of the knee and a cyst begins to form behind the knee.

Unlike some other knee pains, a Baker’s Cyst might go undetected. Some common ways to diagnose the pain is if you experience any of the following symptoms.

  1. Feel and/or see a lump behind the knee
  2. Pain when completely flexing your leg or inability to flex entirely.

4. Iliotibial Band Syndrome

Also known as IT Band Syndrome (ITBS), Iliotibial Band Syndrome is a series of connective “bands” of tissues that have become inflamed from overuse.

The pain is usually felt at the side of the knee as opposed to the front and back. 

When referring to this image, the pain is usually felt around the femoral condyle and top of the lateral collateral ligament. (Found as the cut ligament near the Lateral Meniscus). 

Most people easily call IT Band Syndrome a Runner’s Knee as Runner’s knee can include ITBS as noted above.

It is rather easy to confuse, especially because of the anatomical makeup of the bands of tissues. 

A common way to help detect the difference is if the epicenter of the pain is coming from the side, then it is usually a good indicator that you have IT Band Syndrome.

To help determine if you have ITBS these are a few questions you can ask yourself.

  1. Is my knee pain affecting the general kneecap area?
    1. This is usually a sign of a different cause of Runner’s Knee.
  2. Is my knee pain primarily in the sides of my knee
    1. This is usually a sign of ITBS.

ITBS specifically affects the outer side of your knee, whereas runner’s knee is a generalized pain to the knee.

To better diagnose your knee pain when squatting or sitting, call and visit the offices of Greater Phoenix Orthopedics, located in Scottsdale,  AZ. We provide solutions for total knee replacement surgery using a minimally-invasive technique with MAKO robotic-assisted technology.

Recovering from Knee Pain

Recovery is different for everyone, but not impossible. Chances are, if you’ve done research on your knee pain, you have come across R.I.C.E. (R – Rest, I – Ice, C- Compression, E – Elevate).

If you are looking for more in-depth tips on how you can recover and treat your knee pain, feel free to contact us here at the offices of Greater Phoenix Orthopedics.

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12 Ways to Treat Knee Pain

Knee pain and problems are universal issues and can affect any age group. If you or someone you know are experiencing knee pain, swelling, inflammation or soreness, here are a few ways to combat the symptoms.

1. R.I.C.E 

man pausing from run to remedy knee pain
  • Rest: initially it is important to rest a sore joint, especially with an acute injury. Avoid strenuous activities for 5 days to a week to allow your knee to begin healing
  • Ice: Icing the knee when knee pain appears can help reduce pain and inflammation. Start with ice 2-3 times a day for 15 minutes each session. Never place ice directly on the skin. 
  • Compression: Wearing a over the counter compression sleeve or ace wrap can help reduce swelling and improve the functionality of a sore knee joint. 
  • Elevation: After an initial injury or flare of pain elevating the sore leg above the hip ( ie laying down with the leg elevated) can help the excess swelling drain back into the body. 

2. Keep Moving

  • While recovery is vital, physical activity is also required to expedite the healing process.  Nonimpact activity is often the best treatment for a sore knee because it helps maintain a range of motion while bringing healing elements to the knee. 
  • Exercises like the stationary bike, walking in the water, swimming and the elliptical are recommended. 
  • Stop any activity that makes the pain worse. 

3. Walk Around

  • Without walking around and working the inflammation, the body cannot properly partition oxygen-rich blood and nutrients to the knee. 
  • A brisk 10-minute walk after a meal is advised, but choose a non-impact activity as listed above if walking irritates the knee.  It will serve as a double-edged sword, giving you a chance to digest your food properly and work the knee.

4. Hot & Cold Therapy

  • After the initial injury or flare has begun to heal, using both Hot & Cold Therapy interchangeably will promote a speedy recovery process
  • Hot: Using a heated compress, wrap the compress around your knee and apply pressure for a few minutes. It is important to set the temperature to a reasonably hot setting. The heat promotes blood flow into the injured area.
  • Cold: Using frozen packaged vegetables, ice wrapped in cloth or frozen ice packs, apply the pressure every so often. It is important to let your skin recover and come back to normal temperature after a few rounds of icing. NEVER PLACE ICE ON BARE SKIN. 
  • Be mindful of how you feel while using hot/cold therapy. Do not compress heat or cold against your skin for too long. 
  • A good rule of thumb is 3 Min/Hot to 1-2 min/Cold

5. Change up your tastebuds!

  • Certain anti-inflammatory foods and spices can help the recovery process.
  • Quercetin is a compound that has been found in apples, white & red onions, yellow & green bell peppers, and green tea that has shown to help with inflammation
  • It is recommended that you drink 3 cups of green tea and combine a variety of the aforementioned ingredients
  • Turmeric (curcumin) is also a great anti-inflammatory and can be added to many foods. 

