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 MAKOplasty® International Destination & Training Center of Excellence
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MAKOplasty® Robotic Arm Assisted Partial Knee Resurfacing MAKOplasty® Robotic Arm Assisted Knee Surgery is the most consistently, reproducible, precision joint replacement installation system available in the world today that allows certified surgeons to optimize knee implant sizing, tracking, and ligament balance enhancing implant function and longevity.  Dr. Buechel’s Procedure Dr. Buechel, Jr. has developed the Mini-MAKOplasty® Technique at his Center of Excellence that allows >98% of his patients to return home the same day.  A truly minimally invasive technique & process that provides rapid pain relief with return to an active lifestyle within weeks for most patients. Dr. Buechel’s exposures are 2-3 inches, no muscles are cut, no tourniquets are used, and blood loss is minimal requiring no transfusions. Autologous Platelet Rich Plasma (PRP) stem cell application is used to enhance the healing process during the closure.  Skin adhesive is used to hold the skin edges together and reduce the risk of external contamination while allowing patients to shower the next day .  Patients are walking at home the day of surgery. Most are off prescription pain meds within a week or two and feel better than before surgery in just 3-4 weeks. A short course of rehabilitation is recommended, with most requiring less than 4 weeks before returning to a regular walking exercise program.  Dr. Buechel’s comprehensive Mini-MAKOplasty® Program is designed to enhance patient outcomes, allowing patients the greatest chance of success with the least risk of complications. Why would a person consider Dr. Buechel’s “Mini” MAKOplasty® Knee Resurfacing? People can develop knee pain, swelling, loss of motion, painful limps and angular deformities from the loss of the smooth cushiony articular (hyaline) cartilage on the ends of their knee bones (the femur and tibia). This occurs due to wear and tear, previous knee injury, genetic family predisposition or osteo-necrosis ( a loss of blood flow to a bone area causing localized bone death and pain). Pain can occur during weight bearing activity including walking, stair climbing, getting in an out of cars, sitting or standing, playing golf or tennis, or even rolling over in bed. When people are no longer responsive to oral NSAIDS or have failed to get relief from weight loss, exercise, braces, or intra- articular steroid or hyaluronic acid injections, partial knee replacement (resurfacing) may be a solution. Who is a candidate? If a persons knee arthritis created loss of cartilage and pain primarily on one side of the knee joint (Medial or Lateral) or just the knee cap compartment (Patella-Femoral), then that person may be a candidate for the resurfacing of just one side or compartment of the knee.  X-rays and an orthopaedic examination by a surgeon certified in MAKOplasty® Robotic Arm Assisted Knee Resurfacing is all that is necessary to find out if you’re a candidate. The Benefits of Dr. Buechel’s Mini- MAKOplasty® Technique They include: Leaving all 4 ligaments intact (ACL, PCL, MCL, LCL) which maintains the natural stability front to back, side to side, and rotationally to the knee while maintaining the normal kinematic motions to the knee joint Greater motion by 5-10 degrees is common by 3-6 weeks after the procedure Leaving all the normal healthy or non-painful cartilage surfaces alone Dr. Buechel’s Installations are performed through small 2-3 inch exposures No Muscle is cut during the Medial or Lateral installations No Tourniquet is used with Dr. Buechel’s technique Blood loss is minimal, not requiring a transfusion Blood clot risk is extremely low and has not occurred with this technique with early activity, compression stockings, and aspirin twice a day for most Dr. Buechel is an expert and an instructor in computer CT planning for Makoplasty knee resurfacing which means each and every patient gets the most accurate custom computerized planning for their specific knee requirements including implant sizing, ligament balancing and implant tracking optimization A very sophisticated computer system is communicating live, in real-time, with a highly accurate robotic bone preparation tool that allows Dr. Buechel to achieve precision installation accuracy and ligament tensioning on each and every procedure You go home the same day Your rehab is not painful like total knee replacement rehab generally will be You will be back to most of your activities of daily living in 3-4 weeks with minimal pain No staples or sutures will need to be removed and you can shower the next day   Success of Partial Knee Replacement To achieve the potential long-term success of partial knee replacements, which has been reported to have 20 year success rates at 90%, highly accurate installation is best.  However, with just a few degrees of mal-alignment, partial knee replacements can prematurely fail quicker than a total knee would with less precise installation.  Partial Knee Replacements historically were very difficult procedures to perform well with most manual installation systems and they have a very high learning curve causing many early failures due to surgeon installation difficulty.  