MAKO Robot-Assisted Total Knee Replacement
Total Knee Replacement unlike Partial Knee Replacement is a surgical procedure that involves replacement of the entire knee joint. When the articular cartilage is worn more extensively and involves more than one compartment Partial Knee Replacement is not recommended and all diseased surfaces are replaced. Associate Professor Harvie may recommend a Total Knee Replacement if your arthritis is present throughout your knee rather than localized to only one compartment.
The purpose of Total Knee Replacement is to significant reduce the symptoms of arthritis. These include:
- A rapid and significant reduction of knee pain.
- Recovery of mobility – your knee will move more smoothly again and will function more normally.
- Improvement in quality of life – Everyday activities such as walking and bending your knee will no longer be limited by pain and restricted mobility.
What does MAKO Robot-Assisted Technology actually do?
Associate Professor Harvie currently performs all Total Knee Replacements using MAKO Robot-Assisted Technology. This system utilises pre-operative CT scans to form three-dimensional model of your knee. During the operation the surgeon collects information about the soft tissue balance of the knee. This information is combined with the CT scan and allows the surgeon to perform a virtual operation on the computer.
Once the optimum position has been ascertained for the femoral (thigh bone) component and the tibial (leg bone) component, the robotic arm is then used to precisely cut the bone ends and allow exact placement of the implants. This technology has been utilised in the United States since 2006. It was introduced into Australia in 2015. The indications for Total Knee Replacement are not changed by the use of the robot. Accuracy of implantation has been shown to be improved whilst personalising the positon of components to the patient’s own soft tissues. This means less ‘cutting’ of tissue, less post-operative pain and faster recovery.
Why use MAKO Robot-Assisted Technology?
A multitude of factors affect the patient outcome after Total Knee Replacement. The only two factors that I as a surgeon can control are the choice of implant and the precision with which I implant the Total Knee Replacement components. I use the Stryker Triathlon Total Knee Replacement System for all of my Total Knee Replacements. This system is the most commonly used Total Knee Replacement System in Australia and amongst the best performing on many National Joint Registries. Huge volumes of research data exists supporting its position as one of the best Total Knee Replacements in the World.
Surgeons are notoriously poor at assessing the accuracy of their bone cuts during Total Knee Replacement. Bone cuts determine the alignment and function of the implants and poor alignment can result in early implant failure. The MAKO Robotic Arm allows me to precisely and reproducibly place implants exactly where I want with a minimal error every time. The Robot also assists me in balancing the soft tissues around the knee throughout the full range of motion preventing overloading of the other parts of the knee.
Early data which has now been collected by the Australian National Joint Registry already shows at 2 years post-surgery that Triathlon Total Knee Replacements implanted using MAKO Robot-Assisted technology have a lower revision rate than the same components implanted using any other technique.
Evidence also exists to show patients undergoing MAKO Robot-Assisted Total Knee Replacement:
- Reduced soft tissue dissection and injury
- Experience less postoperative pain
- Less post-operative blood loss
- Have decreased opiate analgesia requirements
- Rehabilitate quicker
- Less post-operative stiffness
- Have increased range of movement
- Have a shorter hospital stay
- Higher patient satisfaction scores when compared to other Total Knee Replacement systems.
Will I have much pain after my MAKO Robot-Assisted Total Knee Replacement?
Traditionally Total Knee Replacement has been noted as being a ‘painful procedure’. Anesthetists who specialise in pain control have made major advances in recent years in regard to eliminating or at least substantially reducing discomfort from surgery. A ‘multimodal’ (multiple simultaneously combined techniques) will be utilised to turn off pain pathways and to then keep you comfortable during your recovery.
With the use of MAKO Robot-Assisted technology evidence exists and my personal experience is that patients experience less pain and require less post-operative pain medication than with other technologies I have utilised. The reason for this is very simple. The MAKO technology results in less soft tissue ‘cutting’ which translates to less pain.
You may still experience some mild discomfort but our patients can generally stand and walk within hours of surgery and usually report than any discomfort is very manageable and that the procedure is very well tolerated.
How difficult is rehabilitation?
I explain to patients that there are two major components to their Total Knee Replacement journey. Firstly there is their surgery which is carried out using MAKO Robot-Assisted Technology and is my responsibility. Secondly there is rehabilitation/mobilization which although directed by myself and physiotherapy colleagues has to be driven by and is the responsibility of the patient.