6. Cushion your feet 

  • Switching out your shoe soles for cushioned ones can ease the pressure placed on your knee.
  • Make sure your shoes are supportive but not too  heavy or constricting 
  • Choose gym shoes or hiking sandals over flip flops or flats when walking long distances or standing for extended periods of time 

 7. Regular Stretches

  • The knee joint is interconnected with multiple leg muscles. Proper stretching of the hamstrings, quads, and calves will help alleviate the stiffness.
  • Being gentle with these exercises and stretches goes a long way. Being careful not to over-extend anything is advised. 
  • If you are unsure of where begin, start with a simple forward fold ( bending towards the toes) and other helpful stretches for knee pain!

8. Acupuncture

  • If you’re not afraid of needles, acupuncture is another great way to alleviate sharp pains.
  • A process that involves small needles that penetrate the skin. Studies suggest that acupuncture activates neurohormonal pathways via nerve stimulation.
  • Be sure to find a reputable practitioner who uses sterile techniques.

9. Losing Weight

  • Our knees take on a good amount of our weight. Losing weight will help alleviate some pressure on the knees. Each pound you lose can unweight your knees by around 5 pounds! 
  • Some aerobic exercises that can be done with higher intensity (not involving the knees) can be biking, swimming, rowing machine, weighted ball exercises, etc.
  • As a precaution, it is good to warm up sufficiently and hydrate well. Taking a few preventative measures will not only help with recovery but strengthen it.

10. Deep-Tissue Massage

  • Knee Pain may also be attributed to jumbled and knotted muscle fibers. Deep tissue massages to the hamstrings, inner thighs and around the knee may alleviate the pain. 
  • If you have a deep tissues massage be sure to hydrate well and stretch lightly after to avoid muscle cramping.

11. Use a Crutch (if needed)

  • Pretty self-explanatory, but using a crutch can relieve a sore knee of stress and pain. 
  • Following the RICE principle is advised.

12. Be Patient

  • Your age and overall health can determine the speed and length of your recovery. The severity of your knee pain and inflammation is something to take into consideration as well. 
  • Time and proper care of your knees will be a marathon. Taking a step at a time will go a long way (pun intended)
  • If you have waited but your pain is worsening or you have developed new symptoms like clicking, locking, or instability in the knee please follow up with a medical provider. 
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Partial vs. Total Knee Replacement: Which is Right for Me?

Patients dealing with debilitating knee problems like arthritis are often faced with a decision to proceed with a partial or total knee replacement.  Both surgeries can produce excellent results but there are significant differences between the two procedures that can affect overall satisfaction. Here are some things to take into consideration when deciding between partial vs total knee replacement.

  1. Age
  2. Overall Health
  3. Fitness level
  4. Recreational Activities
  5. Previous Injuries or Procedures

Run-Down of Partial and Total Knee Replacements

The human knee is made up of three compartments: 

partial knee diagram
Knee Diagram
  1. Medial (inside)
  2. Lateral (outside)
  3. Patellofemoral (under the kneecap).

A total knee replacement involves resurfacing all three compartments with metallic biomaterials designed to function similarly to cartilage.  A partial knee replacement selectively resurfaces one of the three compartments with similar but smaller implants. The most commonly used biomaterials are cobalt chrome, titanium, and polyethylene plastic.

While many problems can lead to knee replacement, the most common diagnosis is osteoarthritis.  This “wear and tear” disease results in the destruction of the protective, white, cartilage layer on the ends of the bones in a joint.  When all of the cartilage has been destroyed, exposing the underlying bone, it is commonly referred to as “end-stage” or “bone on bone” arthritis.  This and other signs of arthritis can easily be seen on a plain x-ray. Advanced imaging techniques such as CT scan or MRI are typically not needed to diagnose osteoarthritis.  Patients can often maintain good function for years with non-operative treatment. When symptoms worsen and stop responding to conservative treatment, knee replacement procedures can be considered.  

How do Partial Knee Replacements Work?

