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The artificial joint surgery robot market has become more intense due to the aging population. The Striker preoccupied the market with Mako Smart Robotics (hereinafter referred to as Mako Robot). The Mako Robot is the only artificial joint surgery robot that has been approved by the US FDA for total knee replacement, partial replacement, and total hip replacement arthroplasty. As of 2020, it has sold more than 1,000 units worldwide and has the largest number of surgical clinical cases with approximately 450,000 cases. We interviewed Chihun Ahn, Section chief of Incheon Hemchan General Hospital (orthopedic specialist) to hear more about this.
Q. How does the artificial joint surgery of the Mako Robot work? First, Mako Robot’s computer program calculates and shows the estimated cutting amount, artificial joint (implant) size, and insertion location based on the patient’s knee information taken by 3D CT in advance (first surgery plan). Then, the operating surgeon allows the Mako Robot to receive patient data through the transceiver sensor, and then transmits the bone cutting position and synchronize the patient’s actual bone state with the image registered in the CT. After that, the operating surgeon checks the patient’s actual leg axis and ligament balance, and then revises the first surgery plan. It is to check the surgery plan once more by adding the professional judgment of the operating surgeon. The Mako Robot then calculates the final cutting value, and the operating surgeon connects the cutting machine to the robot arm and starts the operation in earnest.
Q. What do you think the advantages of Mako Robot are as the operating surgeon? In addition to checking the surgery plan twice, it enhances accuracy by performing the operation according to the coordinate values calculated by the Mako Robot. Furthermore, there is a haptic function that automatically stops the saw when it is out of the planned bone cutting range, so it can be safely operated without damage to the surrounding ligaments and muscles. If we use the Marko program before the actual implant is placed, the error range of this can be grasped up to 1mm, so that the patient’s knee balance can be accurately balanced. Previously, this process was done only with the eyes of the operating surgeon.
Q. Is there a big difference in the actual surgical results compared to general artificial joint surgery? In patients over 80 years of age, the average amount of bleeding from robotic surgery was 185.1 mL, which was about 34% less than that of general surgery (average 279.6 mL) according to the results of a comparative study on robotic artificial joint surgery and general artificial joint surgery by the Joint Medicine Research Institute, Himchan General Hospital. In addition, robotic surgery (correction of 11 degrees → 1.9 degrees, 9.1 degrees correction) was also much better than general surgery (correction of 10.8 degrees → 3.4 degrees, 7.4 degrees correction) on the effect of angular deformity correction. Q. What is the most important consideration for robotic artificial joint surgery? It is the correct alignment of the lower limbs and the ligament balance of the joint. When these two are properly aligned, joint movement can be smoothly performed after surgery, and secondary complications of dissociation of the inserted artificial joint can be prevented. Therefore, the operating surgeon must be able to reflect the state of the leg axis and ligament balance that are different for each patient in the surgical plan established by the Mako Robot. There are many patients who think that robots operate alone, but it is the job of the operating surgeon to guide the surgery smoothly only with the help of robots for more accurate and safer surgery.
Chief Ahn said, “With the help of a robot during artificial joint surgery, we can operate more accurately and safely.” He emphasized, “However, it can lead to a successful surgery only when the surgeon’s professional judgment and clinical experience are fundamentally supported.”
