“The day of my knee replacement surgery, the staff was so assuring and pleasant I almost forgot what was going to happen. I went to sleep, woke up, and was amazed. I had no pain.
I was ready to walk.”
If arthritis or injury has severely damaged your knee, you likely dread simple activities, such as walking or climbing stairs.
You struggle to escape the pain even while sitting or lying down. Not only that, but medications may leave you lacking energy. Walking supports, helpful earlier on, may have grown less effective.
Life doesn’t have to be that way
By resurfacing damaged and worn knee surfaces, total knee replacement surgery can relieve your pain, correct a leg deformity, and get you back to the activities you love. One of the most important orthopaedic surgical advances of this century, knee replacement was first performed in 1968. Improvements in surgical materials and techniques since then have greatly increased its effectiveness. Robotic technology makes knee replacement surgery more accurate and minimally invasive than ever, and Dr. Puri is an international leader who first brought these techniques to Endeavor Health.
Knee Implants
Dr. Puri uses high performance knee implants in his patients’ knee replacements. In the vast majority of instances, the implant is cemented in order to obtain immediate fixation and to enable patients to return to function.
Robotic Partial Knee Replacement
Approximately 10% of patients who qualify for knee replacement surgery are candidates for partial knee replacement surgery. This less invasive procedure enables the patients to return more quickly to function. They also have a slightly more normal appearing and functioning knee when compared to a full knee replacement.
Patients who have arthritis in one particular area of the knee without any arthritis in the other parts of the knee may be candidates for this type of procedure depending upon the severity of the disease.
Your Surgery
You’ll be admitted to the hospital the day of your surgery, and a member of the anesthesia team will evaluate you. The most common type of anesthesia for knee replacement surgery is a spinal anesthesia with sedation (which allows you to be awake but anesthetizes your body from the waist down). In certain cases, it may be necessary to perform a general anesthetic, which puts you to sleep through the procedure. The anesthesia team will discuss these choices with you and help you decide which type of anesthesia is best for you.
Mako robotic-arm assisted technology transforms how total and partial knee replacement procedures are done by integrating 3D virtual modeling and robotic-arm precision into the process. It’s an innovative solution that has been helping knee pain sufferers for more than a decade.
The Mako difference
In a laboratory and clinical stuudies:
Mako Total Knee enabled surgeons to execute their surgical plans more accurately.
Mako protected soft tissues and ligaments from damage.
Mako patients surveyed 6 months after surgery reported better patient satisfaction scores and lower pain scores than those who received a conventional joint replacement.
How does Mako technology work?
Personalized surgical plan: The first step is patient-specific surgical planning. Before surgery, a CT scan of your knee is taken to develop a 3D virtual model of your unique joint. Dr. Puri uses this model to evaluate your bone structure, disease severity, joint alignment and even the surrounding bone and tissue so he can determine the optimal size, placement and alignment of your implants.
Range-of-motion assessment: Throughout your procedure, Mako provides real-time data to Dr. Puri. This allows him to continuously assess the movement and tension of your new joint, and adjust your surgical plan if desired.
Arthritic bone removal: In the operating room, Dr. Puri guides Mako’s robotic arm to remove the arthritic bone and cartilage from your knee. A virtual boundary provides tactile resistance to help protect soft tissues and help Dr. Puri stay within the boundaries of your surgical plan.
Implant placement: With the diseased bone gone, your implant is placed into the knee joint. Then it’s off to the recovery room to begin your journey to strengthen your new knee.
Your Stay in the Hospital
After surgery, you’ll be moved to the recovery room, where you will remain for one to two hours so the team can monitor your recovery from the anesthesia. You’ll then be transferred to a private room.
Expect to sit up in a chair on the first night of your surgery. You’ll then start to walk using an assistive device (crutches or walker) on the following day.
You’ll either stay in the hospital for 1-2 days or, if you qualify, return home same day. After surgery, you’ll feel pain in your knee, and pain medication will help make you as comfortable as possible.
Are you a candidate for outpatient surgery?
