It's hard to sell pro athletes on a knee replacement. Olympic skiing champion Lindsey Vonn underwent a partial knee replacement in 2024 after years of chronic pain and multiple surgeries even after retiring from competition.

The robotic-arm-assisted technology used by Dr. Roche enabled him to scan her knee, remove the damaged bone in a minimally invasive way and then seal all the cracks and pockets with titanium implants. The robots keep getting more precise, and the titanium keeps getting more durable, but the real breakthrough was using the technique on a pro athlete in the first place. A few months later, during physical therapy, Vonn did a single-leg box jump on her right leg, and “I cried because I hadn’t done that in 10 years,” she said.

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“I’m not letting this slip through my fingers,’’ she said. “I’m gonna do it, end of story. I’m not letting myself go down that path. I’m not crying. My head is high. I’m standing tall and I’m gonna do my best, whatever the result is, that’s what it is, but I’ll never say I didn’t try,’’ said Vonn. 

This is not her first ACL tear. It is her third, to go along with a fractured ankle, knee, humerus, microfractures in her forearm, tibial fractures in her leg, a torn LCL, two torn MCLs and an acute facet dysfunction of her back – better known as debilitating spasms brought on by trauma.

Watching the sport go on without her wasn’t easy, but she had made her choice and made peace with it as well. When , crafted a 3D version of her knee to use as a model for her titanium replacement, it wasn’t about returning to skiing. It was about living a life without pain.

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This coverage originally appeared on cbsnews.com. The original article is no longer available online.

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Vonn connected with Martin M. Roche, knee surgeon at HSS Florida, who recommended a robotic-­assisted partial replacement for Vonn’s right knee. Vonn’s major pathology was cartilage loss on her lateral, or outer, side. A minimally invasive procedure would keep her ACL, her medial meniscus and the cartilage on the inner part of her knee intact. This would aid her post surgery proprioception, or “sixth sense” ability to be aware of the movement and location of her knee joint for improved stability and balance.

Through a CAT scan, Dr. Roche built a virtual 3D model of Vonn’s damaged knee. Before the April 2024 surgery, he used it to size the titanium implant. In the operating room, Roche guided the robotic arm that removes damaged bone and cartilage. “It’s almost coloring within the lines,” he says. “I can get down to millimeter precision.” He didn’t touch any muscle, ligaments, or tendons. “Recovery is much faster because we haven’t traumatized or damaged any soft tissue,” he said.

As the world’s best winter athletes gather in February for a celebration of speed, acrobatics, and artistry on snow and ice, Vonn’s attempt to earn another Olympic medal will likely be the buzziest story of the Games. 

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Dr. Roche recommends GLP1 weight loss drugs for many of his patients.

"We have definitely seen patients that have been able to delay surgery," said Dr. Roche. When there is less stress on joints, there is less pain.

He said he also has many diabetic patients who would never have been healthy enough for knee or hip surgery, but after using the weight loss drugs they can have the procedure.

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But instead of simply patching up the damage to Vonn’s knee and ending her days on the slopes, the surgery has marked a new beginning for one of the greatest skiers of all time. 

Against all odds—and testing the limits of science and human resilience—the 40-year-old Vonn is set to ski in World Cup Super G races in St. Moritz, Switzerland. 

Martin W. Roche, MD, knee surgeon and director of arthroplasty at HSS Florida, took on the partial reconstruction last spring. With robotic assistance, he precisely resurfaced the most damaged parts on the outside of Vonn’s knee with titanium alloys and polyethylene components. The replacement parts were custom positioned based on a medical imaging of Vonn’s knee joint.

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Geographic expansion included the opening of HSS Midtown and HSS Orthopedics at Stamford Health-Wilton and more.

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Dr. Roche noted, “It's all about efficiency, outcomes and where patients want to go, as well as what they're having done.”

He added, “I think orthopedic companies are drawing up different types of business models because they see robotics as the future as well.”

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Dr. Roche explained the advancement of robotic applications, including the innovation of a partial knee replacement developed at HSS Florida, which fixes just the worn-out part of the knee and allows people to get their range of motion and function back in a matter of weeks, which is a tremendous improvement in the treatment of arthritis.

Dr. Roche said, “I always want to tell the patient that - knee arthroplasty, even though a complex surgery, it has a successful up-to-20-year lifecycle, so it enables you to restore your function – you can hike, swim, cycle, tennis, golf and restore your active lifestyle.”

The segment aired on May 20, 2021.

