Robot Clinical Study
As most of you are probably aware on November 7, 1992, Dr. Bargar successfully
performed the first human surgery using the robotic technology that he
and Dr. Paul have been researching for the past seven years.
ROBODOC is an image driven computer-controlled surgical robot. ORTHODOC
is the front-end to the system and is a pre-operative planning computer
with workstation for the surgeon that provides the robot with the data
necessary for precision surgery. This initial surgery was part of an authorized
Food & Drug Administration (FDA) feasibility study. Feasibility studies
generally confirm system design and operating parameters. The FDA authorized
ROBODOC to be used in up to ten cementless total hip replacement procedures
at Sutter General Hospital. All have been scheduled.
The data that will be collected on these first ten patients will be compiled
and resubmitted to the FDA in order to obtain approval for ROBODOC's’s
use in other major centers across the nation.
This may result in a gap during which the robot will not be able to be
used on patients. It is expected that for the multi-center study the FDA
will request randomization of subjects. This means that prospective candidates
will be randomly divided into two groups, one will use the robot and the
other will be performed using conventional techniques.
We will continue to keep you informed about developments in this exciting
technology.
A Brief History of Knee Replacement
by Ronald E. Talbert, M.D.
The treatment of severe arthritis of the knee has long been a difficult
problem for the orthopedist. Until the mid 1800s the most acceptable treatment
for the severely diseased knee was arthrodesis (fusion). This procedure
provided good stability and pain relief, but eliminated mobility. The
loss of mobility in the knee was not acceptable to many patients and efforts
began to find other successful treatments.
In 1861 the “first resection arthroplasty” was performed. This
procedure involved removing the articular surfaces of the knee without
inserting any material to act as a joint surface. Most patients experienced
fair pain relief while maintaining some motion. The main problem with
this procedure was the lack of stability. Most patients found that the
knee did not meet the demands of daily living.
In 1863 surgeons began to place flaps of tissue between the resected ends
of the bone. This procedure is called “interpositional arthroplasty.”
Many different materials have been used in this procedure including fat,
bursa, skin, pig bladder, cellophane and nylon. The results of this procedure
were not sufficiently satisfactory to replace arthrodesis as the initial
surgical treatment for the patient with a severely diseased knee.
A metallic mold of the end of the femur (thigh bone) was first used in
1938. Later, attempts were made to cover the end of the tibia with metal
and also plastic. This type of procedure where only one side of the joint
surface is replaced is called a “hemiarthroplasty.” The early
experiences with hemiarthroplasty of the knee were not sufficiently successful
to encourage most orthopaedic surgeons to abandon arthrodesis as the surgical
treatment for destroyed knees. One report looked at the results of 896
hemiarthroplasties performed between 1941 and 1953. A successful result
was attained in only 46% of these cases.
Total knee replacement, or simultaneous replacement of both sides of the
joint, began in the late 1950s with hinged total knee units. This type
of replacement allowed for flexion and extension (bending) of the knee,
but it did not allow side-to-side movement or rotation. This type of replacement
was associated with a significant failure rate, but by 1960 it was gaining
acceptance as an alternative to arthrodesis.
The first non-hinged total knee was designed and used by Dr. Frank Gunston
in 1968 while working with John Charnley (inventor of the total hip) in
Wrightington, England. This new knee not only allowed flexion and extension,
but also some side-to-side movement and rotation. Dr. Gunston was the
first investigator to apply the biomechanical principles of the normal
knee-to-knee prosthesis design.
Multiple variations and modifications of the non-hinged total knee have
been developed over the past twenty years. The current state of the art
total knee replacements are designed to mimic the normal knee and utilize
biological, rather than mechanical, restraints to motion. The use of these
newer types of prostheses along with the development of more accurate
instrumentation has allowed the success rate of knee replacements to increase
dramatically.