A good candidate for a partial knee replacement would have radiographic signs of “bone on bone“ arthritis in only one compartment of the knee with localized pain to that same compartment.  Patients with widespread pain in the knee who are unable to localize their symptoms are typically better candidates for total knee replacement. 

A partial knee replacement can be performed manually or with robotic assistance.  A manual partial knee replacement requires the surgeon to prepare the ends of the bones for implants using specialized jigs that help to align the components. A robotic-assisted partial knee replacement uses a robotic arm to help prepare the ends of the bones in a more accurate and precise way. Validation studies have shown better alignment of implants can be achieved with robotic technology. It is hoped that better alignment will lead to longer-lasting implants.  Although robotic technology has only been available for partial knee replacements for about 10 years early survivorship studies are encouraging.

Robotic-Assisted Procedures

Robotic-assisted procedures help provide a more thorough and efficient method of surgery. A robotic partial knee replacement starts with a CT scan of a patient’s knee. The CT scan is used to construct a three-dimensional image which is stored in the robotic system memory.  This allows the robot to understand the unique bony anatomy of a patient’s knee. At the time of surgery special reflectors are fixed to the patient’s femur and tibia.

The surgeon then identifies unique landmarks on the patient’s knee using special probes that the robot can “see“.  The robot can then confirm that the three-dimensional CT scan image in its memory is accurate and since it knows where the patient’s “knee” is in relation to the two reflectors it can “track“ the patient’s knee as the surgeon moves it in space. 

In this way when the surgeon identifies the system, the best location for the implants the robot knows exactly where that position is.  The robot’s arm, holding either a saw or a burr, is then used by the surgeon to remove bone in the precise location where the implants are to be placed.  Although the surgeon has to manipulate the robotic arm to remove bone the system “guides” the surgeon’s hands by allowing only the precise amount of bone to be removed to accommodate the implants.  After preparing the bone with the robotic arm the implants are typically cemented in place and the knee incision is repaired with suture.  

The majority of partial knee replacements are performed on an outpatient basis with most patients leaving the surgery center or hospital within one hour of waking from Anesthesia. Physical therapy is generally not required and most patients return to work within two weeks of surgery.  Patients usually experience 2 to 3 days of discomfort following the procedure and sometimes require pain medicine. Bandages are removed three days following the procedure and patients are allowed to shower provided there is no bleeding or drainage from the incision. There are numerous advantages to partial knee replacement but also some disadvantages.

Pros:

  1. Minimally invasive
  2. Quick recovery
  3. No PT (Physical Therapy) required
  4. Minimal discomfort
  5. All ligaments are retained
  6. More natural knee motion
  7. No long term activity restrictions
  8. Lower complication rates than total knee replacement 

Cons:

  1. Potential for additional surgery if arthritis develops in other knee compartments
  2. Risk of implants wearing out

How do Total Knee Replacements Work?

Total knee replacement can also be performed either manually or with robotic assistance.  Robotic assistance, similar to partial knee replacement, has consistently been shown to be a more accurate and precise technique for aligning and placing implants in a human knee.  Unlike partial knee replacement where a single compartment is replaced, total knee replacement resurfaces all three compartments with biomaterials. The incision is slightly longer than a partial knee incision to accommodate the larger implants.  The overall procedure is similar in that a CT scan is obtained prior to surgery and used to “visualize“ the patient’s knee. Similar trackers are placed in the femur and tibia during the surgery so that the robotic system can “locate” the patient’s knee in space.  After the surgeon determines the best position for implants the robotic arm precisely controls the saw used to shape the ends of the bones so that the implants fit in that exact location. Fine control of the saw-blade also protects the surrounding soft tissue such as ligaments, tendons, and skin.  After the implants are fixed to the ends of the bones the knee incision is repaired and the patient is awoken from anesthesia.

Pros:

  1. Less pain than with traditional knee replacement
  2. No chance of arthritis recurring
  3. High patient satisfaction
  4. Excellent function with few activity restrictions

Cons:

  1. Larger incision
  2. Longer recovery
  3. Greater blood loss
  4. Higher complication rates

Recovery after knee replacement surgery is a very individual process with many factors influencing the speed of recovery. Recovery can be defined in many different ways. For the purposes of this blog, recovery will be defined as either a return to work or activities of daily living.  Patients should never compare their recovery time to others but some generalities do exist. In general, patients recover from partial knee replacement faster than from total knee replacement. Most patients are able to return to work within 2 weeks of having a partial knee replacement but closer to 6 weeks for total knee replacement depending on work conditions.  

