How Mako robotic surgery is benefitting orthopaedic surgery

One area of research has been the introduction and evaluation of Mako robotic surgery for the hip and knee. Several studies have collected strong data on Mako now, including a randomised study which showed a lower inflammatory response and less pain for knee surgery patients. These fundamental studies are important landmarks in Mako robotic surgery research^{1, 2}.

Professor Fares Haddad is a pioneer in orthopaedic technology for hip and knee joints and is the Orthopaedics Medical Director at HCA UK, here he discusses how the Mako technology benefits patients.

The Mako robot

Mako is a surgical robot designed to aid surgeons with joint replacement surgery. It is formed of a robotic arm with computer-based technology, providing individualisation and customisation of joint replacements. Before surgery, Mako creates a cross-sectional 3D haptic model of the joint based on a CT scan of the patient’s joint. This details the anatomy and implant size needed before the operation begins. When exposing the joint in the operating theatre, a ‘live’ connection is created between the robotic arm and the patient. Mako also models the motion of the joint to make sure the proposed motion is optimal for the patient.

“Mako allows for clear planning and surgical decision-making that wasn't possible before. Adjusting by half a degree or adjusting by half a millimetre isn't something that the human eye can do easily. But you can do it on a computer – widening the scope of what a surgeon can do and allowing us to effectively create a bespoke joint replacement for every patient,” explains Professor Haddad.

The history, examination, and imaging dictate the specific needs of each patient, whether they are suitable for a partial or total joint replacement. Mako is connecting technology with surgical decision making. “You can't take the surgeon out of the equation, but robotic arm technology inevitably improves every surgeon,” states Professor Haddad.

The benefit to patients

Even before the collection of formal data and completion of the studies, there were anecdotal reports from both staff and patients on improvements in pain relief and in mobility. Using Mako for joint replacements, physios and nurses noticed a shift in how quickly patients recovered.

The precision of this technique is due to the accuracy of the robotic arm; Bone cuts can only be made to preordained boundaries determined by the surgeon. This leads to less soft tissue and bone damage for patients because the technology prevents cutting beyond the edge of the bone. Less damage means less pain for patients and quicker recoveries. Patients have returned to a higher level of activity earlier than with traditional surgical techniques as there is less pain, less stiffness, and the joint feels more natural.

Sharing knowledge with other consultants

“The biggest danger is applying the technology without thinking about it and it is important that surgeons appreciate the surgical decision making that is at the heart of this. That's going to be one of the biggest challenges for the future,” says Professor Haddad.

HCA UK recommend surgeons attend a course to learn from someone who's been doing it for a while, because there’s nothing like one-on-one interaction for people to grasp the nuances of how best to use the technology.

“This isn't about switching on a machine and saying ‘go’ and the surgery is automated. It is about the surgeon making decisions in real-time that are right for that patient, making those decisions on a predefined 3D-plan and being able to execute them with greater accuracy than ever before,” says Professor Haddad.

Many of our patients have had knee and hip replacements elsewhere and we redo those replacements when they fail. Mako plans to reduce that revision burden, and to correct those cases that are going to need to be redone. Research is also taking Mako into the revision field – helping a wider range of patients.

There has been exponential growth in Mako usage, with other systems coming onto the market. Mako has proven its value in the knee for partial and full knee replacements and in the hip, and its likely to go from the knee and the hip to the shoulder, then to the spine and ankle.

Professor Haddad affirms “We want the ceiling to be higher for everyone. We don't want people to only be pain free, we want them active. We want them able to enjoy every aspect of their life, including sport, and we want them to do that for a very long time.”

^{1. Kayani B, Tahmassebi J, Ayuob A, Konan S, Oussedik S, Haddad FS.
A prospective randomized controlled trial comparing the systemic inflammatory response in conventional jig-based total knee arthroplasty versus robotic-arm assisted total knee arthroplasty.
Bone Joint J. 2021 Jan;103-B(1):113-122.}

^{2. Fontalis A, Kayani B, Asokan A, Haddad IC, Tahmassebi J, Konan S, Oussedik S, Haddad FS.
Inflammatory Response in Robotic-Arm-Assisted Versus Conventional Jig-Based TKA and the Correlation with Early Functional Outcomes: Results of a Prospective Randomized Controlled Trial.
J Bone Joint Surg Am. 2022 Nov 2;104(21):1905-1914.}