Dr. Roche explained the knee is divided into three compartments: Medial (inside), lateral (outside), and patellar (kneecap). The surgeon will determine if one compartment needs to be replaced or will require a total knee replacement. Thanks to the precision of robotics, the partial option is becoming more common, with the replacements lasting now around 15-20 years.

Dr. Roche cited partial knee arthroplasty (PKA) is a viable surgical option for patients with endstage, unicompartmental (one compartment) osteoarthritis. Major advantages of PKA compared to total knee arthroplasty (TKA) include quicker recovery, less pain, and a lower complication rate. Age and activity level do not affect you as a candidate. Patients undergoing a PKA can expect a 96% chance of returning to preoperative activity levels, and 90% maintain or experience improvement in their sporting activities. In contrast, dissatisfaction rates hover between 14% and 20% for TKA.

Robotics allows surgeons to customize surgery and perform it safely, efficiently, and accurately, added Dr. Roche. The robot assists the surgeon in resecting millimeters of bone accurately, so the implant fits perfectly. Once the implants are cemented patients can start walking on their leg in under an hour. Patients can even go home the same day. Usually, after two to three weeks of therapy patients can resume their own exercise program, as motion and stability return quickly.

This article appeared in the print edition on March 21, 2021.

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Dr. Roche explained robotics bring the most advanced computing technology into the surgeon’s operating room, enabling the surgeon to perform total knee replacements with unparalleled safety and accuracy.

The need for knee replacements is increasing rapidly every year, as patients live active lifestyles through retirement, and younger patients require surgery more often. Dr. Roche noted robotics improves the chances for all patients to have better technical outcomes and enables implants to last over 20 years. Surgeons utilizing robotics can individualize the surgery to match the patient's lifestyle, allowing them to resume activities including tennis, golf, pickle ball, cycling, swimming and hiking. With improved accuracy, newer implants that allow the bone to grow into them can be used, and new designs will enable surgeons to retain all of the ligaments.

According to Dr. Roche, “smart implants” with embedded sensors will soon allow surgeons to check on patients’ knee replacements from anywhere in the world. These technologies are enabling select patients to undergo surgery in an outpatient setting, walk one hour after the procedure and go home safely the same day.

This article appeared in the print edition on March 7, 2021.

HSS believes the best orthopedic care begins with the proper diagnosis and a comprehensive treatment plan delivered by top medical talent every step of the way. The goal is to continue to provide unmatched, personalized care to improve mobility and restore quality of life for its patients. 

Read the full article at Questmag.com. This article also appeared in the February 2021 print issue.

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As a warm-weather state, Florida has a big recreational community and a lot of sports-related injuries. It also has a lot of people with aging orthopedic problems such as total joint replacement and spinal stenosis. "Floridians, as they age, stay as active as they were when they were younger,” said Martin W. Roche, MD, knee surgeon and Director of Hip and Knee Arthroplasty at HSS Florida. "I'm doing knee surgeries for people in their 80s that are playing pickleball, tennis and golf,” he continued.

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When asked what attracted him to his new role at HSS Florida, Dr. Roche noted, “With the timing of COVID, the fact that we were evolving into a more ambulatory approach for a lot of cases, and with HSS developing a center in Florida, all the pieces aligned. HSS was looking for someone to run its joint program and grow its presence in Florida. I felt it was the perfect time in my career to take this opportunity.”

Dr. Roche explained there is a lot of momentum that will continue to drive outpatient care, particularly if surgeons can continue to show the outcomes are just as good. Surgeons are also being driven by patients, as they are requesting the best technology for the best outcomes, including everything from sensor-assisted surgery to robots. “It's going to be exciting over the next couple of years integrating robots, not only into hospitals, but into ASCs [ambulatory surgery centers],” he said. Dr. Roche continued to say remote patient monitoring with wearable sensors and other communication links are the future. “As patients are going home the same day it's still our role to ensure their recovery goes as seamlessly and as safe as possible. I think you're going to see the use of wearables and different telehealth integration to keep an eye on patients to make sure they're not having any complications along the way.”

“’Robotics’ resonates with patients as the most advanced technology available. I think the next stage, what I would call digital orthopedic healthcare, is going to center on improved real-time connectivity with our patients,” cited Dr. Roche. “The next extension of intraoperative sensors and wearables will be implanting sensors within the implant or joint when you do the surgery. I believe the next evolution of care over the next three to five years is delivering intelligence through data. In five years, I think every instrument we use to perform surgery and every implant we use will be smart — they will be data-producing devices."

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