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The MAKO robotic-arm knee arthroplasty system

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The Mako robotic arm knee arthroplasty system was initially indicated in unicompartmental knee arthroplasty followed by bicompartmental and total knee arthroplasty techniques. The system utilizes three elements: (1) Pre-op 3D CT based planning and image based intra-op navigation. (2) Pre-resection implant modifications with integrated alignment, implant position and gap data, and (3) A semi-constrained robotic arm assisted execution of bone resection with “haptic” boundaries, and cemented implants.

Materials and methods

This paper evaluates variable pre-op implant placement, and anatomic reference positioning; data entry with incorporation of alignment, implant congruency through range of motion, and gaps; bone resection with “haptic” boundaries, and final implant evaluation with kinetic sensors.

Results

The Mako system allowed for improved implant placement utilizing CT guidance, bone resection accuracy, flexibility for functional implant placement with gap balancing. When combined with kinetic sensors, there was improved rotation and soft tissue balance.

Conclusion

The MAKO robotic system can assist the surgeon with anatomic landmarks, provides the flexibility for independent gap balance through implant and alignment refinement, and three-dimensional soft tissue balancing data to achieve functional stability. Registry data has shown improved outcome survivorship irrespective of the surgeons’ volumes and learning curves.

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References

  1. Citak M, Suero EM, Citak M et al (2013) Unicompartmental knee arthroplasty: is robotic technology more accurate than conventional technique? Knee 20(4):268–271

    Article  Google Scholar 

  2. Dunbar NJ, Roche MW, Park BH, Branch SH, Conditt MA, Banks SA (2012) Accuracy of dynamic tactile-guided unicompartmental knee arthroplasty. J Arthroplasty 27(5):803-808.e1

    Article  Google Scholar 

  3. Hampp EL, Chughtai M, Scholl LY, Sodhi N, Bhowmik-Stoker M, Jacofsky DJ, et al (2018) Robotic-arm assisted total knee arthroplasty demonstrated greater accuracy and precision to plan compared to manual technique. J Knee Surg

  4. Bell SW, Anthony I, Jones B, MacLean A, Rowe P, Blyth M (2016) Improved accuracy of component positioning with robotic-assisted unicompartmental knee arthroplasty: data from a prospective, randomized controlled study. J Bone Jt Surg Am 98(8):627–635. https://doi.org/10.2106/JBJS.15.00664

    Article  Google Scholar 

  5. Roche M (2015) Robotic-assisted unicompartmental knee arthroplasty: the MAKO experience. Orthop Clin N Am 46(1):125–131. https://doi.org/10.1016/j.ocl.2014.09.008 (PMID: 25435041)

    Article  Google Scholar 

  6. Kazarian GS, Barrack TN, Okafor L, Barrack RL, Nunley RM, Lawrie CM (2020) High prevalence of radiographic outliers and revisions with unicompartmental knee arthroplasty. J Bone Jt Surg Am 15:14. https://doi.org/10.2106/JBJS.19.01277 (Published online May 8)

    Article  Google Scholar 

  7. Chatellard R et al (2013) Medial unicompartmental knee arthroplasty: does tibial component position influence clinical outcomes and arthroplasty survival? Orthop Traumatol Surg Res 99:S219

    Article  CAS  Google Scholar 

  8. Barbadoro P, Ensini A, Leardini A et al (2014) Tibial component alignment and risk of loosening in unicompartmental knee arthroplasty: a radiographic and radiostereometric study. Knee Surg Sports Traumatol Arthrosc 22(12):3157–3162

    Article  CAS  Google Scholar 

  9. Vasso M, Del Regno C, D’Amelio A, Viggiano D, Corona K, Schiavone PA (2015) Minor varus alignment provides better results than neutral alignment in medial UKA. Knee 22(2):117–121

    Article  Google Scholar 

  10. Lonner JH, John TK, Conditt MA (2010) Robotic arm-assisted UKA improves tibial component alignment: a pilot study. Clin Orthop Relat Res 468(01):141–146

    Article  Google Scholar 

  11. Zambianchi F, Daffara V, Franceschi G et al (2020) Robotic arm-assisted unicompartmental knee arthroplasty: high survivorship and good patient-related outcomes at a minimum five years of follow-up. Knee Surg Sports Traumatol Arthrosc

  12. AOANJRR (2021) Australian Registry report 1 September 1999–11 March 2021

  13. Kleeblad LJ, Borus TA, Coon TM, Dounchis J, Nguyen JT, Pearle AD (2018) Midterm survivorship and patient satisfaction of robotic-arm-assisted medial unicompartmental knee arthroplasty: a multicenter study. J Arthroplasty 33(6):1719–1726

    Article  Google Scholar 

  14. Vakharia RM, Law Ty, Roche MW. Survivorship and patient satisfaction rates of robotic-assisted unicompartmental knee arthroplasty. Poster presented at: American Academy of Hip and Knee Surgeons 30th Annual Meeting; November 5-8, 2020; Dallas, Texas.

  15. Fleischman A, Lutz R, Kafshgari HV, Orozco F, Hozack W, Chen A (2018) Time-related learning curve of robotic-arm assisted total knee arthroplasty. In: AAOS; 2018. Annual Meeting

  16. Cheng T, Zhang G, Zhang X. Imageless navigation system does not improve component rotational alignment in total knee arthroplasty. Journal of Surgical Research. 2011;171(2):590-600.

