Hear from Our Patients
Araceli “Jenny” Flanagan: Moving Forward with Robotic-Assisted Knee Replacement Surgery
Whether walking, dancing or bicycling to the beach, Araceli “Jenny” Flanagan likes to keep it moving.
But, when nagging knee pain nearly put the brakes on her independence, Jenny shifted gears.
“I’ve had pain in both knees for years,” said Flanagan. “I tried injections, physical therapy and nonsurgical options, but the pain always returned. So, I came to the realization that I had to try something else.”
The 72-year-old grandmother of four turned to Arup Bhadra, MD, FACS, MSc, Director of The Total Joint Replacement Center at Good Samaritan Hospital, a member of the Westchester Medical Center Health Network. Jenny was diagnosed with osteoarthritis in both knees, a degenerative disease that causes cartilage and tissue to break down, resulting in "bone on bone" joint pain.
Friendly Advice
"The disease was limiting Jenny's daily life and her ability to play with her grandchildren," explained Dr. Bhadra. “I’ve helped eight of her closest friends find knee pain relief through robotic-assisted surgery. So, I told Jenny I could do the same for her and get her moving again."
She was intrigued to learn more. Jenny talked with her friends who all praised Dr. Bhadra’s skill and personalized care as well as the private patient recovery rooms leading to faster recovery at Good Samaritan Hospital.
Jenny scheduled robotic-assisted total joint replacement surgery for her left knee at Good Samaritan Hospital, a Joint Commission-accredited facility and recipient of the Gold Seal of Approval® for Certification for Total Hip and Total Knee Replacement.
Prehab Preparation
Dr. Bhadra advised Jenny to participate in prehab (preoperative rehabilitation) to increase her physical stamina in preparation for surgery.
“They gave me a book filled with different exercises and I practiced each one,” said Flanagan. “It was like giving me homefield advantage for the ‘big game’ because the more work I put into getting my body stronger, the faster I could recover and get back to doing what I loved.”
It wasn’t only Jenny in preparation mode, but Dr. Bhadra, too. In the weeks leading up to the procedure, he developed a patient-specific surgical plan for Jenny. Beginning with a CT (computerized tomography) scan of Jenny's knee, Dr. Bhadra created a three-dimensional model of her joint to determine the optimal size, placement and proper alignment of her new implant.
Robot Ready
When the day finally arrived, both patient and doctor were ready.
Dr. Bhadra used robotic-assisted surgery to navigate and replace Jenny's arthritic left knee. First, he removed the diseased bone and cartilage and then used computer-guidance software to place the new implant in its final position.
“Robotic-assisted surgery enables the surgeon to perform precise and individualized care for each patient,” said Dr. Bhadra. “And in our experience, when the implant fits well, it leads to reduced recovery time and longer life for the new joint.”
Pain Relief Program
Before the completion of surgery, a plant-based medication was injected into Jenny’s new knee to provide her prolonged pain relief during the recovery process. This is part of The Total Joint Replacement Center's ongoing efforts to reduce the use of narcotics or opioid analgesics in post-operative care and offer alternative treatment modalities for pain control.
“I don’t do well with narcotics or general anesthesia and I wanted to avoid both during my surgery,” said Flanagan. “I was happy that Dr. Bhadra and his team were able to accommodate my request. It really put me at ease both mentally and physically.”
Moving Forward
Just hours into her recovery, Jenny was up and walking with the help of physical and occupational therapists at Good Samaritan Hospital.
“Once they told me I could put weight on my new knee, and I felt pain-free, nothing stopped me from moving forward,” said Flanagan. She went home the next day.
Over the next few weeks, Jenny’s prehab and post-operative rehabilitation paid off. She quickly returned to her active lifestyle, which included dancing with her husband on their wedding anniversary and riding her bike to the beach during a girls' trip to Florida.
"We attribute these results to our experienced multidisciplinary team, which employs advanced technology to stay ahead of the curve in total joint replacement surgery," Dr. Bhadra said. "Care like this is only available at a few specialized centers in the area, and Good Samaritan Hospital is one of them."
Making an Iron Man With Robotic-Assisted Knee Replacement Surgery
This revolutionary procedure put firefighter and scuba rescue diver Robert Young back in action.
