Robotic Knee Replacement FAQs
What is Mako?
Mako is a patented, first-in-class technology offered by Stryker Corporation to utilize a “haptic” robotic system to complete joint replacements. This technology permits the surgeon performing the operation to have additional precision during the replacement’s bone preparation due to virtual boundaries created by the robot based on your unique anatomy. As a result, more of your healthy bone is saved, your soft tissues including ligaments and tendons(1) are protected, and the joint replacement is perfectly executed and balanced for motion right away. Having a robotically-balanced knee before you take your first steps with the new prosthesis will allow you to leave the hospital sooner(2), recover faster(2), and potentially improve your long-term outcome(3).
How does the Mako system work?
The robot “knows” precisely your anatomy after the surgeon registers anatomical reference points into the robotic system. In this way, the CT scan of your leg and knee “comes alive” and instruments placed near your anatomy can be seen and moved in real time on a computer screen. In this way, the computer and your surgeon together will generate a surgical plan that is very specific to your unique anatomy. This plan can be modified at the time of surgery to fine-tune implant alignment based on soft tissue balance, and to ensure correction of contractures (deformities or crookedness).
How does the Mako system compare with conventional knee replacement?
Long-term outcomes of robotic-arm assisted knee replacements are only now becoming available due to the novelty of the technology. However, there is good evidence they will improve the alignment and balancing of the implant, with stiffness or looseness among the leading causes of revision of knee replacements performed with manual techniques(4). Evidence suggests that nearly 1 in 3 knee replacements done with manual techniques have evidence of subtle malalignment(5). While it remains a topic of debate as to whether subtle malalignment leads to worse outcomes, why take a chance when robotic technology can more perfectly align the joint?
Before you get to surgery, the robotic system will have predicted the size and near-optimized position of the implant. Also, the bone resection, balancing, and adjustments require less mental and physical exertion on the part of the surgeon, allowing him to spend more energy on achieving a perfect result. In patients undergoing robotic assisted surgery, early postoperative recovery causes less pain and need for opioid medications(6), less blood loss, as well as a shorter hospital stay which is uncommonly longer than 1 day(2), allowing patients to leave the facility and recover more easily in the comfort of their own home. Lastly, these robotic surgeries result in better physical function and total satisfaction up to two years following surgery(7).
What are the take home points about considering Mako robotic-arm assisted total knee replacement?
- More precise and accurate surgery
- Better alignment of the implant
- Safer, with less soft tissue injury
- Faster recovery
- Less pain and blood loss
- Better patient satisfaction
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- Kayani B, Konan S, Pietrzak JRT, Haddad FS. Iatrogenic Bone and Soft Tissue Trauma in Robotic-Arm Assisted Total Knee Arthroplasty Compared With Conventional Jig-Based Total Knee Arthroplasty: A Prospective Cohort Study and Validation of a New Classification System. J Arthroplasty. 2018 Aug;33(8):2496-2501. doi: 10.1016/j.arth.2018.03.042. Epub 2018 Mar 27. PMID: 29699827.
- Kayani B, Konan S, Tahmassebi J, Pietrzak JRT, Haddad FS. Robotic-arm assisted total knee arthroplasty is associated with improved early functional recovery and reduced time to hospital discharge compared with conventional jig-based total knee arthroplasty: a prospective cohort study. Bone Joint J. 2018 Jul;100-B(7):930-937. doi: 10.1302/0301-620X.100B7.BJJ-2017-1449.R1. PMID: 29954217; PMCID: PMC6413767.
- Khlopas A, Sodhi N, Sultan AA, Chughtai M, Molloy RM, Mont MA. Robotic Arm-Assisted Total Knee Arthroplasty. J Arthroplasty. 2018 Jul;33(7):2002-2006. doi: 10.1016/j.arth.2018.01.060. Epub 2018 Feb 5. PMID: 29506926.
- Postler A, Lützner C, Beyer F, Tille E, Lützner J. Analysis of Total Knee Arthroplasty revision causes. BMC Musculoskelet Disord. 2018 Feb 14;19(1):55. doi: 10.1186/s12891-018-1977-y. PMID: 29444666; PMCID: PMC5813428.
- Mason JB, Fehring TK, Estok R, Banel D, Fahrbach K. Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. J Arthroplasty. 2007 Dec;22(8):1097-106. doi: 10.1016/j.arth.2007.08.001. PMID: 18078876.
- Bhimani SJ, Bhimani R, Smith A, Eccles C, Smith L, Malkani A. Robotic-assisted total knee arthroplasty demonstrates decreased postoperative pain and opioid usage compared to conventional total knee arthroplasty. Bone Jt Open. 2020 Oct 27;1(2):8-12. doi: 10.1302/2633-1462.12.BJO-2019-0004.R1. PMID: 33215101; PMCID: PMC7659658.
- Marchand RC, Sodhi N, Khlopas A, Sultan AA, Harwin SF, Malkani AL, Mont MA. Patient Satisfaction Outcomes after Robotic Arm-Assisted Total Knee Arthroplasty: A Short-Term Evaluation. J Knee Surg. 2017 Nov;30(9):849-853. doi: 10.1055/s-0037-1607450. Epub 2017 Oct 13. PMID: 29029352.
At a Glance
Dr. Thomas Obermeyer
- 15+ years of training and experience treating complex shoulder and sports medicine conditions
- Expert subspecialized and board-certified orthopedic care
- Award-winning outstanding patient satisfaction scores
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