If surgeon installation accuracy can be made consistently precise with smart tools on every procedure including the first, then why wouldn’t surgeons want to use these tools on every procedure?  The answer is, most surgeons aren’t trained in this new system and therefore generally recommend total knee replacement even if you meet the criteria for partial knee replacement because they don’t know first hand, the game changing advancements in installation accuracy with the MAKO® System.  But, this game changing technology is precisely why Dr. Buechel chooses to use the MAKO® Surgical Corp Robotic RIO System when performing partial knee replacement.  Accuracy of the MAKOplasty® System The accuracy is within 1mm and 1 degree, and has been shown to be at least 3 times more accurate than standard human held instrument systems.  This system provides precise initial computerized sizing & placement of the implants in virtual reality but that’s where all the other systems stop and MAKOplasty® then exceeds all others. Real-time live motion data is collected during the intra-operative planning phase and this is used to make the fine corrections in the balance and tracking position of the implants, which other systems just don’t do. Once the final adjusted plan is set, the Rio Robotic Arm is used to accurately prepare the bone for the implants within 1mm and 1 degree of the plan, removing only a few millimeters of bone to allow for the implants to be fixed to the surface.  These anatomically designed implants come in 8 sizes and can fit all patients. Design of the MAKOplasty® Implants The MAKOplasty® Implants have been designed with many of the time- tested features of successful partial knee systems.  The Femoral component is cobalt chrome and made to be cemented to the bone surface.  The shape was designed from CT scans of healthy human femurs.  The medial femoral condyle implants were created directly from the common shape found from the CT Scans. There are eight sizes with this common anatomical shape.  This anatomical shape design when combined with real-time data captured intra-operatively, allows the surgeon to position the implant very precisely with an anatomical fit each time. This anatomical shape restoration allows the ligaments to be tensioned properly and near normal range of motion to return. Very little bone is removed compared to other systems because the bone preparation is done with a small 6mm robotic burr instead of a saw like other systems.  Two posts on the back of the implant are used to secure the implant along with the bone cement.  The Tibial component is made of titanium metal with ultra high molecular weight polyethylene as the modular bearing surface.  The Tibial component is similar in design to one of the most successful implants in clinical use and has two posts and a keel for fixation to the tibial surface. The Tibial bearings come in 1mm thickness increments and can be exchanged over time if the bearing wears down with use.  These bearings are “off the shelf” and can be available immediately for revision in the future.  Custom implants of other systems require the bearings to be made custom if ever a needed in the future .  This is a concern if these other companies no longer support their product lines or there is an infection requiring an emergency operation and bearing exchange required. Office Evaluation Office examination is used to obtain a medical history and to evaluate the location of pain and tender spots around the knee, to check the 4 ligament’s stability and function, to check blood flow, skin conditions, and overall strength and walking ability. X-Rays Patients get X-rays with 4 views of the knee to look for mild, moderate or severe joint space loss or destruction in one compartment from osteoarthritis, osteo-necrosis or post traumatic arthritis.  If the xrays and the exam are consistent with partial knee arthritis, and symptoms are only on the x-ray affected side, then a patient may be a candidate for the more anatomical & tissue preserving MAKOplasty® partial knee resurfacing procedure using the MAKO Surgical Corp Robotic Arm Interactive Orthopaedic  System.  A CT scan is then obtained for planning, medical clearance is obtained, and the procedure is scheduled and performed at the Robotic Joint Replacement Center at Physicians Regional Medical Center in Naples, Florida. Dr. Buechel, Jr. is an expert in MAKOplasty® surgery & nationally one of the most experienced MAKOplasty®  Robotic Knee Surgeons, having performed approximately 500 Outpatient Robotic MAKOplasty® Knee resurfacings since he began the program in Southwest Florida in 2009. 
Before Lateral MAKOplasty®
After Lateral MAKOplasty®
Frederick F. Buechel, Jr., M.D. | MAKOplasty® International Destination Center | 239-659-5633 (KNEE) Physicians Regional Medical Center, 6101 Pine Ridge Road, Second Floor, Naples, FL 34119 2014 © by Robotic Joint Replacement Center
Frederick F. Buechel, Jr., M.D. Board Certified Orthopaedic Surgeon  MAKOplasty® Robotic Knee Resurfacing & Total Knee Replacement Specialist (239) 659-5633 (KNEE)
MAKOplasty® 
TIBIAL PREPLANING SCREEN
FEMORAL PREPLANING SCREEN
FEMORAL BONE PREPARATION SCREEN
TIBIAL BONE PREPARATION SCREEN
MEDIAL & LATERAL MAKOPLASTY
LIGAMENT BALANCING GRAPH
TRACKING OPTIMIZATION PLAN
CARTILAGE MAPPING TRANSITIONS