My feeling is that the patient-driven rehabilitation is the MOST important factor that determines the functional outcome of a patient’s Total Knee Replacement. You will see that it is my role to encourage, nag and on occasion even irritate patients with my constant reminders of the need to mobilise and rehabilitate.
This process starts the day after the surgery and is an ongoing process at least for the first 6 months.
What happens if I struggle with my rehabilitation?
The most important aspect of rehabilitation is pre-operative education by myself and my team so you know what to expect. I review patients at 2 and 6 weeks post surgery. If a patient has difficulty performing their exercises and range of movement is being lost this is usually identified at the 6-week review.
Historically this has been managed by a ‘manipulation under anaesthetic’ where the patient is anaesthetised and the stiff knee manipulated to break down existing scar tissue and improve movement. This needs to be done around 6 weeks post-surgery otherwise the scar tissue becomes too strong to break. This can be uncomfortable and the patient essentially recommences their rehabilitation. On the exceptionally rare occasion that I have encountered this issue, I adopt a different approach, using keyhole knee surgery to release the scar tissue surgically combined with a Knee Radiofrequency Ablation for post-procedure pain relief.
I have seen good results in adopting this approach. All said PREVENTION of stiffness vital. I have published research on this issue and I will nag (affectionately) patients to avoid this complication!
What are the Risks and Complications?
As with any major surgery, there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery takes place. Complications can be medical (general) or local complications specific to the Knee. Medical complications include those of the anesthetic and your general well being. Almost any medical condition can occur so this list is not complete.
Complications include:
- Allergic reactions to medications
- Blood loss requiring transfusion with its low risk of disease transmission
- Heart attacks, strokes, kidney failure, pneumonia, bladder infections
- Complications from nerve blocks such as infection or nerve damage
- Serious medical problems can lead to ongoing health concerns, prolonged hospitalization or rarely death
Infection can occur with any operation. In the hip this can be superficial or deep. Infection rates are approximately 1%. If it occurs, it can be treated with antibiotics but may require further surgery. Very rarely your hip may need to be removed to eradicate infection.
These can form in the calf muscles and can travel to the lung (Pulmonary embolism). These can occasionally be serious and even life threatening. If you get calf pain or shortness of breath at any stage, you should notify your surgeon.
Ideally, your knee should bend beyond 115 degrees but on occasion, may not bend as well as expected. Sometimes manipulations are required. This means going to the operating room where the knee is bent for you while under anesthetic.
The plastic liner eventually wears out over time, usually over 10 to 15 years, and may need to be changed. Alternatively the remainder of your own knee may wear out requiring revision to a Total Knee Replacement.
Fractures or breaks can occur during surgery or afterwards if you fall. To repair these, you may require surgery.
The operation will always cut some skin nerves, so you will inevitably have some numbness around the wound. This does not affect the function of your joint. You can also get some aching around the scar. Vitamin E cream and massaging can help reduce this. Occasionally, you can get reactions to the sutures or a wound breakdown that may require antibiotics or rarely, further surgery.
The knee may look different than it was because it is put into the correct alignment to allow proper function.
Your leg will be restored to it’s original length as the deformity caused by wearing of the knee has been corrected.
There are a number of ligaments surrounding the knee. These ligaments can be torn during surgery or break or stretch out any time afterwards. Surgery may be required to correct this problem. This problem is minimised with Robotic Assistance.
Rarely these can be damaged at the time of surgery. If recognized they are repaired but a second operation may be required. Nerve damage can cause a loss of feeling or movement below the knee and can be permanent.
Discuss your concerns thoroughly with your Orthopaedic Surgeon prior to surgery.
Summary
Surgery is not a pleasant prospect for anyone, but for some people with arthritis, it could mean the difference between leading a normal life or putting up with a debilitating condition. Surgery can be regarded as part of your treatment plan it may help to restore function to your damaged joints as well as relieve pain. Surgery is only offered once non-operative treatment has failed. It is an important decision to make and ultimately it is an informed decision between you, your surgeon, family and GP. Although most people are extremely happy with their new knee, complications can occur and you must be aware of these prior to making a decision. If you are undecided, it is best to wait until you are sure this is the procedure for you.