For example, you can arthroscopically remove a popliteal cyst in the
back of the knee with the patient in the supine position. That's a signifi-
cant convenience because the removal can be added to other knee pro-
cedures without having to reposition the patient.
Dr. Lubowitz says surgeons must place a posterior medial port to
remove the popliteal cyst and points out that the procedure requires
specific positioning. First, the patient's non-operative leg must be
placed in a holder and moved away from the operative site, so the sur-
geon has enough room to maneuver the 12-inch long shaver needed to
perform the procedure. Surgeons approach the joint perpendicular,
but also need 6 to 8 inches of clearance in order to direct the shaver
posteriorly and anteriorly, and up and down inside the joint.
During knee replacements, the patient is supine and the operative
leg is draped with a long stockinette dressing. The surgeon needs to
manipulate the leg to ensure implants are placed properly, so the leg
has to be movable outside of the drapes. With the leg free, the sur-
geon can bend and extend it to make sure the implant is positioned
correctly.
"The challenge to positioning knee replacement patients is that at
times surgeons need to flex the joint," says Ms. Rose.
She cautions that proper patient position is even more critical dur-
ing robotic knee replacements, which are growing in popularity. "If
the surgeon's cuts stray outside of the preprogrammed surgical path-
way, the saw on the robotic arm will shut down," she explains. "The
surgery is very precise."
That precision places added importance on positioning the
patient's knee for surgery. Ms. Rose says her surgeons opted to forgo
the proprietary boot attachment that came with the robotic system
because it was too bulky. They instead opted for placing a padded
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