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B ob Davidson isn't your average 73-year- old. In fact, he's far more active than most people 50 years his junior. A competitive walker who logs 2,500 to 3,500 miles a year, he calculates that he's already run/walked more than 100,000 miles in his life, starting in the early seventies. So when his right knee wouldn't stop bothering him, Davidson, a Riverside resident, sought help. A hiking buddy who'd had both knees replaced recommended Ayaz A. Biv i, MD, an orthopedic surgeon at Providence St. Joseph Hospital—the first hospital to bring orthopedic robotic surgery to Orange County, in 2012. Davidson remembers his first conversation with Dr. Biv i. "I said, 'I'm not just looking to walk to the early-bird special pain-free.'" Dr. Biv i, who specializes in treating problems of the hips, knees and shoulders, realized Davidson would be a dedicated patient. Davidson was happy the total knee replacement—a procedure called MAKOPlasty—would be robot-assisted, utilizing the Mako Robotic-Arm Assisted Technology, which was funded by philanthropic donations. Because MAKOplasty is minimally invasive, patients have a shorter hospital stay and less scarring. MAKING A BLUEPRINT Dr. Biv i walked Davidson through what would happen. "Before surgery, we get a CT scan of the knee, which allows us to generate a three-dimensional model," he explains. This enables doctors to do a simulated surgery before the actual procedure and ensure the right position, alignment, rotation and bone support. During surgery the implant positions are finely tuned to achieve the ideal knee and soft tissue balance. When it's time for surgery, the patient's knee or hip is "registered" with the robot, meaning "the robot knows where the person is in space," says Biv i. "That keeps us on our plan." The result is less trauma to surrounding tissue than in other types of knee surgery. Recovery takes roughly the same amount of time as with traditional surgery—about three months. "The biggest impact is long- term," he says. "Because we're able to put the implant in the optimal position, this should improve its longevity." A GREAT OUTCOME As expected, Davidson was devoted in following his doctor 's post-op instructions. Although he was doing better, he hoped to have more flexibility. After discussing this with Dr. Biv i, it was decided that the doctor would perform a minor orthoscopic procedure to remove excessive scar tissue— this ultimately gave the avid walker greater range of motion and flexibility in his knee. Davidson had a specific reason for wanting to be in peak condition: he'd already signed up for the Six Days in the Dome Redux, a competitive walking/running event that would take place in August 2019—just seven months after his surgery. Davidson was able to achieve his goal and logged more than 200 miles on a quarter-mile track in the race. "I'm a huge fan of Providence St. Joseph and the doc. My goal is to get another 25,000 miles out of my knee." Walking on Sunshine Knee surgery gave a competitive walker his life back. Dr. Ayaz A. Biv i, on the medical staff at Providence St. Joseph Hospital for 14 years, has performed the most robotic orthopedic surgeries at the hospital. WHAT TRENDS DO YOU SEE IN JOINT REPLACEMENT? Like all surgical fields, the biggest thing in orthopedics has been the infusion of technology. We see less trauma to the tissues, and procedures are less painful. The ability to place implants perfectly has driven down complication rates. Last year the hospital approved the use of the ExactechGPS system to bring the same level of precision to shoulder replacement surgery as knee and hip replacement surgery. We have seen the demand for robotic surgery increase, requiring the purchase of a second robotic unit. WHAT IMPACT HAS COVID-19 HAD ON YOUR SURGICAL PRACTICE? Initially, patients were afraid to come to the hospital. But in early summer we saw patients who were stuck at home and felt it was a good time for surgery. We haven't had any patients contract COVID-19 from being in the hospital or in post-op therapy. Providence St. Joseph is diligent about following the latest safety guidelines and protocols. The pandemic, along with faster recoveries resulting from advanced technology and better pain management, has accelerated a trend in same-day joint replacement. Patients and their medical teams are motivated to get them home quickly. Safety remains our main priority. Just as telemedicine is more widespread, I believe same-day joint replacements will continue to increase. Health Matters: Providence St. Joseph Hospital | 5 For more information or for questions about our orthopedics program, please call 714-744-8811

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