How advances in local knee replacement improved one patient's recovery

How advances in local knee replacement improved one patient's recovery

When Thomas Sbarra, MD, a retired Falmouth Hospital cardiologist, decided to have right knee replacement surgery in October 2025, he said he prepared for the worst but found it turned out better than he expected.

"I had the left knee replaced by (Paul Dimond, MD) in 2013, and this one went much more smoothly," said Dr. Sbarra, who had arthritis in both knees.

The difference between the two surgeries was largely because of new technology available to Dr. Dimond and other orthopedic surgeons at Cape Cod Healthcare, including Jonathan Sunkin, MD, and Kevin Dwyer, MD.

"Tom's left knee replacement (in 2013) was an instrumented total knee replacement, and his recent right knee replacement was done using the ROSA robotic-assisted knee surgery," explained Dr. Dimond.

The Differences in Techniques

There are a few differences between instrumented and robotic-assisted knee replacement surgery. Total knee replacement surgery is complex and involves taking many measurements of the femur (thigh bone), tibia (shin bone), and angles of the two bones to ensure good placement of the new joint parts, he said.

"During traditional knee replacement surgery, two of the instruments I used were an intramedullary guide, which was a rod inserted into the femur that gave me an assessment of the patient's hip center and alignment of the limb," he said. "The second instrument was the extramedullary guide, placed outside the tibia. It clasps around the ankle, runs up outside of the tibia and guides the standard tibia cut. These instrument guides would show alignment of the leg so I would know where to cut the bones for placement of the new knee joint."

With the ROSA robot, there is no need for a CT scan prior to surgery for the planning stage because the surgeon can enter the measurements of the anatomy during the surgery and an image of the implant with measurements will show up on a screen, Dr. Dimond said.

The first step involves placing tracker pins on the femur and the tibia, he said.

"I can move the image of the knee in different planes on the screen, so I know in real time that I have all the information I need to know before we start the surgery."

The ROSA technology will then give him a complete game plan tailored exactly to the patient's leg anatomy with all the measurements he has done.

The computer screen shows the progress of the measurements he takes before he begins surgery and during surgery, including movement measurements for flexion and extension of the leg. It also validates every measurement taken.

The robotic arm then comes into play with a cutting guide to show the surgeon exactly where to make the cuts in the bone. It shows where to remove more or less tibia and femur bone to get the proper alignment.

"Once the new joint replacement parts are in position, ROSA helps me to assess the ligaments to make sure they are balanced in tension on both sides of the new knee, which is very important in the longevity of the replacement parts, to prevent wear on the new components," said Dr. Dimond.

A Combination of Improvements

While Dr. Sbarra is pleased with the outcome of his latest knee replacement and faster recovery, he believes it is a combination of things that helped to make his recovery better this time.

"I think there are improvements in how quickly they mobilize you following surgery, improvements in anesthesia and pain management at home," he said.

"My initial visit with Dr. Dimond began with an exam, a discussion about the activities I do, and what I was experiencing with pain and any limitations. I got good advice and Dr. Dimond felt it was reasonable to proceed with the knee replacement. It all made sense to me, and I decided to move forward with the surgery."

"In preparation for my surgery, I attended a surgical preop talk given by representatives from the Visiting Nurse Association (VNA) of Cape Cod including a physical therapist and Dr. Dimond's office," Dr. Sbarra said. "They talked about the procedure, home visits by the VNA, what to expect with physical therapy and any signs and symptoms to watch out for following surgery. It was well-coordinated, well done, and very impressive."

The presentation also motivated him to start pre-habilitation months prior to surgery which in turn helped him get moving more quickly during recuperation, he said.

"I felt well-prepared for the surgery and the degree of coordination I experienced was something that was not present in other surgical offices I had visited prior to my visit with Dr. Dimond."

The day of his surgery was seamless, Dr. Sbarra said, and the staff was very reassuring.

Walking in Four Hours

With his previous knee replacement surgery, Dr. Sbarra spent four days in the hospital to recover.

"This time, I was walking up the stairs to go home four hours after I entered the hospital for the surgery," he said.

He recuperated at home with the help of the VNA and their physical therapy services.

"PT was awesome and they had great communication within the team," he said.

Another Helpful Technology

Dr. Sbarra took advantage of the Persona IQ system offered to knee replacement patients at Falmouth Hospital. It is a "smart "knee implant device that provides feedback to him and Dr. Dimond about his progress. The information is communicated using a phone app.

"I like how it keeps track of how many steps I take and tracks my stride length," Dr. Sbarra said.

A recent enhancement to the PIQ program is the addition of PIQ senior manager Candice Dimond.

"She follows the recovery curves," Dr. Dimond said.

If a patient is not taking those steps or their step numbers are dropping off, Candice can call them and encourage them to do the exercises. If they have something going on medically, she can make sure they are referred back to their primary care provider.

"We are trying to prevent patients from having to go the emergency room or get readmitted to the hospital," Dr. Dimond said. "We are engaging with them remotely, which is the beauty of the PIQ."

Dr. Sbarra said he is grateful to all the staff in the Cape Cod Healthcare system who helped him along the way.

"A huge thank you to everyone behind this, it really takes an army of people to perform such intricate procedures," he said. "In many ways, it's kind of a miracle."