Robotic Joint Replacement
Joint replacement surgery is a procedure with excellent success rates. A joint replacement can change the lives of patients previously crippled with pain and poor mobility as a result of arthritis. The surgeon cuts and prepares the bone and then places the new artificial joint (prosthesis). Our aim is to place the prosthesis as accurately and precisely as possible. Surgical robotics helps us plan and execute the operation with increased precision and accuracy.
The most widely used Robot in Australia is the MAKO robotic platform. This highly advanced robotic technology transforms the way joint replacement surgery is performed, enabling surgeons to have a more predictable surgical experience with increased accuracy.[i],[ii],[iii],[iv]
With Mako, surgeons can provide each patient with a personalized surgical experience based on their specific diagnosis and anatomy. Using a virtual 3D model, Mako allows surgeons to create each patient’s surgical plan pre-operatively before entering the operating room. During surgery, we can validate that plan and make any necessary adjustments while guiding the robotic-arm to execute that plan. It’s exciting to be able to offer this transformative technology across the joint replacement service line to perform total knee, total hip and partial knee replacements.
The MAKO robot has been used in the USA for over a decade and has been available in Australia since 2015. Dr Damian Smith was instrumental in bringing this technology to Canberra and he performed the first robotic joint replacement in Canberra in 2017.
Prior to the surgery the patient has a CT scan of their arthritic joint. From this a virtual 3D model of the patient’s joint is produced which allows the surgeon to plan the size and position of the implants. During the operation, trackers are used to communicate with the robotic sensor and tell it where the patient’s leg is in space. The patient’s joint anatomy is then mapped and registered to ensure it matches the CT scan and pre-operative plan. The plan is then checked and modelled and any adjustments to account for the patient’s soft tissues and ligaments can be made. The surgeon then operates the robotic arm and cuts and prepares the bone and then uses the robotic arm to place the prosthesis with increased precision and accuracy. We hope that improved accuracy will lead to better outcomes for patients.
MAKO ROBOTIC ARM ASISTED PARTIAL KNEE REPLACEMENT
The Mako Partial Knee application is a treatment option designed to relieve the pain caused by joint degeneration due to osteoarthritis that has not yet progressed to all three compartments of the knee. Following the personalized pre-operative plan, the surgeon guides the robotic-arm during bone preparation to execute the pre-determined surgical plan and position the implant. By selectively targeting only the part of the knee damaged by osteoarthritis, surgeons can resurface the diseased portion of the knee, while helping to spare the healthy bone and ligaments surrounding the knee joint. Studies have shown robotic-arm assisted partial knee replacement to be two to three times more accurate than manual partial knee replacement procedures.[v],[vi],[vii]
MAKO ROBOTIC ASSISTED TOTAL KNEE REPLACEMENT
The Mako Total Knee application is a knee replacement treatment option designed to relieve the pain caused by joint degeneration due to osteoarthritis. Through CT-based 3D modelling of bone anatomy, surgeons can use the Mako System to create a personalized surgical plan and identify the implant size, orientation and alignment based on each patient’s unique anatomy. The Mako System also enables surgeons to virtually modify the surgical plan intra-operatively and assists the surgeon in executing bone resections. The robotic platform creates stereotactic boundaries that precisely guide the cutting tools and protect the vital structures such as the ligaments, nerves and blood vessels.
MAKO ROBOTIC ASSISTED 
TOTAL HIP REPLACEMENT
The Mako Total Hip application is a treatment option for adults who suffer from degenerative joint disease of the hip. During surgery, the surgeon guides the robotic-arm during bone preparation to prepare the hip socket and position the implant according to the pre-determined surgical plan. In cadaveric studies, Mako total hip replacement acetabular cup placement has been shown to be four times more accurate and reproducible than manual total hip replacement procedures.1
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[i] Nawabi DH, Conditt MA, Ranawat AS, Dunbar NJ et al. Haptically guided robotic technology in total hip arthroplasty: a cadaveric investigation. J Engineering in Medicine. 2012;227(3):302-309.
[ii] Illgen R. Robotic assisted total hip arthroplasty improves accuracy and clinical outcome compared with manual technique. 44th Annual Advances in Arthroplasty Course. October 7-10, 2014, Cambridge, MA.
[iii] Anthony I, Bell SW, Blyth M, Jones B et al. Improved accuracy of component positioning with robotic-assisted unicompartmental knee arthroplasty. J Bone Joint Surg Am. 2016;98-A(8):627-35.
[iv] Hampp EL, Scholl LY, Prieto M, Chang T et al. Robotic-arm assisted total knee arthroplasty demonstrated greater accuracy to plan compared to manual technique. MAKTKA-AJA-9_12509
[v] Dunbar NJ, Roche MW, Park BH, Branch SH et al. Accuracy of Dynamic Tactile-Guided Unicompartmental Knee Arthroplasty. Journal of Arthroplasty. May 2012. 27(5): 803-808.e1.
[vi] Lonner, JH. Robotic-arm assisted unicompartmental knee arthroplasty. Seminars in Arthroplasty. 2009;20(1): 15-22.
[vii] Lonner JH, John TK, Conditt MA. Robotic arm-assisted UKA improved tibial component alignment: A pilot study. Clin Orthop Relat Res. 2010;468(1):141-6.