When osteoarthritis and knee pain began interfering with Marjorie Kulesa's life, the Patchogue resident and orthopedic nurse looked no further than her longtime colleague, Jan Albert Koenig, MD, Vice Chairman, Department of Orthopedics; Chief of Joint Replacement Surgery; and Director of Computer Assisted and Robotic Orthopedic Surgery at NYU Winthrop, for help.
"I know how good NYU Winthrop"s Total Joint Program is because I’ve lived and breathed it," said Ms. Kulesa, who works as a Nurse Coordinator in NYU Winthrop’s Orthopedic Department and helped found the Program more than 14 years ago. The Total Joint Program is now a regional leader in joint replacement and widely recognized for its innovative surgical techniques and high levels of patient satisfaction. "I wanted to be a part of that," added Ms. Kulesa. "For me, there was no other Hospital to go to."
Jan Koening, MD, Vice Chairman, Department of Orthopedics; Chief of Joint Replacement Surgery; and Director of Computer Assisted and Robotic Orthopedic Surgery at NYU Winthrop, performs a robotic assisted total knee replacement. Dr. Koening is a pioneer in the procedure.
The Program places an emphasis on patient and family education, and Ms. Kulesa plays an important part of this process. She is part of the team that is responsible for transitioning patients through each stage of their care, and teaches in the preoperative education class to patients, where she does not hesitate to share her own story of relief from pain.
Ms. Kulesa was suffering from osteoarthritis of the knee, a degenerative process that occurs when the cartilage protecting the knee's bones wears down over time, causing pain, stiffness, and preventing full range of motion in the joint. Eventually, the cartilage can wear down completely and leave bone rubbing on bone. According to Dr. Koenig, osteoarthritis is very common and up to 80 percent of the U.S. population will suffer from it at some point in their lives. Last year, more than 650,000 total knee replacements were performed in the U.S., a number that is expected to grow as the population ages. Ms. Kulesa suffered from osteoarthritis in both knees for many years, to the extent where walking became extremely difficult.
"Marj came to me with tears in her eyes and not one good knee to stand on. We decided to approach one knee at a time," said Dr. Koenig. Dr. Koenig performed two robotic assisted total knee replacements on Ms. Kulesa: the first in December 2014, and the second in August 2016. Dr. Koenig is a pioneer in robotic assisted total knee replacements, having performed the first on Long Island in February 2005. Since that time, he has performed over 2,200 successful total knee implantations with computer and robotic assistance.
Knee replacement is a surgical procedure that resurfaces the knee, using metal and plastic parts to cap the ends of the bones that form the knee joint. According to Dr. Koenig, robotic assisted knee replacement surgery allows the surgeon to customize every patient's surgery and perform virtual surgery on the computer screen before cutting the patient’s bone. This provides an extreme level of accuracy and precision not available with conventional, older, methods.
"After I formulate the plan, a mini robot is attached to the patient during the surgery and moves into position to help cut bone very accurately, according to the plan in place," said Dr. Koenig. Then, once the bone is cut, it is double-checked, or "validated", by the new OmniBotic computer system (the software he utilizes for the surgery which assures an extreme level of accuracy). The computer also helps to balance the knee, by checking and balancing the important ligaments, as well as lining up the hip, knee, and ankle in a straight line called a neutral mechanical axis– all crucial components for balance, function and implant longevity. Robotic assisted knee replacement improves accuracy in this alignment significantly. Dr. Koenig said that in almost 1000 surgeries performed with the OmniBotic system, the accuracy has been greater than 99 percent.
The procedure takes just under an hour, and patients start walking as part of their recovery about three to four hours later. Most patients are out of the hospital in one or two days, followed by a home health care plan that gets the knee moving every day for about seven days. Following home therapy, patients graduate to physical therapy in an office outpatient setting. Each case is different, but most patients can expect four to six weeks of physical therapy to maximize the benefits of the surgery and improve strength.
"For most people, 90 percent recovery takes three to six weeks, at which point they can drive a car again and return to work and normal activities," said Dr. Koenig. Patients continue to improve throughout the whole first year as they recover from surgery, and experience greater muscle and bone strength about every three months. As time goes on, patients report less stiffness and are able to be more active.
Prior to her most recent procedure, Ms. Kulesa could barely walk half a block and pain kept her awake at night. A month following surgery, Ms. Kulesa can straighten her leg, has good stability and range of motion, and most importantly, the confidence to walk, move and be active. In fact, Ms. Kulesa was able to achieve her goal to stand pain-free at her fifth granddaughter's baptism, which she and her family celebrated on September 25, just five weeks after her surgery.
Marjorie Kulesa, RN, BS, ONC, CNOR, Nurse Coordinator in NYU Winthrop's Department of Orthopedic Surgery (second from right), stands pain-free with her family at her granddaughter's christening, just five weeks after undergoing robotic assisted total knee replacement surgery at NYU Winthrop.
NYU Winthrop's Department of Orthopedics is led by James Capozzi, MD, Chair of Orthopedic Surgery, and the team includes Gregory Sirounian, MD, hip and knee replacement/reconstructive surgeon; Omid Barzideh, MD, orthopedic surgeon; Jeffrey Meyer, MD, orthopedic surgeon; Ms. Kulesa; Marie Callari, RN, BSN, ONC, Nurse Coordinator for the Total Joint Replacement Program; and Ellen Jordan, RN, BSN, Transitional Level of Care Nurse Coordinator. Using a team approach, the goal is to improve the lives of patients by offering the most advanced joint replacement surgery options available, including minimally invasive surgery and rapid recovery for patients, including those with osteoarthritis like Ms. Kulesa.
In addition to osteoarthritis, NYU Winthrop’s Total Joint Program treats arthritis following an injury; rheumatoid arthritis; hip pain; childhood deformity of the hip; and avascular necrosis (the death of bone tissue due to lack of blood supply). Dr. Koenig has had patients go on to climb to the subsummit of Mt. Everest following a hip replacement surgery, and others return to surfing, or low impact activities and sports such as golf, tennis, biking, hiking, swimming and dancing.
"Walking without pain; being able to work; enjoying your family and grandchildren; traveling – those are some of the many things patients can do with a successful procedure," said Dr. Koenig.
Not all patients are candidates for surgery. Oftentimes conservative treatment – which can include anti-inflammatory medications, occasional knee joint injections, rest, heat, and gentle exercises to build up the muscle around the knee joint itself, along with behavior modifications such as wearing a brace or using a cane – is very successful. Weight loss can also help by taking off considerable stress to the knee joint.
"When conservative treatments fail and the knee symptoms of arthritis progress and chronic pain continues, surgery is a great option for many patients," said Dr. Koenig.
In the preoperative classes, Ms. Kulesa teaches patients who have decided to undergo the procedure and always congratulates these patients, for they have made a decision to improve the quality of their life by decreasing pain and increasing mobility.
"Grannies don’t sit on a rocking chair these days. You want to get out there and play with those grandkids!" said Ms. Kulesa, before asking: "Why would you let pain in your knee hold you back?"
For more information about NYU Winthrop's Total Joint Program, call 1-866-WINTHROP or visit www.winthrop.org.