Commentary on robotic assisted TKA
Moderator(s): Christopher Wheeler
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11/1/2018 at 10:01:56 PM GMT
Posts: 3
Commentary on robotic assisted TKA
The last forum post I wrote about biologics in orthopedics.  Now I have had my first experience with robotic total joints.  I have been in orthopedics for 21 years.  Initially I did a lot of total knee and hip surgeries with orthopods who were generalists - not fellowship trained total joint surgeons.  These docs relied on feel, their knowledge of orthopedics and experience to complete the total joint surgery.
Two weeks ago I worked with one of our younger surgeons and completed a total knee using the MAKO technology.  This was a first for me.   For those who don't know MAKO Robotic-arm Assisted Sugery uses a robotic arm to assist the surgeon in making exact pre-planned cuts to remove the cartilage and minimal bone.
Initially a patient who is undergoing total knee surgery using the MAKO system, has a pre-operative CT scan to generat e a 3-D model  of the patients anatomy.  Then intra-operatively , the surgeon uses pin point technology to map out exact cuts the MAKO will assist in making.  This requires mapping out multpile sites on the femur and tibia that then compares that to the pre-op CT scan image.  The surgeon then uses the MAKO robotic arm to make precise cuts within planned boundaries developed by the preop and intraop mapping of the joint.  After the cuts a Triathlon Total  Joint implant is used.
I got to thinking after performing two of these MAKO assisted surgeries.  I wondered if the advacement in technology was better then the "feel and expertise" of the surgeon.  I know studies and debates are there that show that this type of technology improves patient outcomes, decreases need for revision and improves safety.  But I wonder what surgeons and providers who have performed these surgeries for years without this technology feel.  I know I might open pandora's box but are we relying too much on technology and not enough on "expertise and skill of the surgeon."  ?


11/1/2018 at 11:07:12 PM GMT
Posts: 5
Chris - we are currently doing all of our non-nickel allergy patients with the MAKO robot. I work with a very high volume surgeon (100 joints a month) and I can tell you there is a big difference in recovery. My surgeon went into the use of MAKO planning on doing one a week for "advertising purposes", but immediately switching because of the ability to make smaller adjustments. If you use the data to balance the knee in flexion and extension, then patients will recover quicker and theoretically, a well balanced knee will last longer. There is a learning curve, as there is with any new procedure. Technological advances in medicine continue to amaze me.


8/20/2019 at 12:32:46 AM GMT
Posts: 1
I have been in ortho 10 years. There is certainly a difference. We have been using MAKO nearly 2 years for all joints. MAKO used by a good surgeon absolutely yields better results. Also very challenging knees can be done in pretty much the same amount of time as a straightforward knee with the same radiographic result!