The VOICE of UPMC Shadyside Winter 2022–2023

The Robot and the Knee

Robotic Knee Replacement Surgery Allows Some Patients to go Home the Same Day and to Recover More Quickly

One day about two years ago, Charles Yelich went to see Michael O’Malley, MD, to discuss his second knee replacement. The orthopaedic surgeon surprised him with a question. 

“How would you feel about letting me use a robot?” 

Mr. Yelich answered immediately: “Go right ahead.” 

Why such a quick “yes”? 

“First, I’m a paramedic, and I’ve always been interested in medical advances,” says Mr. Yelich, 68, of West Newton. “Second, I’m a fan of science and science fiction. And third, I trust Mike. He is a wonderful man. If he told me he wanted to use a robot, I had no problem with that.”

Dr. O’Malley replaced Mr. Yelich’s left knee about five years ago, before Mako robotic-arm assisted surgery arrived at UPMC. “That first surgery went well,” Mr. Yelich remembers. “But I was in the hospital for two and a half days, and my rehab took seven or eight weeks. 

“This second one, the right knee, I did as an outpatient. That amazed me. I was in the hospital for eight hours, and then I went home. And my rehab time was a little less than five weeks. I was up and down with no problems at all.” 

Doubling down on innovation 

Dr. O’Malley typically performs more than 700 joint replacements a year and is the primary user of the Mako robotic-arm assisted surgical technology at UPMC Shadyside. He calls himself “an absolute believer in how it’s improving knee replacements. My patients are doing better based on functional outcomes, like going up and down stairs sooner after surgery. They come in and say, ‘My knee feels great. It feels normal.’ That’s exciting.”

“Shadyside is one of our UPMC Health Plan Hip and Knee Joint Replacement Center of Excellence sites,” notes MaCalus V. Hogan, MD, MBA, chair of the University of Pittsburgh Department of Orthopaedic Surgery and chair of Orthopaedic Surgery for UPMC. 

“Centers of Excellence are where we double down on our innovation, with phenomenal surgeons using the best technology to lead that innovation. The robotics program is one of our main priorities, and Dr. O’Malley has been a huge driver of robotics expansion at Shadyside. This helps lead to the best outcomes for our patients.”

“Always searching”

“We’re always searching for advancements,” says Dr. O’Malley, whose father was a computer programmer for NASA. “I definitely think my dad gave me a lot of my drive to try to innovate and make things better.”

Looking back over the changes in orthopaedic surgery, Dr. O’Malley says that “in the late 1990s, computer navigation improved joint replacements by helping to make our bone cuts more accurate. But the knee is a complex joint, and every knee is different. Computer navigation could not take into account each patient’s actual ligament balance or how that patient hoped to use the new knee.”

Now, Dr. O’Malley says, “Robotic-arm assisted surgery takes us up to the next rung. It works by taking a preoperative CT scan of the patient’s knee, and that’s uploaded into the robot’s computer system. In the operation, we correlate the patient’s anatomy with that scan. Now the robot knows exactly where we are in relation to the patient’s knee, down to half a millimeter. It allows us to account for the differences in each patient’s knee and to fine-tune the balance of the ligaments. We can accurately put the implant right where we want it. 

“It’s fun to be a part of these advancements and try and help drive them at Shadyside.”

It’s still an art

Dr. O’Malley trained under the late Freddie Fu, MD, who was acclaimed worldwide for his innovations in orthopaedic care. And as much as he appreciates the advances in robotic surgery, Dr. O’Malley believes the machine has yet to replace the art of medicine. 

“The art is still present in knowing each individual’s needs,” he states. “That’s where the surgeon’s experience and technique still come in — because what the robot can’t yet tell us is here’s where you put the implant so that people can do whatever they want — golf or ski or move through their day pain-free.”

Just ask Charles Yelich. 

“I believe the Lord put Mike into my life,” he says.