Robotic knee and hip replacement surgery – using a state of the art robotic arm called MAKO – has been hailed as a new era in orthopaedic surgery. Surgeons talk about improved clinical outcomes due to the fact that the robot can assist with increased accuracy of standard implant positioning and exact achievement of the pre-operative planning, allowing a ‘personalised standard prostheses’ replacement surgery.
But, is the hype justified? The new procedure is more expensive than conventional joint replacement surgery and is still in the early days, so are the proposed improved clinical outcomes worth the extra cost? We take a look at the pros and cons of robotic joint replacement surgery…
How MAKO robotic arm assisted surgery works
MAKO technology uses a CT scan to create a 3D model of the patient’s knee or hip. This is then used to design and plan a ‘personalised standard implant’ for them which is the closest match to their natural joint, optimising its fit with their anatomy.
The surgeon uses the system to create a pre-operative plan, mapping out the ideal position and orientation of the implant. During surgery he can make fine adjustments to the plan if necessary, but cannot move outside the planned limits. The MAKO robotic arm assists with this. It has a burr or saw at edge of the arm that ensures it will only cut where it is supposed to. If it is guided by the surgeon to the planned boundary it will stop.
The robotic arm moves with fluidity and control, enabling the surgeon to see a real-time feed in three different dimensions on a screen in front of him.
The precise nature of MAKO technology allows the surgeon to target only those parts of the joint that are affected by the disease, replacing damaged bone and restoring ligament tension, while leaving the healthy joint areas untouched.
Preserving as much healthy bone and tissue as possible ensures a more rapid recovery and this is an important benefit if revision surgery is ever needed.
Hip replacements last on average 15 to 20 years so there is a possibility that further surgery may be needed at a later date. Knee replacements will wear out with time in a similar manner.
MAKO joint replacement technology has been widely welcomed and there are, without doubt, many benefits:
- It allows surgeons to create a personalised surgical plan so they can position the implants with absolute accuracy.
- The standard replacement joint prosthesis is individually optimised to match the patient’s anatomy for greater freedom from pain from any mismatch.
- Intraoperatively the system maps the patient’s natural joint movement patterns, helping to minimise excessive stress on the soft tissues and ligaments. This should ensure that they will be able to move in a natural way once the implant is in place.
- There appear to be fewer prosthesis complications after surgery
- Rehabilitation times tend to be shorter.
- There is less chance of implant failure with possible less need for revision surgery.
- Safety is improved. With the MAKO system turned on, surgeons can only perform within their pre-operative plans due to the robot restricting cutting outside of the pre-planned area. This reduces the risk of human error.
- There is a possibility that blood loss may be reduced as there is less unnecessary exposed bone surface left to bleed.
As with any type of procedure, MAKO is not without its drawbacks.
- Surgical time is likely to be slightly longer than with traditional joint replacements, exposing patients to theoretically greater risk of infection.
- Any computerised system is only as good as the information that is inputted into it. This includes the quality of the initial CT scans, and the proficiency of the team using the MAKO system. Appropriate training and experience helps the workflow process and optimally the final surgical result achieved.
- This is a new technology for joint replacement implantation and, as such, there is only early evidence to show long-term enhanced implant performance. The actual implants used are already traditionally tried and tested prostheses.
In deciding whether to opt for robotic-assisted surgery or traditional manual surgery, patients should consult with an orthopaedic specialist who can provide up to date advice, information and guidance.
Read more about MAKO surgery for the hip and knee: