Robotic Arm Assisted Total Knee Replacement Surgery

Drs Baird, Fassina and Munt were integral in introducing Mako Robotic Arm Assisted Joint Replacement Surgery to South Australia. This innovative and accurate option offers patient specific management of arthritic knee and hip conditions. Robotic Assisted Joint Replacement Surgery has been used throughout the world over the last 10 years with excellent patient outcomes.

It is with great excitement that in 2017 the launch of the total knee application for the Mako robotic arm occurred on a world wide scale and our surgeons at AHKC were amongst the first to be able to offer this innovative solutions to their patients.

what is robotic arm assisted total knee replacement surgery?

Robotic arm assisted total knee replacement surgery is a patient specific procedure for those suffering from painful knee arthritis. It is performed using the same surgeon controlled Robotic arm technology that Drs Fassina, Munt and Baird have been utilising for partial knee and total hip replacement surgery since 2015. Globally this system has assisted with over 100 000 robotic arm assisted hip and knee procedures.

This innovative surgical treatment now also allows our surgeons to achieve consistently reproducible precision in total knee replacement surgery.

how does it work?

All people have unique anatomy (the way your bones, joints, muscle and soft tissues are made). Mako Robotic arm assisted surgery references your unique anatomy in order to plan and implement a patient specific knee replacement.

Enhanced Patient Specific Planning:

Before surgery a CT scan is performed on your knee joint. To help understand your unique alignment, your hip and ankle are also scanned. The information obtained from this CT scan allows for a 3-Dimensional model of your knee joint to be created. This allows the surgeon to pre-operatively plan the size and orientation of your knee replacement.

Functional Implant Positioning

During surgery your knee joint is placed through a range of movement and the overall alignment, ligament tension and the way the knee moves is assessed. Precise movements of the knee replacement components can then be made to best match your anatomy. The robotic software provides real time information to allow accurate implant positioning. This occurs before bone preparation occurs.

Robotic Arm Assisted Bone Preparation

The Mako Total knee application does not require cutting blocks, sizing guides or intramedullary rods for bone preparation. The surgeon controlled robotic arm creates a virtual boundary to assist with the removal of only the damaged bone and cartilage while protecting to soft tissues such as the PCL and the blood vessels and nerves at the back of the knee. It provides the surgeon with tactile feedback, 3-D visualisation and auditory guidance to facilitate precise bone removal.

Finally once all components have been implanted, a summary screen allows your surgeon to confirm that your results are accurate and according to the pre-operative plan.

proven stryker implants

The Mako total Knee system uses the Triathlon Total knee replacement. This prosthesis is manufactured by Stryker, one of the worlds largest orthopaedic companies. The triathlon has over 10 years of proven performance in both Australia and New Zealand. The 10 year survival rate is one of the best seen being 96.6% on the Australian joint replacement registry and 97.4% on the New Zealand Joint replacement registry after 10 years. (1,2)

clinical success

Mako robotic-arm assisted Total Knee Arthroplasty has the potential to increase the accuracy of TKA bone cuts and component placement to plan, even for an experienced user of manual instrumentation who is new to robotic technology.(4)

Accuracy

Comparing the means for all six matched pairs (n=6), RATKA final bone cuts and final component positions were as or more accurate to plan than MTKA control, for 11/12 and 5/5 measurements, respectively, and all (17/17) measurements when comparing the last three matched pairs (n=3).On average, RATKA (n=6) final bone cuts and final component positions were 4.2 and 3.2 times more accurate to plan than the MTKA control, respectively.

Precision

Comparing the standard deviations for all six matched pairs (n=6), RATKA final bone resections and final component positons were as or more precise to plan than the MTKA control on all femoral and tibial V/V measurements, and all measurements when comparing the last three matched pairs (n=3).

On average, RATKA (n=6) final bone cuts and final component positions were 5.0 and 3.1 times more precise to plan than the MTKA control, respectively.

soft tissue protection

Adequate soft tissue protection is achieved using Mako robotic-arm assisted surgery for Total Knee Arthroplasty.  It offers protection of the medial collateral ligament (MCL), lateral collateral ligament (LCL), posterior cruciate ligament (PCL), and patellar ligament with no visible evidence of disruption of any of the ligaments. Tibial subluxation was not required for tibial cutting, which may reduce ligament stretching. All cases were left with a bone island on the tibial plateau, which protected the PCL. In addition, patella eversion was not required for visualization.(5)

  1. Australian Orthopaedic Association National Joint Replacement Registry. Annual Report. Adelaide: AOA; 2016
  2. New Zealand Orthopaedic Association (NZOA). The New Zealand Joint Registry, Fifteen Year Report, January 1999 to December 2015.
  3. Gomez-Barrena E at al. Clin Orthop Relat Res 2010; 468:1214-1220
  4. Robotic-Arm Assisted Total Knee Arthroplasty Demonstrated Accuracy To Plan Even During Learning Phase Hampp E., Scholl L., Prieto M., Chang T., Abbasi A., Bhowmik-Stoker M., Otto J., Jacofsky D.J., Mont M.A. European Knee Society Arthroplasty Congress 2017, London, UK, 20 & 21 April 2017
  5. Robotic-Arm Assisted Total Knee Arthroplasty Demonstrated Soft Tissue Protection Hampp E., Bhowmik-Stoker M., Scholl L., Otto J., Jacofsky D.J., Mont M.A. European Knee Society Arthroplasty Congress 2017, London, UK, 20 & 21 April 2017