A successful total knee replacement will result in a dramatic decrease
in pain and improvement of motion and function. A successful result will
allow a patient to return to routine activities of daily living. A person
with total knee replacement should not expect to resume jumping, jogging,
or heavy lifting (over 20 lbs.). An ideal candidate for total knee replacement
is a patient who is over 65, not overly active, and who is not overweight.
In the ideal patient, a total knee replacement should succeed 95% of the
time.
RX Renewal Dedicated Line: 916-733-8299
As our practice has grown we have found the need to add a dedicated line
for prescription renewals. Please contact your pharmacy for the prescription
you need renewed. They will call the line and leave a message. These calls
are acted on daily by our staff. Please remember there is a 24-hour turn
around time for weekday calls. Weekend calls will be returned late Monday
afternoon.
1993 Presentations by William L. Bargar, M.D.
Custom Cementless Total Hip Replacements – Primary. The first 100,
Robotics in Total Hip Replacement, Classification of Bone Defects, Custom
Cementless Total Hip Replacements – Revision, The First 100. Sixth
Annual State of the Art: Total Hip and Knee Replacement. Vail, CO (Jan
26-31).
Development of Surgical Robotics for Total Hip Replacement. Orthopaedic
Research Society Annual Meeting. Washington, D.C. (Feb 19-25)
Management of Bone Loss in Revision. THR’s Using Custom Prostheses.
AAOS Annual Meeting, Instruction Course Lecture. Washington, D.C. (Feb
19-25).
Management of Bone Defects in Revision Total Hip Replacement Using Custom
Prostheses. The Anderson Clinic of the National Hospital for Orthopaedics
and Rehabilitation. Arlington, VA (March 19-20).
Principals of Acetabular Reconstruction. Robodoc Current Issues and Solutions
in Revision Hip Arthroplasty. Fort Myers, FL (April 24-25).
Pre-operative Assessment for Complex Hip Reconstruction. Classification
of Femoral Defects. Custom Prosthesis in Acetabular Reconstruction. Custom
Prosthesis in Femoral Reconstruction. AAOS Course: Management of Acetabular
and Femoral Bone Defects in Total Hip Replacement. Seattle, WA (May 15-16)
Robodoc Update: Expanded Use. The Contour Hip: Recruiting for Multi-Center
Trial. AORTA Annual Meeting. San Francisco, CA (September 17-19).
A Classification of Bone Defects in Revision Total Knee Arthroplasty.
The Knee Society Interim Meeting. Philadelphia, PA (September 25).
The First 100 CT Based Custom Cementless Primary Total Hip Replacements.
A Prospective Comparison of Titanium vs. Chrome-Cobalt Femoral Heads in
Cementless Total Hip Athroplasty. Present Status and Future Possibilities
of Robot Assisted Surgery. Fifth Annual ISSCP Meeting. London, England
(October 1-3)
Custom Femoral Components: Report of the First 100 Primary Total Hip Replacements.
A Classification of Bone Defects in Revision. Total Knee Arthroplasty.
Western Orthopaedic Association. 56th Annual Meeting, Monterey, CA (October
10-14)
Pre-Operative Planning. Total Hip Arthroplasty in Congenital Dislocation
of the Hip and Osteotomies. Bone Grafting. AAOS Total Hip Replacement-1992.
Scottsdale, AZ (October 22-24).
1993 Presentations by Jeffery K. Taylor M.D.
Biomechanics of Acetabulum Fixation. Orthopedic Research Society. Washington,
D.C. (February 19-25).
The First 100 Custom Revision Total Hip Replacements. CT imaging of Bone
Around Metal Implants: The State of the Art, 3. Custom Femoral Components:
Porous vs.
Hydroxyapatite 4. The First 100 CT-Based Custom Revision Hip Replacements.
Fifth Annual ISSCP Meeting. London, England (October 1-3).
The first 100 Custom Revision Total Hip Replacements. Western Orthopaedic
Association. Monterey, CA (October 13-14).
Osteonecrosis in SLE: Diagnosis and Management Lupus Foundation: Annual
Symposium. Sacramento, CA (October 14).
