OrthoVirginia Blog

Makoplasty Robotic Surgery for Hip and Knee Replacements

by Cyrus S. Kump II, MD

For anyone with hip or knee arthritis, this article is for you. I am a board-certified orthopedic surgeon at OrthoVirginia specializing in hip, knee, partial knee, and shoulder replacement. I have been performing knee and hip replacement surgery for 17 years, and I want to share new technology with you that I use to perform hip and knee replacement surgery.

Basics of Joint Replacement for Arthritis


For 70 years the treatment of debilitating hip and knee arthritis has been hip and knee replacement. If your doctor refers you to the orthopedic surgeon, the surgeon will examine where you hurt and will have you get x-rays. The orthopedic surgeon will determine what he thinks is the cause of your symptoms and discuss this cause with you. If he decides your pain is due to arthritis in the joint, he will advise you on the best form of treatment. Initially, he may advise using pain medications, rest, physical therapy, bracing and/or injections. In time if this form of conservative treatment is not helping, he may eventually recommend considering joint replacement. A joint replacement is reserved for the situation where a person is having difficulty walking due to pain and dysfunction and may be having difficulty doing their job or doing activities of daily living just to care for themselves such as dressing, bathing, or preparing food.

How Does Makoplasty Work?


Anyone who is a candidate for hip and knee replacement surgery is a candidate for the Makoplasty robotic-assisted arm surgery. The only difference in preparation between a traditional joint replacement surgery and a Makoplasty surgery is that you will have a CT scan of the joint before surgery; the scan is covered by insurance. The scan gives the surgeon incredible detail and allows the computer software and surgeon to personalize these surgeries to each patient. The orthopedic surgeon then uses the robotic-assisted arm in surgery to accurately carryout the pre-operative plan. The main incisions (cuts) are the same in all types of joint replacement surgery, but the Makoplasty will also have four small pin sites in the thigh and lower leg.

Once the surgery starts, the surgeon uses a probe to take readings from within your knee joint. The readings are transmitted to the computer by an infrared beam. The process is called registering the knee. The computer already knows what the knee looks like from the CT scan you did before the operation started. Once the computer agrees that the information entered from the probe matches the information from the CT scan, the surgery can proceed. That’s what we call a successful registration! The registration allows the Makoplasty system to know where it is in relationship to the different parts of the knee.

The surgeon then takes a few minutes to balance the knee ligaments to determine the exact position of the knee replacement parts. Once this is complete, the robot-assisted arm is brought in so the surgeon can make precise cuts to the bone for the replacement parts to go into. Once the bone cuts are made, the rest of the surgery involves putting the replacement parts into the bone and closing the wound, which are done the same way regardless of the type of surgery.

Why Makoplasty?


Since the beginning of joint replacements, surgeons have been continuing to look for ways to improve the surgery and improve the longevity of the prosthesis. Orthopedic surgeons now have computer software and a robot to assist in this endeavor. You can go online to see that there are two or three systems available but only the Makoplasty system, made by the Stryker company, has been in use for 10 years with several hundred thousand surgeries performed. I looked at all the other systems and helped my hospital in making the decision to choose Makoplasty due to its unmatched reliability and ability.

The computer guided robot is making the surgery more precise and accurate time and time again. We have known for years the best position that knee and hip components should be placed to have the best function and for the longest survival of the prosthesis. We have used standard equipment for years and this surgery has proven to be very good. Unfortunately, the standard method of performing this surgery is very dependent on surgeon experience. With less experience, the surgery becomes less reliable and outcomes not as good. With the use of the Makoplasty computer software and robotic-assisted arm this nearly completely removes the human factor and allows for many checks and balances to make this surgery highly successful. When you add in a surgeon with a great deal of experience like I have, you then have a winning combination. What are you waiting for?