Dr. Puri encourages what he calls a “Rapid Recovery Program.” Foot and ankle movement is encouraged immediately following the surgery to increase blood flow in your leg muscles, helping prevent leg swelling and blood clots. Most patients begin exercising their knee the day after surgery. A physical therapist will teach you specific exercises to strengthen your leg and restore knee movement, allowing walking and other normal daily activities soon after your surgery.
How Your New Knee is Different
You may feel numbness or stiffness in the skin around your incision, particularly with excessive bending activities. Improvement of the knee motion is a goal of total knee replacement but restoration of full motion is uncommon. Most patients can expect to nearly fully straighten the replacement knee, bend the knee sufficiently to go up and down the stairs, and get in and out of a car. Kneeling is typically uncomfortable, but it is not harmful.
Occasionally, you may feel some soft clicking of the metal and plastic with knee bending or walking. These differences often diminish with time, and most patients find these are minor, compared to the pain and limited function they experienced prior to surgery.
Please note that your new knee may activate metal detectors required for security in airports and some buildings. Tell the security agent about your knee replacement if the alarm is activated.
After your surgery, make sure you:
Participate in a regular light exercise program to maintain proper strength and mobility of your new knee
Take special precautions to avoid falls and injuries. In the event you sustain a fall, please go to the closest emergency room to get evaluated and rule out any fractures
Notify your dentist that you have had a knee replacement. You should be given antibiotics before all dental surgery for the rest of your life
See Dr. Puri periodically for routine follow-up examinations and x-rays
Robotic Knee Replacement FAQ
How long will I be in the hospital?
You will be in the hospital for 1-2 days. Most of Dr. Puri's patients are discharged home and set up with a home health agency, whereby a nurse will come to your home 2x/week and a physical therapist will come in 4-5x/week. You may be discharged at an earlier time, at which point you will be ready to do outpatient therapy.
Am I a candidate for outpatient surgery?
You and Dr. Puri will discuss. He uses techniques that make outpatient surgery possible, but some patients benefit more from a hospital stay. Find out if you qualify for outpatient surgery.
Who can I contact to schedule surgery?
You can contact Marie Albarillo, Dr. Puri's physician assistant or Kim Prado, Dr. Puri's nurse, at (847) 86-ORTHO to schedule surgery.
How long does surgery take?
A robotic total knee replacement will take approximately 1 hour, depending on the severity of the disease.
What happens during robotic total knee replacement surgery?
During a robotic total knee replacement, Dr. Puri removes the arthritis portion of the knee joint and replaces it with metal parts as well as a plastic portion, that is made of a high polymer polyethylene material. Dr. Puri will use a robotic system to help realign the knee.
How is pain managed after knee replacement?
The Endeavor Health Orthopaedic and Spine Institute manages pain through a multi-modal approach and dedicated pain team. This management enables patients to participate in physical therapy. The full-time pain team led by Endeavor Health anesthesiologists will customize a protocol for each patient dependent on individual needs.
How long will I be in the hospital?
You will go home either the same day or the next day. Dr. Puri will work with you to customize what is best for you.
When will I be able to drive after knee replacement?
You will be able when you are off narcotic pain medication and when Dr. Puri lifts your precautions, typically 2.5 to 4 weeks after surgery.
When can I return to work after knee replacement?
Depending on the type of work you do, most of Dr. Puri's patients may resume work within 2-3 weeks.
When can I swim after knee replacement?
You can swim once your incision is fully healed. Dr. Puri will assess the integrity of your incision at your one-month mark and the decision to get the incision wet/soaked will be made.
“My highest recommendation is given to Dr. Lalit Puri for his skill and expertise in Orthopedic Medicine. In 2022-2023, he replaced both of my knees using the MAKO procedure and I couldn’t be more appreciative. His pre-op consultations were both informative and helpful. I never felt pressured into a surgical procedure to relieve the pain I had experienced for several years. There were other less invasive treatments that were first tried without much relief. Dr. Puri and his staff were always professional and gave me their undivided attention, willing to answer all my questions and explain the process thoroughly. After each surgery the team provided support at every stage of recovery. With that, recovery went very well. Thank you, Dr. Puri, for improving my mobility and my quality of life.”