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Dr. Richard Angelo is Certified by the American Board of Orthopedic Sugery and holds a Sports Medicine Certificate of Added Qualification (CAQ). He has served as one of the Univeristy of Washington Husky athletic team physicians, Evergreen Hospital Chief of Surgery, and as a Clinical Professor in the Department of Orthopedics at the University of Washington Medical School. He is the Immediate Past President of the Arthroscopy Association of North America for 2012 – 2013.

He has specialty fellowship training in knee, shoulder, and Sports Medicine disciplines. His practice focus is on the treatment of disorders of the knee, shoulder, elbow and hip including arthroscopic reconstructive and joint replacement procedures. He has a special interest and has lectured nationally and internationally on the development of new arthroscopic reconstructive and minimally invasive surgical techniques for the knee and shoulder.

Specialities include:

Arthroscopic knee ligament repair, minimally-invasive partial knee replacement and total knee replacement.
Minimally-invasive arthroscopic rotator cuff repair, shoulder stabilization, shoulder resurfacing and replacement
Arthroscopic hip treatment of labral, articular cartilage, impingement disorders, and bursitis.

Despite the complexity of many procedures, they can be performed on an outpatient basis.

Makoplasty Robotic Partial Knee Replacement

Knee Arthritis

The loss of the firm, resilient cartilage that surfaces the bones in your knee is what constitutes arthritis and can cause pain, stiffness, swelling and ultimately, limited mobility. This condition of degenerative or osteoarthritis may primarily affect only one region of your knee (inside aspect, outside aspect, and kneecap joint) rather than the entire joint. When conservative management fails, the replacement of those worn surfaces offers the best option to resolve your pain and return you to an active lifestyle.

Makoplasty

An innovative new option has become available (Makoplasty) which harnesses the precision of a robotic arm (RIO – Robotic Arm Interactive Orthopedic System). Prior to surgery, a CAT scan (Computerized Axial Tomography) is obtained which is able to generate an extremely accurate 3D reconstruction of the specific contours of your particular knee including any deformities. The CAT scan information is loaded into the robot’s computer. Prior to surgery, the location and extent of bone resection can be precisely mapped and a myriad of adjustments made to the position of the implants well before the surgery takes place. These refinements permit the optimal position, alignment and orientation to be achieved.

Surgery

During the operation, a minimally-invasive approach is made to expose the knee surfaces. Tracking towers are affixed to the thigh and lower leg bones to permit precise navigation of the position and orientation of the knee joint surfaces using technology similar to a GPS system. Once the computer registers the exact position of your knee joint surfaces, the robotic arm controls the position of the resection burr and removes exactly the amount of bone from each surface that has been pre-operatively programmed into the computer. After trials are used to verify optimal placement, a metal runner is cemented onto the thigh bone and a metal tray onto the upper surface of the leg bone. A space-age plastic spacer is then inserted into the tray to complete the partial knee replacement.

Recovery

You are able to weight bear as tolerated the day following surgery. Range of motion improves rapidly and ambulating without the use of a walker is often achieved within several weeks. The accurate positioning and alignment of your new knee components optimize the durability and range of motion which is achieved. With all of your natural ligaments preserved, your robotically implanted knee replacement tends to feel relatively normal.

RIO RobotComputer Images

Makoplasty Side View

Makoplasty Front View

Articular Cartilage Injury

Each year, millions of Americans experience an injury to the articular cartilage of their knee. Articular cartilage is the white,
gristle-like tissue that covers the ends of the bones forming the knee joint. Damage to that cushioning surface often leads to pain, swelling and progressive deterioration of the knee, or degenerative arthritis. Unfortunately, articular cartilage has minimal potential to repair itself.

A number of options are available to treat the cartilage damage and the most appropriate choice depends on the size of the defect as well as age and activity level of the individual patient. When the area of cartilage loss is ¼ by ¼ inch or less, a technique to make multiple small perforations in the bone (termed microfracture) enables the bone to bleed and results in the formation of a layer of scar cartilage. While not as durable asnormal cartilage, good results are the norm.

Larger areas of damage, up to ½ by ½ inch, are managed by drilling several holes ¼ inch in diameter in the exposed bone. The holes are then filled with short “dowels”of bone with an intact cartilage cap that have been obtained from another, less important area of the knee. Thus, the defect is resurfaced as a “mosaic” of normal cartilage. (see below)

A third technique is employed when the area of exposed bone is up to 1 by 1 inch in size and is termed “articular cartilage implantation” which requires 2 stages. During a minimally-invasive arthroscopic surgery, a small quantity of the patient’s own articular cartilage is harvested from their knee and sent to a special lab where, under sterile conditions, literally millions of their own cartilage cells are grown in culture for a minimum of 4 weeks. During a second surgery performed in an open manner, the margins of the defect are carefully sharpened and a thin “lid” of tissue is sewn over the defect. The cultured cells are then injected into the covered space where the cells attach themselves to the bone and begin to generate new cartilage and a reasonably healthy joint surface.

A great deal of research is underway to create even more normal and durable joint cartilage surfaces that have been damaged. If you’ve injured your knee and have persistent pain and swelling, consider obtaining an evaluation and an accurate diagnosis. There may be treatment options available to help you avoid the long term disabling effects of articular cartilage damage in your knee.

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Partial Knee Replacement

Unicompartmental Arthritis

Arthritis of your knee can cause both significant pain as well as limit your ability to move about freely. Degenerative or osteoarthritis is caused either by progressive wearing away of the smooth, resilient bearing surface (articular cartilage) which “treads” the bone, or by an injury which damages that surface. When the articular cartilage is lost, the knee joint bearing surfaces become “bone-on-bone”. Arthritis, however, does not always involve your entire joint uniformly and can be relatively localized. The knee is considered to have three compartments, medial (along the inside), lateral (along the outside) and the third, your kneecap (or patellofemoral) joint.

Partial Knee Replacement

The goal of knee replacement is to alleviate pain and restore function. Most of your knee may be healthy, in which case, it would be unnecessary to replace the entire joint. A unicompartmental (UNI) or partial knee replacement resurfaces the worn thigh bone (femur) with a metal runner, and the lower leg (tibia) surface with a high density plastic material only in the compartment which has degenerative arthritis. Minimally-invasive surgical techniques facilitate a quicker recovery and enable restoration of more normal range-of-motion.

Am I a candidate for a “UNI”?

Your knee arthritis pain should be significantly affecting your quality of life before any surgical procedure is appropriate. Certain prerequisites are necessary for an optimal result from a partial knee replacement. Your history and examination should confirm that your pain is localized to one compartment, that your knee is stable and not ligamentously lax, and that any loss of knee motion is relatively small. In general, significant bone deformities are not amenable to correction with a partial knee replacement.

What could I expect from a partial replacement?

When performed using a minimally-invasive technique and compared to a complete knee replacement, a partial replacement generally result in a quicker recovery as well as less pain and blood loss. Because all of your normal ligaments are preserved (unlike complete knee replacement which sacrifices the anterior cruciate ligament or ACL), patients with a partial knee replacement tend to have a more normal feeling and function of their knee. UNI knee replacements using a minimally-invasive surgical technique have been shown to perform well over extended periods of time (12 – 15 years). A very active lifestyle with relatively few limitations can be resumed although repetitive, high impact activities should be avoided. Find out if a partial knee replacement might be able to offer you a “new lease on life”!

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