The California Files

Makoplasty and Me

The newspaper where I’m employed has been carrying an advert from a local hospital touting the advantages of a surgical technique called Makoplasty, which it advertises as being less invasive than traditional surgical methods.

“Come on in for a seminar on this new procedure,” the advert invites.

A comment on this seems in order, since I have recent experience with this procedure.

Makoplasty is orthopedic surgery using robotics. A machine controlled by a physician armed with a computer uses a robotic arm to do whatever it is it’s supposed to do, and supposedly does it with great precision, efficiency and effectiveness.

In my case, the procedure was a partial knee replacement. And in my case, this was done at the hospital that now is running the Makoplasty advert.

Four years ago, I underwent a total knee replacement using the traditional method – the knee is opened with a 12-inch incision and the surgeon goes to work manually. This is not easy stuff, but I worked at recovery and was home in 36 hours and out hiking Scotland’s moors, without discomfort, in four weeks.

Two months ago I had a partial replacement in my remaining knee done by the same surgeon and at the same hospital, but this time using Makoplasty. I was home in about 30 hours. But recovery has been very difficult indeed, with discomfort levels that remain much higher and more prolonged than I experienced in my previous surgery.

What got me thinking about all this, I think, was this business of Makoplasty supposedly being “less invasive.”  

Yes, the incision required for this procedure is much smaller than for the older type procedure – 4 inches longitudinally atop the kneecap instead of 12. But Makoplasty also required, at least in my case, a pair of small incisions above and below the knee, four in total. I’m not sure, but I suspect that each pair were for a drain and a camera, two pairs. The traditional surgery did not require these.

As far as I can tell, that’s the big difference – those four small incisions and the shorter major one. Once the knee is open and visible, the surgeon still has to grind away material to resurface the ends of the joint and prepare those ends to accept whatever appliance he’s installing in the knee. What does it matter how this is done? What does it matter if this is done by a robot or by hand and eye? However you slice it, it’s still somebody in there grinding away, filing away, on your bones. There will be consequences of this.

As I’ve noted, my recovery from this procedure has been nowhere nearly as rapid as recovery from the older, supposedly more invasive, procedure. Mind you, I continue to have complete faith in my surgeon, one of the very best in the business. It’s just that knee surgery is tough.

So here’s my take: If you’re pondering knee replacement and your physician says he/she plans to use Makoplasty, be aware. Makoplasty may indeed have its advantages. It may indeed work wonders for some people. I do not think it did that fo rme,. But reduced invasiveness - I mean really, truly, reduced invasiveness - that isn’t one of them. That, I think, is corporate hype.

If I had it to do over again, knowing what I now, I think I’d have lobbied for use of the traditional method for my partial replacement, the method in which a very skilled orthopod like mine does everything by hand. I don’t know if that would have aided my recovery. But I doubt it would have been much worse.

-JFT

 

My New Knee

I’ve been staying quiet the last two days. Here’s why:

After about a month of planning, and considerable discomfort over a longer period, yesterday at 6 a.m. I was admitted into Glendale Adventist Medical Center. At 7 a.m., I underwent surgery for what’s called a Makoplasty, which is a partial knee replacement using robotic equipment.

Surgery took about 45 minutes, my doc told me this morning.

It actually went quite well – well enough that when I told him I was coming home today, he said OK to that crazy-assed notion.

Here’s what it looked like just before they kicked me out the door at 1 p.m. today, Tuesday. And yes, if you would like to see it fullsize in all its post-surgical glory, click on the image.

You will see that the incision is about four inches long, and that there are small punctures above it and below it. They were made to accommodate cameras and drains, I think probably.

This incision is much shorter than the one this same doc – a wizard named Philip Merritt, hence those initials there to mark the knee he'd be working on - did on my left knee in 2008. That one is a full 12 inches long, the better to accommodate the significant hardware required for a total replacement.

As you might imagine, I’m really pleased to have gotten away with this less stressful procedure. I’m also pleased that the good people at work are being patient with me. I’ll take today and tomorrow off, and work as usual on Thursday. Well, not exactly as usual – I’ll work from home so that I can minimize stress on that new knee, which is a bit stiff and a little sore. Not bad, though; not bad at all. After many years of struggling with both knees, I should be good to go now until I’m too old to care.

-JFT

Modified Suspension

Oh, your chassis isn’t handling quite the way you’d like it to? Modify the suspension.

It’s not hard to do. Swap out old parts for new, better parts.

And this is what I’m about to do.

Tomorrow morning, 7 a.m. sharp, the procedure starts. My mechanic will let me down off the lift after about an hour of work and I will be equipped with a new right knee, one that is made of steel, with Teflon load-bearing surfaces.

Whether I get a partial replacement or a total remains to be seen. My doc says he won’t know for sure until he gets in there and has a look at what, exactly, is going on.

I’m hoping for a partial and so, I think, is the doc. I had a total four years ago, and let me tell you, I quite happily would wish this sort of thing on my worse enemies.