Physical therapy is another concern after knee replacement. Most partial knee patients do not require physical therapy but most total knee patients participate in 4 weeks of therapy.  In terms of pain, most patients report varying degrees of discomfort for 2 – 3 days after partial knee replacement but more like 2 – 3 weeks after total knee replacement. While full healing requires 6 to 12 months most patients report 80% improvement in symptoms two weeks after partial knee replacement and six weeks after total knee replacement.

From a functional standpoint, both partial and total knee replacements can provide excellent results. Most patients after either procedure can resume all activities.  The only exception is a general recommendation against impact type exercise such as running. The concern is that the repetitive loads placed on knee implants with running can lead to increased wear and premature failure. Kneeling can initially be difficult for patients undergoing either procedure but with proper instruction, most patients can perform this activity.  Competitive athletes who place huge demands on their knees may notice improved function with a partial knee replacement. This is likely due to the retention of the anterior cruciate ligament (ACL) which allows for more natural knee motion and increased proprioception. Total knee replacements compensate for the removal of the ACL with implants that fit more tightly together. 

Both partial and total knee replacement are excellent options for patients with advanced degenerative diseases of the knee who have failed conservative treatment. Both procedures can result in a highly functional knee that allows patients to resume almost all activities.  There are some differences however between partial and total knee replacement that should be taken into consideration when planning surgery. These differences should be discussed with your surgeon so that you can choose the procedure that fits you and your lifestyle the best.

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Top Tips for Avoiding Joint Pain this Winter

When winter weather rolls into town people often feel that it not only brings tidings of holidays, shopping, and family but also joint pain. For some, they feel it so keenly that they seem to be able to predict the weather changes based on the status of their joints. Although science provides no clear explanation of this phenomenon several studies have documented the correlation between weather fluctuations and joint pain. 

The Correlation Between Weather And Joint Pain

There are some theories that can explain the correlation including the changes in barometric pressure with the shift in season. A decrease in temperature may also thicken the fluid that lines the joints, causing more stiffness and sensitivity to pain. Winter also leads to inactivity and changes in the activity which can lead to painful joints. Cold weather may even affect us at the genetic level as a 2015 study noted that genes that promote inflammation are more active in the winter while anti-inflammatory genes are suppressed. 

In addition to all of this, the incidence of illness increases in the winter, leading to more pain and inflammation for those who fall sick. 

Tips To Prevent Joint Pain in the Winter

As for patients who experience this influx of pain with the season change, they certainly agree there is a link and often look for a way to relieve the joint pain. If cold weather has been causing joint pain for you or your loved ones the following conservative treatments may offer some relief: 

  • Warm-up with activity: When the temperature drops doing a few stretches, using a recumbent bike, or finding a local exercise class can increase mobility and reduce pain. Be sure not to overdo it and listen to your body. 
  • Help reduce inflammation: Diet plays a large role in the body’s overall inflammation. Highly processed foods, sugary foods and foods high in saturated fat can increase inflammation and therefore pain. Avoiding these can help reduce pain and help patients lose extra weight which will also reduce stress on your painful joints. 
  • Stay warm with layers and heat: wearing the proper clothing, especially here in Arizona, will be helpful. If you are used to wearing shorts year-round it may be time to get some long pants to wade through the winter months. Moreover, we are hesitant to use heat here, but it can be helpful to prevent joint pain. An electric blanket or heating pads are also wonderful. 
  • Taking OTC (over the counter) painkillers with care: medication like Advil (ibuprofen/Motrin), Aleve (naproxen/Naprosyn) and acetaminophen (Tylenol) can help get you through painful periods. These medicines are not without side effects, however, and if you plan to use them you should consult with your doctor before using them. Follow the instructions they give you regarding dosing, type and frequency because these medications can cause new problems or worsen existing ones. 
  • Try OTC rubs and creams: Patients often find relief with OTC ointments and creams including Blue Emu, Salonpas Icy Hot, Bio Freeze, Arnicare, and Aspercreme. In a recent study, Capzasin was the top-recommended product, but each person’s experience is different. Find what works best for you. 
  • Try an herbal remedy: Turmeric (curcumin), arnica, ginger, aloe vera, and other medications have been shown to help reduce pain and inflammation. As with any medications these can have side effects and you should contact your doctor prior to trying them. 
  • Alternate between using ice and heat: Ice and heat can both be effective during flare-ups, and alternating between the two throughout a painful spell can be beneficial. Do no use either for longer than 10-20 minutes and do not sleep with heating pads or ice machines on. This can cause serious skin damage. 
  • Keep swelling to a minimum: keeping your joints from swelling can help prevent pain. You can use well-fitting gloves, compression garments, and compressive knee braces to help reduce swelling and improve functionality. Make sure any tight item whether it be a piece of clothing, glove, or brace does not squeeze too tight so as to prevent blood flow. If you feel a limb become cold or tingly remove the items immediately. 
  • Lastly, remember the weather will change: Looking ahead to warmer days can help prevent the psychological effect that the cold, dark, and damp weather may have on your body. Studies have found that patients can experience a lower threshold of pain during the winter months due to a lack of sunlight. To prevent this find ways to occupy your mind with things you enjoy, try to get enough sleep and maintain a good diet (even during the holidays). Learning how to improve your mood plays a big role when managing chronic joint pain, but if you feel your mood is slipping out of your control follow up with your doctor. 
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Common Running Injuries And How To Prevent Them