    Article  Google Scholar 

  17. Yau WP et al (2007) Interobserver and intra-observer errors in obtaining visually selected anatomical landmarks during registration process in non–image-based navigation-assisted total knee arthroplasty. J Arthroplasty 22(8):1150–1161

    Article  CAS  Google Scholar 

  18. Seidenstein A, et al (2020) Better accuracy and reproducibility of a new robotically-assisted system for total knee arthroplasty compared to conventional instrumentation: a cadaveric study. Knee Surg Sports Traumatol Arthrosc, pp 1–8

  19. Sires JD, Wilson CJ (2020) CT validation of intraoperative implant position and knee alignment as determined by the MAKO total knee arthroplasty system. The J Knee Surg

  20. Roche M, Elson L, Anderson C. Dynamic soft tissue balancing in total knee arthroplasty. Orthopedic Clinics. 2014;45(2):157-65.

    Article  Google Scholar 

  21. Kayani B et al (2018) Iatrogenic bone and soft tissue trauma in robotic-arm assisted total knee arthroplasty compared with conventional jig-based total knee arthroplasty: a prospective cohort study and validation of a new classification system. J Arthroplasty 33(8):2496–2501

    Article  Google Scholar 

  22. Bhimani SJ, Bhimani R, Smith A, Eccles C, Smith L, Malkani A (2020) Robotic- assisted total knee arthroplasty demonstrates decreased postoperative pain and opioid usage compared to conventional total knee arthroplasty. Bone Jt Open 1(2)

  23. Sultan AA et al (2017) Utilization of robotic-arm assisted total knee arthroplasty for soft tissue protection. Expert Rev Med Dev 14(12):925–927

    Article  CAS  Google Scholar 

  24. Khlopas A, Chughtai M, Hampp EL, Scholl LY, Prieto M, Chang TC, Abbasi A, Bhowmik-Stoker M, Otto J, Jacofsky DJ, Mont MA. Robotic-Arm Assisted Total Knee Arthroplasty Demonstrated Soft Tissue Protection. Surgical technology international. 2017;30:441-6.

    Google Scholar 

  25. Golladay GJ et al (2019) Are patients more satisfied with a balanced total knee arthroplasty? J Arthroplasty 34(7):S195–S200

    Article  Google Scholar 

  26. Emodi GJ et al (1999) Posterior cruciate ligament function following total knee arthroplasty: the effect of joint line elevation. Iowa Orthop J 19:82

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Geller JA, Lakra A, Murtaugh T (2017) The use of electronic sensor device to augment ligament balancing leads to a lower rate of arthrofibrosis after total knee arthroplasty. J Arthroplasty 32(5):1502–1504

    Article  Google Scholar 

  28. Moore RE et al (2021) How to quantitatively balance a total knee? A surgical algorithm to assure balance and control alignment. Sensors 21(3):700

    Article  Google Scholar 

  29. Marchand RC, Sodhi N, Khlopas A, Sultan AA, Harwin SF, Malkani AL et al (2017) Patient satisfaction outcomes after robotic arm-assisted total knee arthroplasty: a short-term evaluation. J Knee Surg 30:849e53. https://doi.org/10.1055/s-0037-1607450

    Article  Google Scholar 

  30. Marchand RC, Sodhi N, Anis HK et al (2019) One-year patient outcomes for robotic-arm-assisted versus manual total knee arthroplasty. J Knee Surg 32:1063–1068

    Article  Google Scholar 

  31. Liow MHL, Goh GSH, Wong MK, Chin PL, Tay DKJ, Yeo SJ (2017) Robotic-assisted total knee arthroplasty may lead to improvement in quality-of-life measures: a 2- year follow-up of a prospective randomized trial. Knee Surg Sports Traumatol Arthrosc 25:2942e51. https://doi.org/10.1007/s00167-016-4076-3

    Article  Google Scholar 

  32. Kayani B et al (2018) Robotic-arm assisted total knee arthroplasty is associated with improved early functional recovery and reduced time to hospital discharge compared with conventional jig-based total knee arthroplasty: a prospective cohort study. Bone Jt J 100(7):930–937

    Article  Google Scholar 

  33. Mont MA, Cool C, Gregory D, Coppolecchia A, Sodhi N, Jacofsky DJ (2019) Health care utilization and payer cost analysis of robotic arm assisted total knee arthroplasty at 30, 60, and 90 days. J Knee Surg

  34. Cool CL, Jacofsky DJ, Seeger KA, Sodhi N, Mont MA (2019) A 90-day episode-of-care cost analysis of robotic-arm assisted total knee arthroplasty. J Comp Eff Res 8:327–336

    Article  Google Scholar 

  35. Pierce J, Needham K, Adams C, Coppolecchia A, Lavernia C (2020) Robotic assisted total knee surgery: an economic analysis, orthopedic research Society Annual Meeting, Feb. 7–11, 2020, Phoenix AZ

  36. Roche et.al. (2021) 10 year Robotic Assisted Medial Unicompartmental Survival and Satisfication, Closed Knee Society Meeting Sept 10th 2021 Napa, California

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Correspondence to Martin Roche.

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Roche, M. The MAKO robotic-arm knee arthroplasty system. Arch Orthop Trauma Surg 141, 2043–2047 (2021). https://doi.org/10.1007/s00402-021-04208-0

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  • DOI: https://doi.org/10.1007/s00402-021-04208-0

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