Robotic Makoplasty Knee Surgery – How it Works

How robotic assisted makoplasty knee surgery works

While the thought of robotic knee surgery may seem a little like science fiction, the use of robots in the operating room is growing. I think many people really don’t understand exactly what this means. It’s time to find out.

First, robots do not operate on their own. There is no button that I push, and then step back, and watch the robot take over. In fact, the robot requires me still do most of the work. LEt’s answer two questions: What is the robot and how can it help:

What is the makoplasty robot?

The robot is essentially a small machining or cutting tool that has several three-dimensional markers on it. These markers are ‘watched’ by a computer video system in the operating room. This allows the computer to understand exactly where the cutting tool is in space down to less than 0.5mm of accuracy. While the computer can track the tools, it can also track the bones around your knee with similar markers placed during surgery. By knowing where the knee surfaces are along with the robot tools, we can precisely understand what is going to happen in the surgery on a computer screen. Think of it, for the mechanical people out there, as a machining tool, or CNC machine, the surgeon can control.

Image slices of a knee

The robot can help with planning before your surgery.

Before a robotic knee procedure, we get a CT scan of your knee, load this into a computer, and create a 3D image of you. A CT scan is a special x-ray machine that can take 100’s of images at different angles quickly. We call these slices.

Each slice can be matched up with the next to create a 3-D picture. With this, we can accurately plan where we want to put the new parts in the joint before actually doing it. We can also understand how the knee will work, and make small adjustments if needed. Again, this is all done before you ever drift off to sleep.

During the procedure, we first match up the 3D model in the computer with your knee by using a special tool to map the surface of the real bone. The computer compares this with the model it has created, and matches them up. Now we are able to make adjustments as needed to the plan in the computer. This is a key step and is best done by an experienced surgeon with the system. Next, we trim the bone just enough to put the new surfaces in place allowing the computer to keep me on track.
Once the bony shaping has taken place, the rest of the procedure is similar to traditional knee resurfacing. Implants are placed or glued into the knee by hand.
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Computer Control

With the Makoplasty knee robot, certain parts of the surgery can be controlled by computer. First, the system can help me understand how your knee moves in three-dimensional space, and I can watch this on a computer screen. Using the principals we’ve applied to knee surgery for 40 years, we can then replace the joint surfaces exactly according to the robot ‘plan’ I create.

I like to think of the robot as a coloring pen that can’t go outside the lines. The system literally will not let me make any mistakes to 0.5mm of precision.

I perform Makoplasty partial and total replacement in San Diego, California.

Stay tuned for the next post in which we will explore why we think robotic surgery is better.

Please let me know if you have questions about the technique and how it may help you.