Running is a physically demanding activity that works your entire body but impacts your lower body with every footstrike. When you run your weight-bearing joints, specifically the knees and hips experience pressure around 3 times your body weight when walking and approximately 5 times your weight when running. Although reported running injuries range in each study a broad review of the literature notes that the average runner experiences from 2.5 to 12.1 injuries per 1000 hours of running.  It’s not surprising then that hip and knee pain is a common trend among runners. Although sometimes debilitating, these pains can often be managed with conservative treatments like RICE ( rest, ice, elevation, compression), stretching, strengthening exercises and modifying the frequency and intensity of your runs. 

Common Running Injuries Runners Face

Knee Injuries

The knees are the major shock absorbers for the body while running and they also play an important role in locomotion or propelling you forward as you run. Because of this function, the kees are often injured or irritated by running. 

1. Patellofemoral Pain Syndrome (PFPS) 

Also known as runner’s knee is the most common knee injury. Runner’s Knee affects the point between your patella (kneecap) and the femur (thigh bone), more specifically the cartilage behind the kneecap. Symptoms of runner’s knee include Mild swelling, pain or soreness when you complete any activity that puts pressure on the knee, such as running, stairs, kneeling and squatting. Your knee may pop and crack (known as crepitus) a lot more when you bend and straighten the knee. 

 How To Treat Runner’s Knee:
  • Take a break from running
  • Reduce mileage
  • Cross-train with activities that don’t aggravate your knee
  • Apply ice for 15 minutes five times a day
  • Compress the knee with an ACE wrap or compression sleeve 
  • Take an anti-inflammatory like Aleve 
  • Quad and hamstring stretching 
  • If the pain persists or worsens, follow up with a doctor
How To Prevent Runner’s Knee:
  • Keep the muscles around your knee and hip strong with strength training 
  • Stretch and roll daily
  • Shortening your stride can take the pressure off your knees. Aim for 170-180 foot strikes per minute

2. Patellar Tendonopathy 

Or patellar tendonitis is a common soft tissue pain from running.  It is typically called Jumper’s Knee because it affects people who do a lot of sports that require excessive jumping or landing on the knee – such as with running. The patellar tendon connects your kneecap to your tibia( lower leg bone). When the attachment is stressed repetitively it becomes inflamed and irritated. Symptoms for patellar tendonitis include a stiff or swollen knee. The tendon may look thicker and swollen along the front of your knee. To be sure, compare it to the unaffected side. You may have pain in your knee while walking or running along with pinching or burning sensation on the bottom of the kneecap. 

How To Treat Patellar Tendonitis: 
  • Stop running until you can do so pain-free; cross-train instead
  • Apply ice for 15 minutes five times a day
  • Using a Chopat strap AKA  patellar tendon strap can reduce pain

If the pain persists or worsens, follow up with a doctor.

How To Prevent Patellar Tendonitis: 
  • Strength training to balance muscle tension in your hamstrings and quadriceps 
  • Stretch your quads and hamstrings 
  • Foam roll daily

3. Illiotibial Band Syndrome (ITBS) 

Another common knee injury from running is Iliotibial Band Syndrome (ITBS) and is in line to overtake PFPS as the most common knee pain from running. This injury affects the outer hip to the knee which is where your iliotibial band (ITB) runs from your ilium of the hip to the tibia or your lower leg bone.  Your knee extends and flexes when you run, which causes the IT band (outer hip to knee area) to run against the femur, leading to friction and pain in the outer knee joint. Symptoms of ITBS include swelling and inflammation with lateral knee pain that comes when you are using the knee and goes away when you stop using it.

