Robotic surgery with the MAKO® robotic arm

The Orthopaedics Department at HRS was the first department in the Grand Duchy of Luxembourg to introduce robotic surgery in 2016 under the impetus of Dr Pit Putzeys. The aim was to be able to offer patients a personalized and safe solution for osteoarthritis of the hip and knee.

Since 2016, more than 3,500 total hip, knee, uni-compartmental or patellofemoral prostheses have been implanted by HRS orthopedic surgeons including Doctor Putzeys Pit, Doctor Schlammes and their colleagues.

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Since its introduction in the USA, over 1.5 million procedures have been published, with more than 425 scientific studies in specialist journals.

How does the MAKO® technique work?

Before surgery, the patient undergoes a reduced-dose CT scan to produce a 3-dimensional model of the affected joint. Based on this model, precise, personalized planning is carried out by the surgeon and the engineer, who checks that the robot functions correctly during the operation.

CT scan

Segmentation

CT landmarks

In knee osteoarthritis, the surgeon and patient decide together whether 1, 2 or all 3 compartments will be replaced, depending on the severity of the osteoarthritis.

In the case of osteoarthritis or wear of only 1 or 2 compartments, the surgeon may propose only 1 partial prosthesis of the affected compartment.

Patellofemoral prosthesis

External unicompartmental prosthesis

3-dimensional planning of a total knee prosthesis.

Congenital hip dislocation with 3-D planning, preoperative and postoperative image.

During the operation

The Mako® robot features STRYKER’s AccuStop technique, which enables bone to be milled or cut in a safe space without the risk of damaging noble vascular or nerve structures.

The Mako® robotic arm is a semi-autonomous robot that cannot operate on its own, and requires the constant presence of the surgeon and technical engineer to be active.

Numerous studies have shown that STRYKER’s Mako® technique reduces post-operative inflammation and pain in knee prostheses, reduces the need for morphine, and facilitates rehabilitation and faster discharge home.

In the case of hip prostheses, preoperative virtual simulation, taking into account the dynamics of the spine, enables customized implantation to avoid mechanical conflict and postoperative dislocation.

To summarize

The Mako® robot enables the surgeon to be more precise and reproducible. The robot has no “bad day”, and makes every surgeon a “better surgeon”.

Bell SW, Anthony I, Jones B, MacLean A, Rowe P, Blyth M. Improved accuracy of component positioning with robotic-assisted
unicompartmental knee arthroplasty: data from a prospective, randomized controlled study. J Bone Joint Surg Am. 2016;98(8):627-635.
doi:10.2106/JBJS.15.00664
Illgen RL, Bukowski BR, Abiola R, et al. Robotic-assisted total hip arthroplasty: outcomes at minimum two year follow up. Surg Technol
Int. 2017;30:365-372.
Mahoney O, Kinsey T, Mont M, Hozack W, Orozco F, Chen A. Can computer generated 3D bone models improve the accuracy of total
knee component placement compared to manual instrumentation? A prospective multi-center evaluation. Poster presented at: 32nd
Annual Congress of the International Society for Technology in Arthroplasty; October 2-5, 2019; Toronto, Canada.
Suarez-Ahedo C, Gui C, Martin TJ, Chandrasekaran S, Lodhia P, Domb BG. Robotic-arm assisted total hip arthroplasty results in smaller
acetabular cup size in relation to the femoral head size: a matched-pair controlled study. Hip Int. 2017;27(2):147-152.
doi:10.5301/hipint.5000418
Kayani B, Konan S, Pietrzak JRT, Haddad FS. latrogenic 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. 2018;33(8):2496-2501. doi:10.1016/j.arth. 2018.03.042
Hozack WJ. Multicentre analysis of outcomes after robotic-arm assisted total knee arthroplasty. Bone Joint J:Orthop Proc. 2018;100-
B(Supp_12):38.
Banks SA. Haptic robotics enable a systems approach to design of a minimally invasive modular knee arthroplasty. Am J Orthop (Belle
Mead NJO. 2009;38(2 Suppl):23-27.
Hampp E, Chang TC, Pearle A. Robotic partial knee arthroplasty demonstrated greater bone preservation compared to robotic total
knee arthroplasty. Poster presented at: Orthopaedic Research Society Annual Meeting; February 2-5, 2019; Austin, TX.
Piazza S. Designed to maintain collateral ligament stability throughout the range of motion. Stryker-Initiated Dynamic Computer
Simulations of Passive ROM and Oxford Rig Test. 2003.
Wang H, Simpson KJ, Ferrara MS, Chamnongkich S, Kinsey T, Mahoney OM. Biomechanical differences exhibited during sit-to-stand
between total knee arthroplasty designs of varying radii. J Arthroplasty. 2006;21(8):1193-1199. doi:10.1016/j.arth.2006.02.172

Reduce All references

Dr. Putzeys

Orthopédiste du bas du corps

Dr. Schlammes

Orthopédiste et médecin du sport

Dr. Piwonski

Orthopédiste et traumatologue

Consultants

Dr. Leemrijse

Chirurgie orthopédique

MAKO®

Chirurgie robotique

Confection / implantation de prothèses

Dr. Putzeys

Lower body orthopedist

Dr. Schlammes

Orthopedist and sports physician

Dr. Piwonski

Orthopedist and traumatologist

Consultants

Dr. Leemrijse

Orthopaedic surgery

MAKO®

Robotic surgery

Prosthesis manufacture/implantation