Robotic-Arm Assisted Total Knee Replacement
Is Mako robotic knee replacement any better than conventional knee replacement?
Prior to the advent of robotics, conventional knee replacement had been considered one of the most successful surgical procedures in all of medicine, enhancing quality of life for hundreds of thousands of Americans each year. Despite the overwhelming success of the conventional procedure, there are still between 11% and 18% of individuals undergoing conventional knee replacement that remain unsatisfied with the results of their surgery. In fact, even when conventional total knee replacements are performed by well regarded, high-volume knee specialists, as many as 19% may remain unsatisfied at one year postoperatively(1). Stiffness, instability, and ongoing residual pain accounts for many of these suboptimal outcomes. Can these results be improved? Can we limit the number of unsatisfied patients? The introduction of Mako robotic technology offered by knee surgeon Dr. Obermeyer may be one factor helping to limit these unsatisfactory results, minimizing human error and maximizing surgical accuracy.
Robotic knee replacement was introduced to decrease even subtle mistakes and imperfections that may come with bone preparation and prosthesis position with conventional manual techniques. Robotic assisted knee replacements demonstrate greater accuracy and better precision compared with conventional manual techniques(2). Robotic technology in knee replacement may also lead to better protection of the surrounding soft tissues(3) and to help balance the knee in a flexion-extension arc(4).
The incision and overall surgical procedures are quite similar between robotic and conventional knee replacement. However, there is some evidence that the postoperative pain, requirement for pain medications, early motion recovery, and muscle (quad) function are improved with robotic knee replacement compared with conventional manual knee replacement(5). Additionally, the chemical (inflammatory) markers the body generates in response to the surgery are substantially lower in patients undergoing robotic vs conventional knee replacement(6). And finally, patients undergoing Mako robotic surgery report lower pain scores at six months compared with those undergoing traditional knee replacement(7). The reasons for these differences are still being investigated but likely relate to the protection of soft tissues, correction of deformity (crookedness), and “balancing” the knee to optimize the function and stability for each individual patient.
Robotic knee replacement uses a CT scan of the patient’s knee to create a 3D model of the original knee. This model is then used to precisely predict the size and position of the implant used. Then at surgery, the patient’s bone is registered into a computer that tells the robot the position of the knee bones. Prior to the robotic-assisted preparation of the bone to accept the implant, the femoral and tibial components of the prosthesis can be fine-tuned to ensure the knee is “balanced” between flexion and extension, to ensure the kneecap tracks appropriately, and the position of the joint line is restored. The result? A more natural-feeling knee that allows you to walk right after the procedure and embark on your recovery with confidence.
To optimize your recovery, you will be encouraged with assistance to get up, walk, and negotiate stairs the day of surgery. Dr. Obermeyer uses surgical techniques to apply numbing injections into your knee joint during surgery, does not use a blood flow-restricting tourniquet, and uses oral pills to ensure the pain after surgery is controlled and not interfering with your activity. Most patients can leave the facility the same day or some stay overnight to observe medical comorbidities. Physical therapy starts 1-2 days after surgery at home and continues at home for a couple weeks. Once you can transition to the clinic setting after a couple weeks, you will start outpatient therapy for approximately 6-8 weeks. Most patients can drive approximately 4 weeks following surgery, which is approximately the time that nearly all independent activities are resumed. Dr. Obermeyer and his team will check on your progress at multiple visits for the months following surgery, with improvements noted for up to one year following the replacement.
Schedule an orthopedic appointment
If you have knee pain and are concerned you may require an orthopedic subspecialist evaluation, call our office, or book an appointment with knee surgeon Dr. Thomas Obermeyer. Dr. Obermeyer provides expert orthopedic care for patients in need of a knee replacement. Dr. Obermeyer has orthopedic offices in Schaumburg, Bartlett, and Elk Grove Village, Illinois. Dr. Obermeyer regularly sees patients from throughout Illinois including Hoffman Estates, Palatine, Elgin, Streamwood, Arlington Heights, and Roselle communities.
References:
- Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res. 2010 Jan;468(1):57-63. doi: 10.1007/s11999-009-1119-9. PMID: 19844772; PMCID: PMC2795819.
- Hampp EL, Chughtai M, Scholl LY, Sodhi N, Bhowmik-Stoker M, Jacofsky DJ, Mont MA. Robotic-Arm Assisted Total Knee Arthroplasty Demonstrated Greater Accuracy and Precision to Plan Compared with Manual Techniques. J Knee Surg. 2019 Mar;32(3):239-250. doi: 10.1055/s-0038-1641729. Epub 2018 May 1. PMID: 29715696.
- Sultan AA, Piuzzi N, Khlopas A, Chughtai M, Sodhi N, Mont MA. Utilization of robotic-arm assisted total knee arthroplasty for soft tissue protection. Expert Rev Med Devices. 2017 Dec;14(12):925-927. doi: 10.1080/17434440.2017.1392237. Epub 2017 Oct 24. PMID: 29025351.
- Song EK, Seon JK, Yim JH, Netravali NA, Bargar WL. Robotic-assisted TKA reduces postoperative alignment outliers and improves gap balance compared to conventional TKA. Clin Orthop Relat Res. 2013 Jan;471(1):118-26. doi: 10.1007/s11999-012-2407-3. Erratum in: Clin Orthop Relat Res. 2012 Sep;470(9):2627. PMID: 22669549; PMCID: PMC3528918.
- Kayani B, Konan S, Tahmassebi J, Pietrzak JRT, Haddad FS. 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 Joint J. 2018 Jul;100-B(7):930-937. doi: 10.1302/0301-620X.100B7.BJJ-2017-1449.R1. PMID: 29954217; PMCID: PMC6413767.
- Fontalis A, Kayani B, Asokan A, Haddad IC, Tahmassebi J, Konan S, Oussedik S, Haddad FS. Inflammatory Response in Robotic-Arm-Assisted Versus Conventional Jig-Based TKA and the Correlation with Early Functional Outcomes: Results of a Prospective Randomized Controlled Trial. J Bone Joint Surg Am. 2022 Nov 2;104(21):1905-1914. doi: 10.2106/JBJS.22.00167. Epub 2022 Sep 8. PMID: 36074816.
- Marchand RC, Sodhi N, Khlopas A, Sultan AA, Harwin SF, Malkani AL, Mont MA. Patient Satisfaction Outcomes after Robotic Arm-Assisted Total Knee Arthroplasty: A Short-Term Evaluation. J Knee Surg. 2017 Nov;30(9):849-853. doi: 10.1055/s-0037-1607450. Epub 2017 Oct 13. PMID: 29029352.
At a Glance
Dr. Thomas Obermeyer
- 15+ years of training and experience treating complex shoulder and sports medicine conditions
- Expert subspecialized and board-certified orthopedic care
- Award-winning outstanding patient satisfaction scores
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