How To Treat ITBS:
  • You can run unless pain forces a change in your form; Reduce your mileage and cross-train
  • Foam roll your ITB on the soft part of your outer thigh
  • Do ITB stretches 
  • If you overpronate when you run/walk, wear motion-control shoes 
  • See a doctor if it persists
How To Prevent ITBS:
  • Strengthen your glute and core (abdominal) muscles 
  • Foam roll or stretch your ITB daily
  • A shorter, quicker stride can help. Aim for 170-180 foot strikes per minute

4. Osteoarthritis ( OA)

OA is a form of wear and tear arthritis. Running increases the wear on the hyaline cartilage which protects the ends of your bones. Once this cartilage begins to degrade your bones will rub on each other and cause pain. OA will also present with stiffness, warmth and swelling after impact activity like running. 

How To Treat OA:
  • Continued movement helps preserve the knees
  • Take an anti-inflammatory or Tylenol 
  • Run on soft surfaces 
  • Add in non-impact activities such as swimming or biking 
  • Follow up with a specialist for other conservative options 
How To Prevent OA:
  • Weight loss
  • Reduce impact activity 
  • Strength training

5. Other Soft Tissue and Bone Injuries 

Running can elicit a variety of injuries to the knee including meniscal pathology, subchondral fractures, chondral lesions, among others. The key for knee pain is that if it fails to respond to conservative treatments like RICE and over the counter (OTC) medications then you should stop running or the activity that causes the pain and follow up with a specialist. 

Common Hip Injuries In Runners

The hip is our largest ball and socket joint in the body and is surrounded by large ligaments and muscles. Running can not only stress the ball and socket joint itself but also the hips support structures. Hip pain is common in runners because it is easy for hips to become tight. This can leave them less flexible under the pressure and impact of running, leading to stress and strain. Eventually, this can lead to pain and injury.

1. Muscle Strain and Tendonitis

Muscle strain and tendonitis occur when muscles in the hips are overused. You may feel aches, pains, and stiffness in your hips, especially when you flex your hip or climb the stairs.

How To Treat Muscle/Tendon Strain:
  • Stretch before and after your run, focusing on the muscles around the hip joint 
  • Foam roll
  • Take a break from running and cross-train with non-impact exercise 
  • If you overpronate when you run/walk, wear motion-control shoes 
  • Ice the affected area for 20 mins, 3-4 times a day
  • Over the counter (OTC) non-steroidal anti-inflammatory medications (NSAIDs) like ibuprofen if allowed can be helpful 
  • See a doctor if it persists
How To Prevent Muscle/Tendon Strain:
  • Strengthen your glute and core (abdominal) muscles 
  • Stretch your hip and gluteal muscles regularly, especially the hip flexors (think runners lunge) 
  • A shorter, quicker stride can help. Aim for 170-180 foot strikes per minute

2. Bursitis 

Bursae are fluid-filled sacs that cushion the bones, tendons, and muscles protecting each other from shear forces. Repetitive motions, such as running, put pressure on your bursa, causing them to become painful and inflamed. This leads to bursitis, which is characterized by swelling, redness, and irritation.

How To Treat Bursitis:
  • Stretch before and after your run, focusing on the muscles around the hip joint 
  • Foam roll
  • Take a break from running and cross-train with non-impact exercise 
  • If you overpronate when you run/walk, wear motion-control shoes 
  • Ice the affected area for 20 mins, 3-4 times a day
  • Over the counter (OTC) non-steroidal anti-inflammatory medications (NSAIDs) like ibuprofen if allowed can be helpful 
  • Physical therapy 
  • See a doctor if it persists
How To Prevent Bursitis: 
  • Strengthen your glute and core (abdominal) muscles 
  • Stretch your hip and gluteal muscles regularly, especially the hip flexors  runners lunge) and IT band ( figure 4 stretch) 
  • A shorter, quicker stride can help. Aim for 170-180 foot strikes per minute
  • Running on a softer surface like a track 

3. Iliotibial Band Syndrome (ITBS) 

Iliotibial Band Syndrome (ITBS) is the same IT band that can give you knee pain. This injury affects the outer hip to the knee which is where your iliotibial band (ITB) runs from your ilium of the hip to the tibia or your lower leg bone. You may feel or hear a clicking or popping noise when you move. Symptoms of ITBS include swelling and inflammation with lateral hip pain that comes when you are using the hip and goes away when you stop using it.

