Mako Knee and Hip Replacements

Video Transcript

My name is Mark Mayer and I'm originally from Bronson, Michigan, which is on the southern part of Michigan. My specialty is orthopedic surgery. I practice what we call general orthopedics, so I do carpal tunnel releases or taking care of hip and ankle fractures or doing knee and hip replacements. I do a wide variety of things, I would say probably covering about 80% of the scope of orthopedics.

What types of surgery can be assisted by the Mako robotic-arm?

So at the present time, the Mako Stryker robot is able to be used for total hip replacements, partial knee replacements and total knee replacements.

How does the Mako robotic-arm assist in knee replacement?

The Mako robotic-arm is basically a device which helps me to do the operation as accurately and as precisely as possible. Preoperatively, we get a CT scan, which allows us to three dimensionally plan the surgery. So I'm able to determine, based on every individual's specific anatomy, how to do their surgery best. I can determine the implant size, I can determine what orientation of the implants three dimensionally would be optimal for that patient. Then during the operation, I'll collect data as far as the range of motion that the patient's knee has if it's a knee replacement, and also be able to determine the pressures in the different parts of the knee.

So part of doing a knee replacement is getting the parts in right, but also having the right what we call ligamentous balancing, which is really the amount of pressure or laxity in the different parts of the knee throughout the range of motion. So it's similar to like putting a nice pair of tires on a car, but they need to be well balanced, otherwise the car is going to ride bumpy and cause problems. So we're able to determine the pressures in the different parts of the knee. Then I can change my preoperative plan based on the pressures that I'm detecting intraoperatively. If I need to tweak it a half a degree or two degrees here and there, I can do that three dimensionally before we even touch the bone.

Then we bring in the robotic-arm, which is draped and I guide the arm to make the bone cuts. When I'm making the bone cuts, it's only going to allow me to do basically what I programmed for it to do within basically a half a millimeter of accuracy. So if I were to try to move the saw in a direction which I haven't programmed it to, it'd actually stop the saw. So we have a lot more accurate surgery, we have a lot more precise surgery and also we can create boundaries around the bone so that the saw doesn't go into the soft tissues at all. So there's a lot more soft tissue protection, a lot less retraction on the tissues, which ultimately leads to a better outcome.

How does the Mako robotic-arm assist in total hip replacement?

With a total hip replacement, it's a little different. We don't have the same kind of joint, but there are very similar kinds of aspects to the surgery. So preoperatively, we're planning the size of the cup, the size of the stem. We know what's the patient's normal anatomy and how to try to recreate that as close as possible.

For example, when replacing the cup and a hip replacement, traditionally, you just kind of eyeball it and you're guessing how many degrees is this tilted? Well, here we can actually dial it in within just a few degrees and have it hit the mark pretty much every time. Putting in the cup correctly allows for a better outcome, less risk of pain, less risk of dislocation, less likely to have a leg length discrepancy. And so with a hip replacement, same kind of ideas as far as determining the sizes, the bony preparation. You know, we're again able to ream the hip socket to within basically a half a millimeter to a millimeter of accuracy.

What are the benefits of Mako robotic-arm assisted surgery?

So the benefits of having a Mako assisted joint replacement surgery is that you're going to get more accurate surgery. There's a lot of guessing when you're using manual cutting guides and with the Mako robotic, you're really getting very accurate placement of the implants and the cuts to within a half a millimeter of accuracy. In addition, the precision, so the reliability of doing it case to case, you're really giving every patient the best chance possible to have a good outcome. There's none of this business, "Well I made a good cut on 9 patients, but that 10th one, it was more tilted than I thought." With the Mako assist surgery, you're really making it more reliable or precise for every patient.

In addition, during normal operations, you're retracting on the soft tissues a lot in order to protect the ligaments from the saw blade. With the Mako system, we can actually put virtual boundaries around the bone so that we protect the soft tissues with that boundary. So it's much less retraction on the soft tissues, which generally leads to less pain and a quicker outcome.

What is the difference between partial knee replacement and total knee replacement?

The difference between a partial knee replacement and a total knee replacement is essentially how much of the joint you're replacing. In both conditions, you have severe arthritis, but in about 15% to 25% of the knees the arthritis is limited to just one part of the knee. In those cases, we can just do a partial knee replacement. And with a partial knee replacement, we're doing really about 20% to 25% of the operation of a total knee replacement. We're maintaining more of the patient's normal anatomy, we're disturbing a lot less soft tissue irritation from the surgery and so patients have a quicker recovery. Typically, I don't even do physical therapy after a partial knee replacement. Less risks of various complications with the surgery, so it's really a minimally invasive type of operation.

With a partial knee, the recovery is much faster than with a total knee replacement. Typically, people return to their normal activities by a month after the operation. With a total knee, it's still an invasive operation because you're still doing a total knee replacement, but in general I'd say by about a month and a half people are done seeing me in the office under most circumstances and they're good to go.

How do Mako, assisted knee replacement, recovery times compare to traditional surgery?

I think the main difference is that with a well done manual partial knee replacement you have a quick recovery as well and with a well done total knee replacement, it'd be similar time. But there's much more chance that it isn't a well done operation. There's more opportunity for surgeon error contributing to a poor outcome, whereas with this, you're really minimizing the chance of human error.

Is Mako assisted surgery still considered major surgery?

So one misconception is that robotic surgery automatically means minimally invasive and there's no minimally invasive total knee replacement. There's no minimally invasive total hip replacement. So these are big surgeries, no matter if they're done with robotic assistance or without. The question is whether or not the surgery's done accurately. And so there is a human error element to any operation and with the robotic assistance it minimizes that to the lowest possible level so that each patient gets the best chance for a good outcome and the number of patients who have a bad outcome as a result of surgeon error is basically almost eliminated.

Does the Mako robot perform the procedure?

When we bring the robotic-arm in I'm still holding the robotic arm and guiding it, it's just only going to allow me to move the robotic-arm within the parameters that I've already programmed for it to accomplish.

Who is a good candidate for a Mako robotic-arm assisted surgery?

Essentially, anybody who is a candidate for a knee replacement or a hip replacement is a candidate for a Mako guided replacement. It's the same patients. It's just whether or not you want to have somebody eyeball the surgery or if you want to have it done with a robotic assist, which makes for much more accurate, precise surgery.

Can a patient choose between traditional and Mako assisted surgery?

There's only two places right now in South Dakota that make that technology available and we're lucky to be one of those hospitals here in Brookings, which is almost unheard of for a small to mid-sized population. But as far as whether or not somebody can choose to have the technology used or not, I think if somebody understands the technology, they'll realize that it's a more accurate, precise, safe surgery and I don't think anybody would ever choose not to have it.

Why is Brookings Health System a great choice for orthopedic surgery?

I've worked in a lot of different hospitals and I think Brookings Health System is a great place to have your operation. We really have an administration and staff that's dedicated to high quality care that's exemplified by having equipment, technology like the Mako robot, which isn't available at most hospitals, let alone mid-sized hospitals like this. Because at the end of the day, the robotic technology is so good, it's so accurate, it's so precise that it's better than an individual no matter how much experience they have who's using an eyeball technique to try to perform the surgery.