On the other hand, if my doc decides a total is what’s required, that’s OK too. I would be quite happy to have him fix whatever he can while he's got me in his repair bay.

So, new suspension, new hardware for that human component that allows a leg to totally articulate free of complication.

Downside? Loss of maybe 10 to 12 degrees of flexion. Also, airport security people already freak out when their examinations, their ministrations, reveal that yes, I’ve got a metallic artifact about my person. So metal in two places on my person probably will excite them even more.

Good. It’s good to keep them interested, I think.

I rather suspect that they feel at least some small sense of relief when they discover that it's just a distinguished older gentleman with steel suspension components in his pantleg.

And I feel a sense of relief when my suspension works the way it was designed to work.

-JFT

Lamenting the Electric Car's Demise

 Recently I was forwarded a tome lamenting the passing of electric cars from GM and Toyota.

 It seemed to suggest that this was the result of some evil corporate conspiracy. Or something.

That’s balderdash.

First and most important, neither corporation – and I sure as hell am not going to defend any corporation – planned for GM’s EV1 or Toyota’s RAV4 EV to be a long-term deal. They were experimental programs involving experimental vehicles with very limited life spans. When they wore out, and when the programs ended, they were done.

Just as well. The EV1 relied on lead-acid batteries. These are short-term batteries. You gots to replace them sooner or later. Probably sooner. Expensive. Same deal with the RAV4 EV. It used nickel-metal hydride batteries. Also not a lot of life, but huge replacement expense. These days, replacing them costs more than the base RAV4 EV is worth –close to $5,000. And if you do replace them, what do you do with the old batteries? This problem of battery recycling is extremely problematic, which is also the problem with current hybrids like the Prius, and with all other electric cars, no matter how advanced their battery packs.

Furthermore, the EV1 and the RAV4 EV had very limited ranges. You got beyond that range, you needed a tow truck, onaccounta back in the ‘90s and early 2000s when these programs were active, there were no charging stations. Zero, zip, nada, bupkis. Well, maybe a few, eventually. But far fewer, and far farther apart, than we have now. And even now it’s not like there’s a charging station on every corner.

If there was a conspiracy by the big companies to kill electric cars, how can it be that electric cars do in fact exist, built by those same corporations that supposedly killed them off? GM builds the Volt, Toyota has electric Priuses in fleet use prior to producing them for larger use, and Nissan offers the Leaf. If there was a conspiracy, none of these ever would have seen the light of day.

But wait, let us back up: Electric cars in the first place? Phooey!

Think electricity is generated without penalty, out there in the ether? It isn’t, you know. With the exception of the Pacific Northwest, which gets a good bit of its juice from the Bonneville Dam generation facility, that thing that has screwed up the salmon runs good and proper, most of our electricity is generated by coal-fired generating plants. In spite of what that industry says, there is no such thing as clean coal. Think heavy pollution.

Don’t believe me? Drive to the Grand Canyon. Notice the layer of haze that lies across that entire section of Arizona. It’s smoke from the coal-fired generation plants that dot the landscape there. Coal definitely is not our friend.

So no, electric cars are not the hot tip.

Also, while we’re at it, phooey to the so-called “water-powered” car. Man, we’re a gullible bunch. Think about it: We don't have enough water for drinking and crops in many parts of the country. Why would we want to fuel transportation with it, even if we could?

Then there’s the compressed-air car, which actually works. But that still takes electricity to supply the compressed air upon which it runs, and electricity is not our friend. We like it for keeping our refrigerators running onaccounta that keeps the beer cold and the pizzas frozen. But we don’t like it for this use.

Ultimately, what is? In my view, at least, hydrogen probably is the hot tip – BMW and GM both could produce cars today to use this fuel. So could M-Bz. They are absolutely pollution-free, and hydrogen is the most abundant substance on planet Earth. The problem is the lack of a hydrogen infrastructure. Can’t just pull into the corner station and fill ‘er up. And given the investment involved, such an infrastructure isn’t going to get built anytime soon.

So, where does that leave us?

It leaves us with the high mpg requirements and the internal combustion engine we know and love. Ultimately, we as a nation will use much less fuel because of them, and that’s a good thing, because the more gas we buy, the more money we send the Saudis and others, and the more of that money finds its way into the hands of people who hate us and want to use it to destroy us.

These high mpg requirements are good, and they’re why you won’t be seeing many more new generations of V8 and V6 engines. There’re why it’s not hard these days to find cars that routinely will deliver 30 mpg on the highway.

To meet those requirements, think in terms of smaller cars with smaller engines. The Europeans have lived like this for decades. No reason we can’t live without Suburbans, huge pickups, enormous sedans. We may want ‘em, but we sure as hell don’t need ‘em.

So, smaller cars. Or, maybe not-so-small. The new BMW 5 Series, quite a large and comfortable car, uses a two-liter (that’s just 122 cubic inches, friends) four-cylinder turbocharged engine. It is rated at 34 mpg in the highway cycle, and makes as much horsepower and torque as last year’s three-liter six-cylinder engine. So this can be done, and is being done. All we have to do is wrap our heads around this notion.

A second option involves modern diesel engines. With these, you get the best of most worlds – great economy, wonderful power and torque, excellent fuel economy -- and the new tech being used allows them to run very cleanly. Diesel fuel tends to be a few cents more expensive than gas, but the mileage is so much better it’s basically a wash. A pal with a diesel VW station wagon gets 45 mpg. Routinely. Why would you not want that?

A third option, if a bit more extreme, is to not buy a new car at all. Keep the one have for as long as you can, drive it, fix it when you need to, keep it in top running condition. Buying a new car is very expensive, and manufacturing a new car is a very high-pollution enterprise – even the cleanest new car, like a Prius, pollutes terribly during the manufacturing phase. There are lots of environmental penalties when you’re making steel and plastic, aluminum and glass – not just scratching those materials out of the ground, but also generating the electricity to make things from the base substances.

Or, this: If you absolutely must have an electric car, buy a Volt. These things are cool, and the dealers are struggling with them, thanks to a recent scare about “car fires.” The feds have inspected this and found there to be no problem. But buyers have stampeded away from Volts like a bunch of chickens frightened by a coyote. Now’s a good time to get a good deal on one. They get about a zillion miles per gallon, and drive quite nicely, from what I’m told, even if they also have the battery recycling problem.

As bad luck would have it, we’re coming up on needing a new car. What to buy, what to buy! Undecided yet. But whatever it is, it’s going to get killer miles per gallon. Gas will not get any cheaper. And we’d much rather spend money on good wine and travel. We sure as hell don’t want to give money to the oil companies.

So the next time someone sings the praises of the electric vehicle, remember the message of this post: Phooey! There are much better ways.

 -JFT

 

A New Knee

Thank the Lord that’s over!

Bright and early yesterday Laura drove me down to Glendale Adventist Medical Center and not long after arriving, my orthopod, Phil Merritt, replaced my left knee.

This has been a long time coming. Doc Merritt has done a lot of work on this knee, including an ACL reconstruction a number of years ago, and he’s always told me that the day would come when I’d need a steel knee. What’s going on here is that thanks to years of running, there no longer is a meniscus between the femur and shin bone. They’re grinding against each other, bone on bone.

This damage is repaired by resurfacing both bone ends, then inserting a two-piece appliance like the one shown in the picture here.

For the last year, I’ve had very little control over that knee, it frequently failed to lock and was quite uncomfortable. Doc Merritt told me, “I think it’s time.”

I was determined to do this while spending a minimum of time in the hospital. Hospitals are terrible places. People die there. So I figured I’d be outta-there in one day, maybe two.

Everybody I talked to laughed at that. “Three days, maybe five,” they said.

So I arrived there at 6:00 am yesterday, after about 90 minutes I was wheeled into surgery, and by 9:00 I was in recovery.

Man, you talk about loopy! The drugs they gave me were still evident to me 24 hours later. This is a good thing. This procedure is not fun and games – it’s just as Herbranson warned me – sorry Eric, for not taking you more seriously. I told him I’d be skiing the weekend after, and he said, “Thompson’s in denial.” He’s in a position to know because he knows me pretty well, also because he had both of his knees done last summer.

So: Yesterday morning and afternoon, I was pretty drugged-up, so didn’t feel much. Last night was ugly. Not only did everything in my room go wrong that could go wrong, I was becoming increasingly uncomfortable. Oh, and the hospital’s A/C wasn’t working. So I got no sleep. A therapist did have me up, walking and climbing stairs, though, as the knee became stiffer and more uncomfortable, and that exercise made it even stiffer and even more uncomfortable.

This morning I was in trouble. Doc Merritt re-showed me how to use the magic drug button at my bedside, and that helped some. A shot of morphine and a series of Vicodin tabs helped even more.

My game plan was to come home today, but that wasn’t looking good. Doc Merritt left it up to me – he said that as soon as the pain was managable with oral meds, I could go home. Well, it wasn’t manageable at all, much less at home.

Slept most of today, after that awful night last night, did some more therapy – and waddiaknow, the Vicodins were working and I seemed to turn a corner. So after the nurse changed the dressing – this photo here shows what my left knee now looks like - the hospital released me at about 5:30 this evening. Laura was there waiting and she drove me home – which never looked so good.

Overall, this was a bit tougher than I’d thought. Herbranson was right about that. But it’s worth doing. At its worst now, it’s still better than an average day on my old knee. (Good Lord, did I actually make that assertion? It's obviously bullshit. Clearly, I was still feeling the hospital's drugs. The truth is that the knee, now more than a week after my release, remains far more uncomfortable than it was prior to the surgery, and it seems worst at night. But it is getting better every day.) At least the improved structural tightness is very evident to me. So now begins the planning for the other knee. It’ll be a piece of cake. (Right. No way in hell will I have the other knee done, not until it gets a lot worse than it is now. What was i thinking? Oh, I remember: Drugs.)

-JFT