How To Treat ITBS:
  • You can run unless pain forces a change in your form; Reduce your mileage and cross-train
  • Foam roll your ITB on the soft part of your outer thigh
  • Do ITB stretches 
  • If you overpronate when you run/walk, wear motion-control shoes 
  • Rest, Ice 
  • OTC medications like Ibuprofen as discussed above 
  • See a doctor if it persists
How To Prevent ITBS:
  • Strengthen your glute and core (abdominal) muscles 
  • Foam roll or stretch your ITB daily
  • Stretch the other large muscles around the hip to avoid imbalance 
  • A shorter, quicker stride can help. Aim for 170-180 foot strikes per minute

4. Labral Cartilage Tears

  • Your labrum is the ring of cartilage in the socket portion of the hip that helps cushion and stabilizes the ball. Tears in the labrum can occur from repetitive motions like running or jogging. Often times these tears present with a clicking, catching or locking when you move. You may feel and hear it. You may experience stiffness and limited mobility. 
How To Treat a Labral Tear: 
  • If you suspect you have a labral tear, make an appointment with a doctor 
  • Stop running and ice the joint
  • Use OTC medications like Tylenol or ibuprofen if allowed 
How To Prevent a Labral Tear: 
  • Maintain a healthy weight 
  • Stretch regularly
  • Cross-train and allow your hip to rest 

5. Other Soft Tissue and Bone Injuries 

Running can elicit a variety of irritations in the hip including but not limited to iliopsoas (hip flexor muscle) tightness and snapping, avascular necrosis, subchondral fractures, chondral lesions, among others. The key for hip pain elicited by running is that if it fails to respond to conservative treatments like RICE and over the counter (OTC) medications then you should stop running or the activity that causes the pain and follow up with a specialist. 

Ankle Injuries

Runners are extremely susceptible to ankle injuries because the ankles are important in all 3 axis of rotation in addition to shock absorption.  Ankle strain, tendonitis, and stress fractures are the most common injuries that runners sustain in the ankle joint. Injuries to the ankle often require a hiatus from running while the injury heals and you rehab the joint.  If your ankle pain fails to improve with RICE and other conservative treatments it is important to follow up with a medical professional. 

Exercises to Prevent Running Injuries

To prevent injuries from running, always start slow.  Take small bites when approaching a new training program, whether it be running itself or a strength and conditioning program to help manage your endurance. 

Here are some exercises that can help prevent injuries 

Single-Leg Squat (helps improve pelvic stability, gluteal strength, overall balance)

  • Stand on one foot. Bending at the knee, sit your hips back as if you are going to sit in a chair behind you. Aim for your upper leg to be parallel or lower to the ground. Do not let your knee pass your foot. 
  • Return to a standing position. Repeat 12 reps before switching to the other leg.

Standing Calf Raises/ Calf Stretch

  • Start on your tiptoes on the edge of a step (make sure you are well balanced), gradually lower one heel below the step.
  • Using the other leg, raise yourself back to the starting position.
  • Do three sets of 15 reps of each exercise twice a day.

Gluteal and Hip External Rotator Strengthening

  • Kneel on the floor with your hands on the ground, knees below your hips and hands beneath shoulders.
  • Lift one knee off the floor and way out to the side
  • Hold for 1-2 seconds and lower as slowly as you can. 
  • Perform 10  times, then repeat on the other leg.

Side Leg Raises (for gluteal strength) 

  • Lay on your right side with your legs extended out and stacked on each other.  Head can be supported with hand or on a pad/pillow.
  • Engage your left glute muscles and slowly lift up your leg keeping your foot in a neutral position.
  • Lower leg to starting position. Do 12 reps. Repeat on the other side. May use a resistance band for higher intensity.

Plank (core building)

  • Begin in push up position and lower down to your forearms, making sure shoulders are over elbows and palms are flat on the floor.
  • Make a straight line from your head to your heels, hold this position for 20-60 seconds.
  • Do not drop your hips, make sure to squeeze your glutes to protect your low spine. 

Side Plank (core building)

  • Put one elbow on the ground with your side on the ground.
  • Extend both legs out so that your body is in one straight line, balancing on the outside edge of your bottom foot.
  • Keep your waist up and lifted, and don’t sink into your bottom shoulder. Reach your upper hand to the ceiling.
  • Hold for 20-60 seconds before repeating on the opposite side.