Medical and Surgical Management of Arthritis of the Hip and Knee. American
Osteopathic Association – Annual Meeting. San Diego, CA (November
14-15).
Corrosion at the Interface: A Possible Solution to CoCr Heads on T1 Alloy
Stems. American Society for the Testing of Materials (ASTM): Seminar on
Modular Implants. Miami, FL (November 18).
Important 1993 Billing Changes
We have to work together to control practice costs, patient fees, and
to receive your insurance payments promptly. The following procedures
help us to achieve these goals.
Your payment will now be requested at the time of each visit unless other
arrangements have been made with one of our staff prior to seeing the
physician.
You will receive a copy of your paid receipt for your records. We will
submit a claim for the services rendered and request that your insurance
carrier pay you directly and your account with us is clear. This is standard
already for Medicare patients.
We always need to be kept informed of ANY changes in your insurance, it
is necessary for us to have a copy of your insurance card in our files
to aid in filing your claim. Remember, the better informed you are about
your insurance, the more helpful we can be in filing it for you.
Motor Home Parking
There is off-site parking at Sutter General Hospital if the unit is small
and self contained. There is no power or sewer.
Otherwise you may part at Sutter Memorial Hospital at 52 and F Street.
Please contact Hermon Moralas or Jim Curr at (916) 454-3333 for further
information.
If parking at Sutter Memorial Hospital there is a shuttle that goes between
the two hospitals. The shuttle runs from 5:55 a.m. to 6:00 p.m.
Staff Profile:
As a long time friend of Betty, I can tell you that after 30 years in
the medical profession, she is exactly where she wants to be with her
career. She was born in Sheffield, Alabama and was the oldest girl of
8 children. She attended nursing school in the Birmingham, Alabama for
two years, and later graduated from the University of North Alabama with
a BS degree in Biology and Secondary Education. (She only taught school
for 1 year).
In 1969 she married Charles Lowe who was in pilot training in Valdasta,
Georgia. While stationed in Abilene, Texas, she returned to nursing, working
in Cardiology for the next 4 years.
In 1972 her son Garrett was born and he became high priority with his
activities, especially with his swimming abilities. He is presently a
Cadet at the USAF Academy.
Betty moved to Davis in 1974 so her husband could obtain a graduate degree
in Enology. In 1978 Betty and Charles started Cache Cellars a small family
winery. Since she couldn’t find a job in Cardiology she went to work
for an orthopedist, Dr. Frank Boutin and loved it so much she stayed with
him for 15 years. When Dr. Boutin retired from private practice, she came
to work here in our office as Dr. Bargar’s nurse to help relieve
Jane Bislend, RN, who was then the office nurse for both Dr. Bargar and
Dr. Taylor.
When she is not at work, Betty can usually be found practicing the piano,
her latest passion. But she also enjoys gardening, cooking and playing
with her two dogs, Sara Lee and Charlotte.
Insurance Update
Another important issue is all the new HMOs, PPOs, IPAs, etc. (Health
Maintenance Organizations), some of which supplement your Medicare insurance.
It is important for you to look at what you are receiving in terms of
benefits. Most are very restrictive and we are not providers because the
reimbursement rate is extremely low and the procedure for scheduling is
difficult, if not impossible.
For example if you belong to an HMO, you must have authorization to be
seen in our office. If you are a surgical candidate, all tests and the
surgery must be authorized and scheduled by your primary care physician.
This happens even with plans that are supplements to your Medicare. This
is not a problem if our office is a member of the plan in question. Therefore,
we want to notify you of the plans of which we are participants:
Blue Cross Prudent
Buyer Blue Shield Preferred Plan
Sutter Preferred
PersCare
OMNI
InterPlan
PHCS Affordable Care: pending for Dr. Jeffery Taylor
If you want to continue to be under our care, it is best not to sign up
for plans of which we are not members. If you have any questions or concerns,
we will do our best to help you.
JOINT SURGEONS 
