Robotic Assisted Total Knee Arthroplasty
During the procedure, real-time visual, tactile, and auditory feedback are given to the surgeon, which ideally reduces the potential for complications. Robotic-assisted surgery has been around since the 1980s, in recent years significant improvements have been made particularly in joint replacement surgery. The use of robotics in total knee replacements is increasing amongst orthopedic surgeons. Depending on the surgeon’s preference the robotic assistance used varies. Each robot is linked to a specific implant company. Regardless of the company, robotic assistance usually requires the placement of sensors either within the midline knee incision or at another point along the extremity outside the incision. In the operating room the procedure is performed by the surgeon with specific information about alignment determined by the robotic arm. The robotic feedback assists the surgeon in determining his bone cuts and correct implant sizing and position.
Total Knee Arthroplasty
Total knee arthroplasty also known as a knee replacement is very common procedure performed by orthopedic surgeons worldwide. The goal of a total knee replacement is to restore function and alleviate pain when nonoperative treatments have been unsuccessful. Surgery involves removing portions of the femur (thigh bone), tibia (shin), and patella (kneecap) and placing appropriately sized components to restore the knee joint. Usually there is a single incision made along the anterior aspect of the knee. The procedure can take approximately 1 – 2 hours and patients commonly are able to weight bear on the extremity the day of surgery. Recent technological advancements have allowed incorporation of robotic feedback in the operating room to assist surgeons in implant placement.
Knee osteoarthritis is a common condition that is due to degenerative changes of the articular cartilage. The disease is associated with “wear and tear” of the knee joint over multiple years and can occur at an accelerated pace following trauma or ligament laxity. Osteoarthritis of the knee is fairly common in elderly patients. A few risk factors that attribute to the development of osteoarthritis are female gender, obesity, muscle weakness, trauma, and occupational demands.
Multiple entities exist to help alleviate the pain from osteoarthritis and restore adequate function. Nonoperative modalities include physical therapy, anti-inflammatory medications, knee braces, as well as corticosteroid or gel injections. If these treatments are unsuccessful and appropriate function is not able to be achieved, surgical intervention with a Total Knee Arthroplasty may be considered.
The Stryker MAKOplasty® Robotic Assisted Total Knee Arthroplasty is an example of the latest surgical developments in knee replacement surgery. The use MAKOplasty in knee replacement dates back to 2006 and was FDA approved in 2015. Greater than 23,000 MAKOplasty procedures have been performed and the number continues to increase. Mako uses a CT-based software to help develop a surgical plan. A CT scan is obtained prior to surgery. The CT scan is integrated with the Mako software which develops a 3D model of the patient’s knee. This software allows the surgeon to make adjustment and accurately gauge implant size and position prior to the day of surgery. Mako also gives the surgeon the ability to make real time changes and visualize subtle changes during the surgery in the software. Unique to MAKOplasty is the Mako’s AccuStop™ technology which gives haptic feedback to the surgeon via a guiding robotic arm saw and theoretically cuts less bone due to the precision of the system. MAKO currently only works with the Stryker Triathlon Knee system.