By Laurie Yarnell
Knee pain forced him to give up rowing. Next was bowling. But “the straw that broke the camel’s back,” says Robert Young of Sloatsburg, was severe pain after he moved some tree trunks around his property in a wheelbarrow.
Young, 65, leads an active life. His job as a condominium superintendent keeps him on the move all day, climbing ladders, fixing elevators and the like. For 38 years, he’s been a volunteer firefighter; for the last five, he’s served the department as a scuba rescue diver.
But Young’s knee pain was interfering with activities he loved. Despite his “very high tolerance for pain,” he knew he had to do something about his knees. In the fall of 2016, Young consulted orthopaedic surgeon Arup Bhadra, MD, Director of the Total Joint Replacement Center at Good Samaritan Hospital, a member of the Westchester Medical Center Health Network (WMCHealth). After an exam and X-rays, Dr. Bhadra diagnosed Young with osteoarthritis (OA) in both knees.
Experienced by about 27 million Americans, OA is the most common chronic condition of the joints. Unlike in normal joints, where cartilage is a cushion between bones, in OA, cartilage breaks down, resulting in pain, swelling and decreased mobility. While OA is most commonly seen in those over 65, obesity, overuse, previous injury and genetics are contributing factors.
Given the deterioration of Young’s knees, replacements were recommended. Because he was on the younger side, in excellent shape and has good bone density, less-invasive partial replacements were recommended, says Dr. Bhadra. “Because partial replacements avoid the cutting of ligaments and muscles, you have a smaller incision and faster recovery.”
Damaged tissue and bone are replaced with a prosthetic implant. “We take a very thin slice of arthritic bone from the knee, and we add in metal pieces of the same shape, with a little plastic spacer in between, which works like smooth cartilage,” says Dr. Bhadra. In September 2016, he performed this procedure on Young’s left knee. Young recovered quickly, returning to light-work duty after five weeks and to the fire department after two months.
Young was so pleased that he returned to The Total Joint Replacement Center to have a partial replacement on his right knee in October 2017. This time, Dr. Bhadra offered him a newer, more technically advanced procedure — MAKO robotic-arm-assisted surgery. The Center started offering robotic surgery earlier that year, and Good Samaritan Hospital is one of the only hospitals in the region with this capability. “By bringing this option to Good Samaritan Hospital, we’re staying ahead of the curve and offering our patients the very best care,” says Dr. Bhadra.
“We call it robotic, but it’s actually minimally invasive, computer-assisted surgery,” says Dr. Bhadra. “The surgeon remains totally in control.” A robotic CT scan of the joint, taken before surgery, gives a three-dimensional picture of the joint.
During robotic-assisted surgery, he adds, “Technology helps enable the surgeon to be 100 percent precise, working almost like a GPS signal.” Less soft-tissue invasion also may result in quicker recovery, adds Dr. Bhadra.
“My mobility came back twice as fast the second time around with the robotic surgery,” Young confirms. “I got off painkillers earlier and had an easier and faster recovery.”
Indeed, just three weeks after his second surgery, Young was dancing at a reunion party held for the hospital’s joint-replacement patients and medical staff.
“The hospital was excellent, and Dr. Bhadra was amazing and very clear in explaining what was going to happen,” says Young.
Today, Young is back to his active routine and feels “wonderful – I’m 99 percent better.” In fact, his ability to keep up with his 30-year-old buddies at the firehouse has earned him a new nickname: Iron Man.
Road to Recovery
Two new knees and a new attitude got a Harley lover back in the saddle.
By Melissa Pheterson
Richard Granai knew he needed both of his knees replaced. Yet, for three years, he stalled and cooled his engines.
As a motorcycle instructor, active community volunteer and “a chicken when it comes to needles,” he received injections of cortisone for his arthritis as a patient of Arup Bhadra, MD, orthopaedic surgeon and Head of the Total Joint Replacement Center at Good Samaritan Hospital, a member of the Westchester Medical Center Health Network (WMCHealth).
“When I tried to get up off the floor, I felt like a beached whale,” Granai recalls. “The turning point was the summer of 2015. I was in Hersheypark with my family, at the food court. I went to get up, and my knee locked up.” Massaging his leg as his young grandson ran about, he remembers thinking: This would be a very bad day on a motorcycle.
