Andrew Wassef, MD

MemorialCare Joint Replacement Center at Long Beach Medical Center
Long Beach, CA
 

How important is precision and efficiency in your OR? For me it is of utmost importance and led me to adopt the use of Mako SmartRobotics™ in my total joint practice. My early experience began with the Mako Total Hip application about five years ago. I quickly noticed I was now using relatively smaller cup sizes. I routinely measured the femoral head with a caliper, and with the robotic-arm assisted total hips, I was consistently using smaller cups in relation to the measured head when compared to my conventional total hip replacements. Domb, et al. published findings indicating that acetabular bone preservation is another potential benefit of Mako Total Hips.¹ Prior to Mako, I often used screws during acetabular cup placement as I was not as confident with my fixation. After I began to use Mako, I found myself using screws a minority of the time and found myself often reaming line to line in younger patients with good bone stock.

The AccuStop™ haptic technology allows me to ream the bone that I’ve planned while receiving visual, audible and haptic feedback during reaming and impaction using the robotic arm. The abundance of information available to me for preoperative planning with the CT scan was also transformational for my understanding of each patient’s unique anatomy. This deeper preoperative understanding coupled with the precision of the robotic arm for preparation and impaction of the cup has helped me achieve reproducible solid fixation even in cases involving complex anatomy. I have had the ability to achieve equal leg lengths and a reproducible hip center with precision for my patients.² In addition, the efficiency in my OR with single stage reaming and the ability to only open instruments and trials that are necessary has greatly cut down on operative time and turnover.

My experience using Mako SmartRobotics™ for partial and total knee replacements closely mirrors my experience with the hip application. The ability to customize my surgical plan based on the knowledge obtained from 3D imaging with the CT scan is priceless. This amount of information is unobtainable from just plain radiographs and in my opinion, helps me form a better surgical plan. The ability to factor in multiple attributes when planning in 3D, such as setting tibial slope, varus/valgus alignment, and maintaining the posterior condylar offset, allows me to create my desired flexion and extension gap and to enhance both the surgical procedure and my patients’ outcomes. On average my tibial cut is now significantly less than it was with conventional cutting jigs as I am taking only the bone that I planned to create a well-balanced total or partial knee replacement.

The AccuStop™ haptic boundaries help decrease the excursion of the saw, and studies have shown this results in less soft tissue damage for total knee replacements.^3,4 Our hospital system has observed decreased length of stay for patients who have undergone robotic-arm assisted total knee replacement. We have also noticed a significant decrease in the required inventory per case as we are able to predict the sizes of both the femoral and tibial components before starting the procedure.⁵ We now use disposable trial components which has allowed us to reduce the number of trays per procedure. This helps cut down on the overall cost of the case and decrease the burden on our Sterile Processing Department. The incorporation of Mako SmartRobotics™ in my practice has been fundamental in enhancing my outcomes and giving me a new level of excitement regarding the future of total joint replacement surgery.

Clint Wooten, MD

Mountain Orthopaedics, Bountiful, UT

Mako Technology has added so much to my practice. One of the more exciting advantages that I have come to truly appreciate is the ability to “know more” based on obtaining a preoperative CT scan. This feature has allowed me to pre-plan my hips and knees. I am able to predetermine the anticipated level of bone resection and soft tissue modification which helps me to “cut less”.

In my experience, “cut less” means something different for each application.  With the total knee application, Mako’s Accustop™ haptic technology has been shown to help protect the patient’s soft tissues.⁴ This technology allows for a higher level of precision and accuracy to plan, which has also been shown to allow for less pain after surgery and a quicker recovery.^5,6 A quicker recovery is top of the wish list for both the patient and the surgeon. With preservation of soft tissues and enhanced bone resection I have seen quicker recovery, less pain and early return on range of motion in my practice.⁶ I have also found Mako procedures require fewer soft tissue releases.⁴ Because I can provide a better individualized 3D implant position using Mako Technology, patients can walk more naturally, sooner.⁶

For me, the Mako Total Hip Application has helped me preserve healthy bone by allowing me to “cut less”. Pre-op planning using Mako’s CT-based planning helps me execute a more accurate placement of the cup.⁷ The CT scan also has allowed for me to improve my efficiency in the OR by using haptic guidance to single ream. I have found that single ream technique allows for greater bone preservation and improved initial fixation.¹ Mako Total Hip has also allowed me to use a smaller cup than with manual preparation.¹

In my early experience with the Direct Anterior Approach and Mako, I always used fluoroscopy as a way to verify my pre-op plan. I have now been able to remove that as part of my workflow which has enhanced our efficiencies and limited the traffic in and out of the OR.

I am a true believer in the concept of using Mako Technology to help me “cut less”. My ability to plan my surgery ahead of time and use the robotic arm to execute my plan has made joint replacement surgery more predictable in my hands and more importantly has helped me enhance outcomes for my patients.^3,8