Surgeon explains how he uses the MAKO Robot for knee replacement

Dr. Ronald Hillock 2Orthopedic Surgeon Dr. Ronald Hillock Explains the MAKO Robot (Blog: Voyager Med)

I am frequently asked by patients and their families about “Laser Surgery” and “Robot Surgery” as if it is magic that can work miracles.  Sadly this is not the case.  So then what are the benefits of robotic surgery for partial knee replacement?

Let’s consider one of the biggest challenges with partial knee replacement; consistency. Joint replacement surgery is technically demanding and requires a highly-skilled surgeon.  The implant must be aligned accurately and secured precisely or the patient’s function will be suboptimal.

The key to success in partial knee replacement, or in any surgery for that matter, is performing it repeatedly with reproducible results.  The more accurate the plan, the more accurate the action which leads to more consistent outcomes.  The robot allows me as a surgeon to perform precise, accurate bone shaping for optimal implant positioning and alignment. And the major benefit of using a robot for orthopedic surgery is that it helps the surgeon complete tasks repeatedly with more accuracy.

The robot is a high tech tool, but like any other knife or retractor, it is just another instrument to aid the in the delivery of treatment. And the decision to go ahead with knee replacement surgery, the actual surgical procedure and the patient’s recovery are all primarily based on the skill and judgment of the surgeon.

Let’s take a step back and consider what are the advantages of a partial knee replacement.  We divide the knee into three compartments, they are: the patellofemoral or kneecap compartment, the medial or inside compartment and the lateral or outside compartment.  If arthritic changes or cartilage damage is limited to a single compartment of the knee, then ideally it would be best to replace only that one area.  The normal areas of the joint are retained and function is then closer to a normal knee.  The ligaments are left in their natural position and the knee motion feels more natural once the patient has recovered.

MAKOplasty Robotic Arm - Orthopedic Surgeon - Dr. Ronald Hillock - VoyagerMed

One of the other major challenges with partial knee replacement is the method by which the bone has been cut and contoured during traditional surgery.  The surgeon must take great care to align the implants in a manner that allows for smooth gliding motion.  If the implants are not aligned properly then they will wear too soon.  Early wear leads to early failure.  Historically the best longevity that could be expected from a partial knee replacement, or uni-knee replacement, was about 5 to 7 years of smooth pain free function.

Robotic surgery has now arrived in Las Vegas for Joint Replacement. The MAKO robot allows us to more accurately and consistently perform complex reconstructions.  The MAKO Robot is not an android like R2D2, but rather a robotic arm with a precise cutting tool attached. Complex planning goes into the process that leads to each surgery with the MAKO system. The MAKO robot only cuts what the surgeon wishes to be cut, nothing more or less.

Here is how it works. Once we have exhausted the non-operative options for the management of your arthritis and you have been found to be a candidate for partial knee replacement, then we begin the process of planning the surgery.

This is how a MAKOplasty is preformed:

  1. After consultation and evaluation the patient is advised that partial knee replacement is an option to treat their arthritis.  If this recommendation is accepted by the patient then we start the planning steps of the surgery.
  1. To obtain a more precise evaluation of the bone shape and contours a CT scan is completed of the limb to be operated upon. The images are taken from the hip to the ankle.  This helps determine the limb’s alignment, shape and size.
  1. The CT scan is then digitally transmitted to a software program that then takes the information and creates a 3 dimensional model of the bones of the limb, like a blue print in digital format.  The model is then used to determine the ideal alignment and implant size to achieve the desired correction.
  1. The plan is then used to program the robot so accurate and precise bone cuts can be completed to achieve the planned implant positioning.
  1. The plan is transmitted electronically to the robot and stored.  Prior to the surgery the plan is reviewed and adjusted by the surgeon to further customize the treatment for the individual patient.
  1. On the day of the surgery the robot must be register to the patient, a sort of surgical GPS alignment.  This is done through the attachment of Infrared reflective markers to the bones of the thigh and shin (femur and tibia).
  1. Once calibrated and registered the robot then can find the patient in space and is then used to make the surgeon can make the planned bone changes or cuts.  The robot only cuts what the surgeon allows; the surgeon can only cut according to the planned position and alignment.  The precision of the cuts is beyond what any human could achieve without the robotic arm aiding the process.
  1. The implants are then placed and secured with bone cement.

My patient’s success with MAKOplasty to date has been nothing short of amazing.  Patients are returning to activity in a fraction of the time traditional joint replacement would have required.  Their function is as good as I could have hoped.  I have seen a cocktail waitress return to working 10-hour days, 40-hour weeks, walking her entire shift, full time at 4 weeks after surgery.  I have seen a man return to the driving range at 3 weeks post surgery, playing 18 holes 5 weeks after surgery.

If you have knee pain or have been told you might need knee replacement, please contact me for an evaluation and review of your medical condition.

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