Dr. Bhadra says he and his staff offer injections, physical therapy and plenty of patient education before pursuing a surgical intervention. Together, they review X-rays and take into account both range of motion and functionality to gauge the severity of the arthritis. “It’s well-organized teamwork, which starts at my office. Patients meet the team of medical doctors, anesthetists and pain-management physicians, physical therapists, dieticians and case managers to plan out perioperative care and set up goals.”
“I tell my patients, ‘Surgery is not a decision I’m going to impose on you. We review the X-rays and the options; when you need the surgery, you are going to come back and tell me based on the discomfort you’re going through on a daily basis.” Granai, 72, was “quite active, quite adventurous, but very apprehensive,” says his doctor.
The cartilage that had cushioned his left thighbone, shinbone and kneecap had worn away to the point that bone was rubbing against bone, causing pain, stiffness and swelling. On the right knee, an intrusive bone spur had formed underneath the traces of cartilage remaining, causing severe pain when Granai extended or bent his knee.
To conquer his fear, Granai became a fixture of the monthly Total Joint Replacement meetings at Good Samaritan Hospital. “I was so scared. I wanted to learn everything I could.”
Finally, in the fall, he said to Dr. Bhadra: “Let’s do this.”
“Dr. Bhadra looked at me and said, ‘What brought you back?’” Granai recalls. “I said, ‘I guess I’ve run out of excuses.’”
Two weeks later, just before Thanksgiving, he was admitted into surgery for his left knee.
“Some people said I should go to New York City for the surgery,” Granai says. “But I trusted Dr. Bhadra — he ranked as high as anyone on the online report cards — and Good Sam is within walking distance of my house.”
Rather than slice through the quadriceps tendon to open the knee, Dr. Bhadra’s “muscle-sparing” technique creates a plane between the muscles, pushing muscles, tendons and kneecaps to the side with one small incision. He recreated the knee anatomy by inserting a metal-alloy replacement knee and plastic spacer. The result: a smooth cushion and functioning joint.
After two nights in the hospital, Granai was discharged.
“My vision was to get back on that motorcycle,” he says. “I was on a mission.”
While Dr. Bhadra observed that his patient was soon “walking excellently,” Granai was disinclined to sit back, relax or delay surgery on the right knee. His second surgery took place seven weeks later, giving him time to recover and build strength in his left leg.
Driven to ride his Harley again, Granai has taken his recovery by the reins — and the handlebars. “Attitude is everything,” he says. “My recovery and rehab are my responsibility. The physical therapists give you all the tools, but they’re not going to sit by your bed or chair, forcing you to ‘do this; do that.’”
In the spring, Dr. Bhadra gave Granai the go-ahead to ride his motorcycle again. He has since returned to visit Dr. Bhadra and the entire staff; he also speaks at the Joint Replacement Meetings at Good Samaritan Hospital.
“I’m back on the bike and back teaching,” he says. “Now I can actually grab my ankle. I want to be able to sit on my heels, and I will get there, gradually. But again, there’s only one person who will make that happen, and that’s me.”
New Hip, New Hope
Try as she might, Lise Crapella, 64, couldn’t seem to shake the pain in her hip. In the course of nearly 30 years, the Suffern grandmother of two had put her body through a lot, including 22 New York City Marathons, two Boston Marathons, half Ironman triathlons and group expeditions to climb Mount Kilimanjaro and Mount Everest. After a while, she reluctantly cut out running in favor of hiking and biking. But last winter, the pain in her hip grew so acute that she couldn’t even bend to tie her shoe.
An adult/geriatric nurse practitioner specializing in wound and ostomy care at Good Samaritan Hospital, a member of the Westchester Medical Center Health Network, Crapella finally turned to Arup Bhadra, MD, head of Good Samaritan’s Total Joint Replacement Center. Dr. Bhadra ordered an MRI and immediately noticed extensive arthritis, or lost cartilage—partly from repetitive physical motion, partly from normal bone degeneration. Without cartilage to cushion and protect the hip joint, the pain would continue.
“We talked about getting injections for temporary relief, but the X-ray showed it was too far gone,” Dr. Bhadra says. “She was fit, but in pain for four years, and every day it was getting worse.”
The verdict was clear: Crapella needed a hip replacement.