Runners Lunge 

  • Place one leg forward, knee bent at 90 degrees. Do not let your knee pass your foot. 
  • Place the other leg behind you, toe to the ground, heal in the air. 
  • Hold a static stretch for 15- 30 seconds. Do not bounce
  • Repeat on the other side, repeat as many times on each side as feels good.

Forward Stretch

  • While protecting your low back, keep your knees straight and lean forward
  • Hold for 15-39 seconds
  • Stand up slowly, one vertebra at a time. 
  • Repeat one more time for a full stretch
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8 Things To Know About Makoplasty Joint Replacement

Robotic surgery is at the cutting edge of medicine and is often an important discussion point for patients undergoing elective surgery. Makoplasty offers valuable insight into precision methods that allow surgeons to work more efficiently, and for patients to recover much sooner than with traditional surgical methods.

1. What Is Robotic Surgery? 

Robotic surgery, in general, is a type of surgical procedure that allows surgeons to perform complex surgical procedures while circumventing limitations of traditional and minimally-invasive surgery. Robotics enhance the surgeon’s skills with advanced control, flexibility and precision. Robotic surgery or robotic-arm -assisted surgery for MAKOplasty, allows Dr. Martin to perform a total hip replacement, total knee replacement, and partial knee replacement with these benefits. 

2. What Is The Makoplasty Robotic System? 

It is a state of the art remedy for patients suffering from painful joints and arthritis of the hip or knee. The system utilizes a 3D virtual model of your unique anatomy and a robotic arm, called Mako which helps Dr. Martin plan and perform your joint replacement surgery with increased accuracy and efficiency. 

3. What Does The MAKOplasty treat? 

The Makoplasty robotic-arm assisted surgery is indicated for patients with degenerative or traumatic damage in the hip and knee joints. 

The current Mako System offers Partial Knee, Total Hip and Total Knee applications.

4. Who Is A Candidate For A Mako Procedure? 

Any patient who is a candidate for a traditional hip or knee joint replacement procedure is a candidate for a robotic arm assisted procedure. 

Typically, robotic joint replacement patients share the following characteristics:

  • Knee or hip pain with activity
  • Start-up pain or stiffness when activities are initiated from a sitting position
  • Failure to respond to non-surgical treatments including injections, physical therapy, activity modification and nonsteroidal anti-inflammatory medication

Patients suffering from diseases including osteoarthritis, rheumatoid arthritis, avascular necrosis, and traumatic arthritis can find their way back to activities and a better lifestyle with robotic replacement surgery. 

5. How Does MAKOplasty Work? 

The MAKO robotic arm interactive orthopedic system creates a three-dimensional pre-surgical plan from your personal CT scan. Dr. Martin uses this pre-surgical plan to template the appropriate implants for your needs. 

During surgery, the system provides him with real-time visual, tactile and auditory feedback to facilitate optimal joint resurfacing and implant positioning. 

It is this precise placement that can result in more natural knee or hip motion following surgery.

The precision of the robotic arm also lessens post-op soft tissue irritation. 

6. What Can I Expect If I Have A Robotic-Arm Assisted Surgery? 

MAKOplasty robotic surgery can be performed as either an inpatient procedure or on an outpatient basis depending on what Dr. Martin determines is right for you. 

The majority of Dr. Martin’s MAKOplasty surgery is performed in an outpatient setting and patients return home the same day.

Patients are permitted to walk directly after surgery, drive a car within two weeks and return to normal daily activities shortly thereafter. 

7. Is Mako Covered By Insurance?

MAKOplasty is typically covered by most Medicare-approved and private health insurers.

8. What Is The Lifespan Of A Makoplasty Implant?

All implants have a life expectancy that depends on several factors including the patient’s weight, activity level, quality of bone stock and compliance with Dr. Martin’s recommendations.

Proper implant alignment and precise positioning during surgery are also very important factors that can improve the life expectancy of an implant.

Through the use of the robotic arm system, your implants are optimally aligned and positioned to ensure the longest benefit.

Individual results may vary. There are risks associated with any joint replacement surgical procedure, including MAKOplasty®. Dr. Martin can explain these risks and help determine if a MAKOplasty® procedure is right for you. For more information on the MAKOplasty robotic-arm assisted surgery please click here.