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Is Mako Robotic Knee Replacement Better Than The Conventional One?

by | May 31, 2024 | Blog

Is Mako Robotic Knee Replacement Better Than The Conventional One?

Mako Robotic Total Knee Replacement provides better accuracy for implant positioning hence resulting in better patient outcomes, lesser pain, faster recovery, and improved results.

Mako robotic total knee replacement is the most innovative technology in the field of orthopedics. With over 5 lakh Mako robotic total knee replacements done worldwide, Mako stands as the state-of-the-art technology.

So, with all the buzz around Mako and Robotics, you would be wondering if there is any additional benefit of Mako Robotic Total Knee Replacements (TKRs) over manual ones.

There are over 250 published, peer-reviewed studies which highlight the patient benefits and clinical outcomes of the Mako Total Knee Replacements.

Broadly, following are the major differences between Mako Total Knee Replacements and Manual Total Knee Replacements:

Stage Manual Total Knee Replacements Mako Total Knee Replacements
Pre-surgery ·   Planning based on simple X-ray

·   Planning based on CT scan

·   Improved precision in planning
Surgery

·   Positioning and alignment done by traditional tools

·   May need larger cut

·   Standard ligament release

·   Positioning and alignment performed by Mako

·   Smaller cut

·   Less ligament release so less pain
>Benefits of Mako Total Knee Replacements over Manual Total Knee Replacements post-surgery

·   Lesser pain

·   Faster recovery

·   Faster abandonment of crutches

·   Improved results

Let’s now delve deeper into understanding the factors that contribute to these benefits of Mako Total Knee Replacements over Manual Total Knee Replacements:

