When knee osteoarthritis has gotten to the point of “bone-on-bone” pain, it means  the cartilage that protects the bones from rubbing against each other has deteriorated. After years of pain, Julian Palacios Arroyo, 71, could barely walk or continue his job as a chauffeur – the pain was in his right knee. He looked online for a specialist and found Giovanni Paraliticci, M.D., an orthopedic surgeon with Baptist Health Orthopedic Care and an orthopedic surgical oncologist with Miami Cancer Institute.

Mr. Palacios Arroyo led an active life and sought out a knee replacement, but another orthopedic surgeon in South Florida, outside of Baptist Health, said he couldn’t operate because of his underlying health issue: Immune thrombocytopenic purpura (ITP), a rare autoimmune disorder in which a person's blood doesn't clot properly because the immune system destroys the blood-clotting platelets. ITP increases risk of excessive bleeding during surgery.

“I started looking on the Internet and found Dr. Paraliticci,” a grateful Mr. Palacios recalls. “I made an appointment for a Wednesday, and by the following Monday morning at 6 a.m., he operated on me.”

Mr. Palacios would be treated for his ITP the day before his robotic-assisted, minimally invasive knee replacement.

Recounts Dr. Paraliticci: “His pain was bone-on-bone. His quality of life was completely limited. He was not able to walk and he’s very active. He loves the outdoors and he still works. So, he comes to me and I saw him at the clinic and I said: ‘I don't see why this is a problem. We'll do the right thing.’ And we consulted our hematology service on the ITP issue. And we admitted him the day before his knee replacement. We got everything set up and we were prepared for everything -- all the different scenarios that included excessive bleeding.”

His knee replacement was in June of last year. But Mr. Palacios Arroyo says his pain relief came almost immediately after his surgery. He was walking without pain a few hours afterward.  “I made an appointment for a Wednesday, and by the following Monday morning at 6 a.m., he operated on me,” recalls the patient. “I came out of the operation perfectly fine, without any complications. It’s been more than a year and he’s given me the all-clear. “

Dr. Paraliticci says that no one should ignore persistent knee pain without consulting an orthopedic surgeon, even if a knee replacement isn’t required. In the case of Mr. Palacios, the surgery was a bit challenging – but there were no complications.

“I would say his knee replacement was harder than normal because he had prior injuries to his knee,” said Dr. Paraliticci. “He developed post-traumatic arthritis. His knee was very stiff, very rigid, and very swollen. And he waited a long time for his knee replacement. After patients wait for too long, the knee and the soft tissues become stiffer -- and balancing the knee is a little more tricky.”

Baptist Health Orthopedic Care was the first institution in Miami-Dade County to invest in the Mako Robotic-Arm Assisted Technology, manufactured by Stryker. Mako has helped surgeons perform partial and knee replacements more accurately. For patients, that means preserving soft tissue, saving healthy bone, and realizing faster recoveries.

Total or partial knee replacements using Mako starts with a CT scan that creates 3-D images of a patient’s unique anatomy. Using these images, the Mako technology guides surgeons to cut what’s planned precisely for each patient. The surgeon uses the technology to evaluate bone structure, disease severity, joint alignment and the surrounding bone and tissue. This enables them to determine the optimal size, placement and alignment of the implant. With the help of increased precision, Mako protects soft tissue and ligaments from damage.

“Robotic-assisted knee replacement provides  a more personalized alignment,” explains Dr. Paraliticci. “We do a scan of the hip, knee and ankle. And then we use our bone cuts to balance the knee, meaning that we use the information from the scan and the interpretive finding. We then perform the knee replacement that will be tailored towards that patient’s anatomy.”

Mr. Palacios Arroyo is extremely grateful for being able to resume an active life. He overflows with praise for Dr. Paraliticci.

“I’ll give him 10 stars, not five stars,” he says. “I had many years with pain. I couldn’t even walk. Two or three hours after the surgery, I was walking. I went home the next day. I got a stationary exercise bike at home. I am perfectly fine.”

He has completed more than a dozen sessions of physical therapy.

“I am back working as a chauffeur, and my right leg doesn’t hurt anymore, particularly when braking. Now, I can drive anything with no problem. I didn’t need to take pain medication because I never felt any pain.  I am perfectly fine. Dr. Paraliticci is an exceptional doctor and he truly cares about his patients.“