The number of patients presenting with osteoarthritis has increased by 32% in the last decade (Schaal, Schoenfelder, Klewer & Kugler, 2017). For many of these patients with osteoarthritis in their knees, surgery is the needed treatment. This surgery is called a knee arthroplasty. The following diagram shows a basic outline of a knee replacement:

 

Taken from: http://www.doereport.com/generateexhibit.php?ID=63883&ExhibitKeywordsRaw=&TL=&A=

 

During this surgery, a surgeon uses their best judgement to remove bone and properly place the prosthesis. A recent innovation in orthopedic surgery seen in my work place is the use of a MAKO robot to assist surgeons during a knee replacement. With the use of a MAKO robot, a preoperative CT scan is taken of the patient’s knee and the robot uses the image to formulate exactly how much of the bone the surgeon needs to saw as well as the exact positioning of the prosthesis (Kimball, 2013). Minimal bone loss along with better prosthesis positioning is important because they affect postoperative pain as well as mobility of the joint during recovery (Kimball, 2013). 

 

Taken from: https://bonesmart.org/knee/about-knee-replacement/ 

 

The MAKO robot also has the capability of performing unicompartmental knee arthroplasty versus a total knee arthroplasty. During a unicompartmental knee arthroplasty, there is only a small part of the joint that is experiencing osteoarthritis and needs replacing. The following picture shows a comparison of the two:

 

Taken from: http://orthoinfo.aaos.org/topic.cfm?topic=a00585 

 

 

According to Kimball (2013), patients with MAKO joint replacements have reported less postoperative pain. Overall, these patients have experienced better clinical outcomes (Kimball, 2013). According to Ponnusamy and Raymond (2013), the prosthesis is better positioned, leading to better outcomes. They also state that more research needs to be done in order to better compare MAKO joint replacements with the standard surgical technique (Ponnusamy & Raymond Golish, 2013).

 

For surgeries with which a MAKO robot is used, there is additional surgical time required which possibly leads to higher risk of infection (Ponnusamy & Raymond Golish, 2013). The study shows no specific data proving a higher infection rate, however. Another problem with using a MAKO robot is the cost of the robot along with its maintenance (Ponnusamy & Raymond Golish, 2013).

 

 

In my experience working with MAKO knee patients postoperatively, they did experience less postop pain and had faster recovery times. I observed no patterns of infection rates in patients with MAKO knee replacements versus regular total knee arthroplasties. What I was taught as a floor nurse caring for these patients was that their recovery was better overall because less bone was removed, there was a smaller incision, and therefore that was less postoperative pain. On the unit I worked, the patient was required to walk with a physical therapist the same day of surgery. The MAKO patients were much more compliant with this rule than other orthopedic patients.

 

Now, as a circulator in the operating room, I can attest to the fact that MAKO knee replacements do take longer than a total knee arthroplasty not using the MAKO robot. Longer surgery time poses risks to the patient such as longer time under anesthesia, their position, and infection rate among other risks. 

 

I agree that because this is such a new innovation, more research needs to be done about the benefits versus risk of using a MAKO robot. Overall, I think it is a great new direction and use of current medical technology.

                                              References

KIMBALL, R. (2013). MAKO gains favorable results in implant    positioning study. (Cover story). Medical Device Daily, 17(57), 1-5.

PONNUSAMY, K. E., & RAYMOND GOLISH, S. (2013). Robotic Surgery in Arthroplasty. AAOS Now, 7(12), 36-38.

Schaal, T., Schoenfelder, T., Klewer, J., & Kugler, J. (2017). Effects of perceptions of care, medical advice, and hospital quality on patient satisfaction after primary total knee replacement: A cross-sectional study. Plos ONE, 12(6), 1-12. doi:10.1371/journal.pone.0178591