  1.   Accuracy:
CT validation of intraoperative implant position and knee alignment as determined by the Mako Total Knee Arthroplasty System: This was the first independent study to clinically evaluate the accuracy of intraoperative component alignment through CT validation of the Mako Total Knee System software. Overall, intraoperatively measured component and limb alignment as estimated by Mako Total Knee was comparable to postoperative CT-based measurements (within 1-2 degrees) and mean absolute difference of limb alignment (and standard deviation) was 1.29 degrees (1.25). Postoperative measurements were made off of postoperative CTs and compared to intraoperative values Reference: Sires JD, Wilson CJ. CT Validation of Intraoperative Implant Position and Knee Alignment as Determined by the MAKO Total Knee Arthroplasty System. J Knee Surg. 2021;34(10):1133-1137. doi:10.1055/s-0040-1701447 Read more: https://pubmed.ncbi.nlm. nih.gov/32131103/   Robotic-assisted total knee arthroplasty demonstrates greater component placement accuracy compared with manual instrumentation: initial results of a prospective multicentre evaluation This study showed improved accuracy to plan for robotic-arm assisted TKA (RA-TKA) compared to manual TKA. Compared to manual TKA, RA-TKA cases were typically 47% more accurate for tibial component alignment, 59% more accurate for tibial slope, and 36% more accurate for femoral component rotation (percent differences of median absolute deviations from plan). Reference: Mont M, Kinsey T, Zhang J, et al. Robotic-assisted total knee arthroplasty demonstrates greater component placement accuracy compared with manual instrumentation: initial results of a prospective multicentre evaluation. Bone Joint J:Orthop Proc. 2020;102-B(Supp_2):43. Read more: https://online. boneandjoint.org.uk/ doi/abs/10.1302/1358- 992X.2020.2.043   Accuracy of bone resection in Mako Total Knee roboticassisted surgery On a series of 37 patients, the mean observed difference (and standard deviation) from the surgical plan for distal femoral cuts was 0.38 mm (0.32 mm) deep/proud, for anterior femoral cuts was 0.44 mm (0.27 mm) deep/proud and for tibial cuts was 0.37 mm (0.30 mm) deep/proud. In total, 99 out of 105 (94.29%) of bone resections were within 1 mm of the plan. Mean absolute difference in final limb coronal alignment was 0.78° (0.78°), with 78.13% being ≤ 1.00° of the plan, and 100% being ≤ 3.00° of the plan. These results indicate the ability of the surgeon to accurately achieve preoperatively planned bone resection and final limb coronal alignment using Mako Total Knee.   Reference: Sires JD, Craik JD, Wilson CJ. Accuracy of bone resection in Mako Total Knee Robotic-assisted Surgery. J Knee Surg. Accepted manuscript. Published online November 6, 2019. doi:10.1055/s-0039-1700570 Read more: https://pubmed.ncbi.nlm. nih.gov/31694057/
  1. Outcomes
Patient-reported functional and satisfaction outcomes after robotic-armassisted total knee arthroplasty: early results of a prospective multicenter investigation “At 4 to 6 weeks postoperatively, RA-TKA patients were found to have significantly larger improvements in walking and standing (1.4 vs. -1.2 points; p = 0.019), advanced activities (1.3 vs. 2.3 points), pain with walking (3.3 vs. 3.2 points), satisfaction score (12.4 vs. 12 points), and expectations score (5.1 vs. 4.4 points) when compared with manual TKA patients. At 3 months, RA-TKA patients were also found to have larger improvements in walking and standing (6.0 vs. 4.8 points), standard activities (11.4 vs. 10.1 points), advanced activities (6.2 vs. 4.6 points), functional activities total score (22.8 vs. 21.2 points), pain with walking (4.3 vs. 4.1 points), total symptoms score (10.5 vs. 10.3 points), satisfaction score (17.0 vs. 15.5 points), and expectations score (4.8 vs. 4.0 points) when compared with manual TKA patients.”   Reference: Khlopas A, Sodhi N, Hozack WJ, et al. Patient-reported functional and satisfaction outcomes after roboticarm-assisted total knee arthroplasty: early results of a prospective multicenter investigation. J Knee Surg. 2020;33(7):685-690. doi:10.1055/s-0039-1684014 Read more: https://pubmed.ncbi.nlm. nih.gov/30959541/   Do total knee arthroplasty surgical instruments influence clinical outcomes? A prospective parallel study of 150 patients Compared to computer-navigated TKA, patients who received RA-TKA had significantly improved postoperative pain, reduced total morphine consumption and a reduced length of stay Reference: Bhowmik-Stoker M, Faizan A, Nevelos JE, Tippett B, Clark G. Do total knee arthroplasty surgical instruments influence clinical outcomes? A prospective parallel study of 150 patients. Presented at: Orthopaedic Research Society Annual Meeting; February 2-5, 2019; Austin, TX Read more: https://www.ors.org/ Transactions/65/0329.pdf   New technology for total knee arthroplasty provides excellent patient-reported outcomes: a minimum two-year analysis Five fellowship-trained, high-volume surgeons at different institutions performed a total of 188 total knee arthroplasty surgeries using Mako Total Knee and had a two-year minimum clinical follow-up. All patients reported excellent postoperative outcomes for Forgotten Joint Score (FJS), Short Form-12 Questionnaire (SF-12) and Knee Society total and subscores (KSS). The mean postoperative SF-12 mental composite score (MCS) and physical composite score (PCS) scores were both 57 points, with 50 as the threshold for norm-based scoring (MCS range: 42 to 69 points; PCS range: 41 to 68 points). The mean FJS was 75 points (range: 14 to 100 points). The mean KSS functional score was 84 points (range: 20 to 100) while the mean Knee Score was 92 points (range: 40 to 100). Similarly, the authors found that the aseptic revision rates were low (n=2, 1.06%, one for unexplained pain, and another for a post-traumatic tibial fracture) with few other postoperative complications (n=7 patients [3.7%]) in this cohort. This analysis found that patients had excellent outcomes across multiple patient-reported outcome measures at a minimum of two-year clinical follow-up after a Mako Total Knee. Reference: Malkani AL, Roche MW, Kolisek FR, et al. New technology for total knee arthroplasty provides excellent patient-reported outcomes: a minimum twoyear analysis. Surg Technol Int. 2020;36:276-280. Read more: https://pubmed.ncbi.nlm. nih.gov/31732961/
  1. Patient Satisfaction:
Improved patient satisfaction following robotic assisted total knee arthroplasty One hundred twenty consecutive patients who underwent RA-TKA were compared with a prospective cohort of 103 consecutive patients undergoing TKA with manual jig-based instruments during the same time period. There were no differences between groups with age, gender, baseline Knee Society Score (KSS) knee and function scores, follow-up, and ASA scores. TKAs were performed using same technique, implant design, anesthesia and postoperative treatment protocols. Likert scoring system demonstrated 94% of the patients in the RA-TKA group were either very satisfied or satisfied versus 82% in the manual instruments TKA group (p=0.005) at one-year follow-up. The RA-TKA group had a better average overall satisfaction score of 7.1 versus 6.6 in the manual instrument group, p=0.03 at one-year follow-up. KSS function scores for the RA-TKA group were significantly better than those observed in the manual cohort at six weeks and one year postoperatively (p=0.02, 0.005), and KSS knee scores were significantly better at one year postoperatively (p=0.046). Reference: Smith AF, Eccles CJ, Bhimani SJ, et al. Improved Patient Satisfaction following Robotic-Assisted Total Knee Arthroplasty. J Knee Surg. 2021;34(7):730-738. doi:10.1055/s-0039-1700837 Read more: https://pubmed.ncbi.nlm. nih.gov/31731324/

Takeaway:

Mako Robotic Total Knee Replacements offer a wide array of benefits when compared to the regular, manual total knee replacements in terms of accuracy, survivorship, and patient outcomes. It provides the patient with increased precision resulting in faster recovery, less pain and better outcomes as compared to the manual total knee replacement.

It is also noteworthy that the implant used with Mako Total Knee Replacement is called Triathlon and Dr. Narayan Hulse is the first surgeon in India to complete 1000 Triathlon total knee replacements.

If you are interested in Mako Total Knee Replacement or to know more about the same, book an appointment with Dr. Narayan Hulse today.

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