“I didn’t expect to run marathons; I just wanted to take a nice long walk,” she says. “I had no range of motion; I hadn’t even slept on my left side for 10 years.”
Still, Crapella put off the surgery for nine months, hoping the pain would be tolerable.
“Dr. Bhadra looked at the X-ray, told me then and there that I needed a hip replacement, and said I’d know when I was ready,” she says. “He was right. When the pain grew progressively worse, I came to the conclusion if I wanted to be active and do the things I enjoy, I had to get the surgery done.”
In late March, she called Dr. Bhadra’s office, “I think I’m ready; I can’t tie my shoe.” With the assistance of Camille, the GSH Total Joint Program Nursing Navigator, the preoperative process was streamlined, efficient and hassle free. Her surgery was scheduled within two weeks.
“My department was shocked, yet supportive, that I was scheduled so soon,” Crapella recalls. “My family also said, ‘What! Already?’ But they all said, ‘Go ahead, do it now.’ And because the surgery would be at Good Samaritan, they knew they could easily visit and take care of me.”
Due to Crapella’s level of fitness and good bone health, Dr. Bhadra chose the anterior approach to hip replacement, accessing the hip joint through an interval between muscles, without cutting any muscles or tendons. This technique facilitates the initial recovery over the traditional, posterior method. “Around the world, most surgeons still approach the joint through the back,” says Dr. Bhadra.
Instead, Dr. Bhadra created a small incision at the front of the hip, locating a natural interval between Crapella’s muscles. Extracting the damaged head of the thigh bone, or femur, he replaced it with a ceramic ball and titanium socket, insulating both with a high-quality polyethylene in between that works like cartilage.
“We didn’t cut the tendon, ligament or muscle,” says Dr. Bhadra. “She regained full range of motion without any pain. Recovery is quicker; pain is reduced. Almost all my patients return home within a day or two and have minimal blood loss.”
“In the past, complex cases involving hips, knees and shoulders would often get transferred to Westchester or New York City,” adds Dr. Bhadra. “Now they don’t have to cross the river. Minimally invasive bloodless surgeries facilitate rapid recovery for the patients. We can now care for them here in the community, close to home and get ‘big-city quality’ in our local state-of-the-art facility.”
To protect his patients, Dr. Bhadra has specific selection criteria for this type of surgery.
“Careful patient selection is very important in order to achieve the best outcome. Anterior approach is not for everybody,” he says. “But aside from the damaged joint, Lise was in great shape.”
Without the need for general anesthesia, Crapella was awake and alert immediately after her surgery. “I didn’t have to worry about intubation or sore throat.” And because of the frontal incision, she didn’t experience pain while sitting or lying down. Resting comfortably in bed, Crapella texted the organizer of the trips to Everest and Kilimanjaro.
“His reply came back: ‘How can you text just after surgery?’” she recalls. “I laughed and replied I hadn’t had surgery on my thumbs.”
On the evening of the surgery, Crapella was out of bed and taking steps. The next day, she was walking up and down steps, with a physical therapist. And the following day, she checked out of the hospital—easily taking the flight of stairs up to her house. “No pain,” she marvels. “It was just as successful and straightforward as Dr. Bhadra had promised.” She was even able to return to work—and care for others—after a month.
And her friend, the trip organizer, found that not only could she text, she was also game for a third expedition. At press time, she was planning on hiking the Grand Canyon this fall. “I have no doubt I’ll be ready,” she says.
Dr. Bhadra suggested regular follow-ups with an X-ray every year to make sure Crapella can continue her adventures. This way, any aberration in the artificial joint can be identified and rectified early. “She got back to her regular lifestyle,” he says. “Hiking, biking, sports. Less pounding will make the hip joint last longer, but she has no restrictions.”
In the meantime, thanks to weekly physical therapy, Crapella has steadily increased her level of activity. She can easily take the stairs, enter and exit the car and “get up off the floor much faster and more gracefully.” To gear up for her Grand Canyon trip, she returned to walking and biking. And she can easily keep up with her grandsons, 11 and 14.
“I’m glad I made the decision,” she says. “Dr. Bhadra’s team made me feel so well taken care of, and the nursing staff was exceptional. It was major surgery, yes; it was also a really good experience.”