Firing on All Cylinders After Knee Replacement

Typically, we photograph every patient appearing in HealthU. Because this story was planned during the surge of COVID-19, that contact would have been too risky. Instead, our team took a creative approach and replaced photo shoots with illustrated portraits of patients.

Saturday, March 30, 2019, was a fairly normal day for Nancy Heinze at her home in Montvale, New Jersey. She was finishing up her round of chores—raking in the yard and chopping firewood—when she tripped and fell. Searing pain and a loud crack in her left knee let Nancy know that this wasn’t an ordinary stumble.

Even though she followed the usual first aid RICE protocol—rest, ice, compression and elevation—her knee was badly bruised and continued to throb. The following Monday, she went in for an appointment with orthopedic surgeon Robert Kayal, M.D., who examined her and ordered X-rays and an MRI of both knees.

In addition to soft-tissue damage, Dr. Kayal found changes in both knees because of arthritis. Nancy was sent home with anti-inflammatory medication, a brace for her knee and orders to begin preparing for knee replacement surgery for her left knee.

Preparing for Surgery

Prior to surgery, Dr. Kayal prescribed physical therapy for Nancy. “I needed therapy before the surgery to strengthen my calf and thigh,” Nancy says. “You’re not working the injured part, but those muscles have to take over for the knee. That [physical therapy] was four weeks.” The hourlong exercise sessions included standing on tiptoe and pushing up into a bridge position from the floor. “They had me do a lot with resistance bands,” she adds.

Nancy was such an active person, so having an injury take her away from her normal routine took some getting used to. “I never expected it. I could hardly walk, and I love to walk. I was also a bike rider,” she says.

The other aspect of preparing for surgery was not as strenuous. Because Dr. Kayal planned to use robotically assisted surgery, he gave Nancy a video that explained the procedure.

The Robotic Advantage

Dr. Kayal relies on the Mako robotic surgical system when he performs knee or hip replacement surgeries at Pascack Valley Medical Center. He considers it the gold standard for these types of operations.

“The robot allows us to precisely place the implants specifically to each patient’s unique bone anatomy,” Dr. Kayal says. “We get a CAT scan of the patient’s hip, knee and ankle. We look at the overall mechanical alignment of the limb. We look at the severity of the deformity. We appreciate the size and shape of the bone. Then cross-sectional imaging data from the software program allows us to perform a virtual knee replacement on the computer to perfectly position, align and size the implants.”

By virtually performing the surgery on a computer before the actual surgery, Dr. Kayal can plan removal of the damaged bone and the implant’s placement down to a millimeter. Then, during the actual surgery, “we bring in the robot to help execute that plan. The robot is so precise that it doesn’t allow us to deviate from the design at all.”

Dr. Kayal says the ultra-precise surgical plan means there is less damage to surrounding soft tissue because the software designs the least-invasive path for the surgeon. All of this contributes to less postoperative pain, swelling, stiffness and blood loss, and much faster recuperation.

Going for the Double

The surgery on Nancy’s left knee went well. She followed her postoperative plan and resumed physical therapy. About a year later, she and Dr. Kayal planned the same surgery for her right knee.

In the year that elapsed between the first and second surgeries, Dr. Kayal instituted a few improvements in the surgical procedure and postoperative care. He now performs the knee-replacement surgery without using a tourniquet. He says this helps the thigh muscle return to function immediately and limits postoperative bleeding, which in turn leads to less swelling and pain for the patient.

Nancy had to stay in the hospital for two nights after the second surgery so the team could keep an eye on her electrolyte levels, but she says it was not a hardship. “They treated me like a queen,” she says. The nursing staff was so attentive that she wrote a letter of praise to the hospital.

Nancy reports less pain the second time around. All in all, Nancy says the surgeries were worth the effort. “My greatest joy was to be able to climb the stairs and go to the choir loft and sing with the choir at my church,” she says.

Next Steps & Resources:

• Meet your source: Robert Kayal, M.D.
• To make an appointment with Robert Kayal, M.D. or another provider call 800-822-8905 or visit our website

The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.