Mako Robotic Partial Knee Replacement
Learn about advanced robotic knee replacement surgery – By Dr Daniel Meyerkort – Perth Orthopaedic & Sports Medicine Centre
IS ROBOTIC KNEE SURGERY BETTER?
Robotic assisted knee replacement is a technology to allow accurate implantation of the prosthesis. Robotic assistance has been shown to be very accurate in performing bone resection compared to conventional ‘jigged’ knee replacement. Other surgical aids such as computer navigation have also been shown to allow for accurate bone cuts when compared to conventional knee replacement. As yet, clear data does not exist to demonstrate that robotic assisted knee surgery leads to better implant survival or a higher level of function. Robotic knee surgery is a semi autonomous system, so the surgeon remains in complete control of your surgery.
WHAT IS THE RECOVERY TIME FOR ROBOTIC KNEE REPLACEMENT?
The standard inpatient stay after robotic knee replacement is 2 – 4 nights after surgery. Prehabilitation with your physiotherapist is important before surgery as it has been shown patients with strong muscles have a quicker recovery, shorter hospital stay and higher level of function. The MAKO surgical robot has a ‘haptic’ boundary around the cutting tip of the robot. In cadaveric studies this has shown to lead to low levels of soft tissue damage compared to conventional knee replacement. It has been postulated that this may lead to a quicker recovery after surgery, This has not currently been demonstrated in high quality clinical trials.
IS ROBOTIC PARTIAL KNEE REPLACEMENT WORTH IT?
Robotic partial knee replacement can be a good option for relief of pain and regaining your function if you have isolated (usually medial) compartment arthritis of your knee. Robotic partial knee replacement allows for a short recovery, low levels of pain, high satisfaction and a lower rate of medical complication compared to total knee replacement. The disadvantage of partial knee replacement compared to total knee replacement is there is a higher rate of repeat surgery (conversion to total knee replacement) in the future. In my practice, partial knee replacement is a good option for patients with isolated, medial sided pain. I recommend discussion with your surgeon about the pros and cons of partial vs total knee replacement and your suitability for partial knee replacement.
WHAT IS THE BEST PARTIAL KNEE REPLACEMENT DEVICE?
Many factors are involved in successful partial knee replacement surgery. A list of all partial knee replacement prosthesis can be publicly accessible from the Australian Joint Replacement Registry. You can ask your surgeon about the expected survival of the prosthesis being used. Other factors are important in successful surgery, the most important being patient selection. Patients expected to do well from partial knee replacement surgery have isolated (usually medial) pain, an intact ACL and a good range of motion of the knee. Accurate bony cuts are also important for successful surgery. The MAKO surgical robot is able to assist in performing accurate bone cuts for insertion of your partial knee replacement.
IS IT BETTER TO HAVE PARTIAL OR FULL KNEE REPLACEMENT?
It is best to have the surgery that is best suited to your knee! Benefits of partial knee replacement include low length of stay, faster recovery, lower risk of infection, lower rate of medical risks and a more ‘natural’ feeling knee due to retaining important structures such as the ACL ligament. However, if you are not suitable for partial knee replacement you are at risk of ongoing pain and dissatisfaction if your arthritis is widespread. Benefits of total knee replacement are a lower risk of repeat surgery (conversion to total knee replacement). A good discussion with your surgeon will determine if you are better suited to partial or total knee replacement.
HOW LONG WILL A PARTIAL KNEE REPLACEMENT LAST?
The best performing partial knee replacements in Australia with over 10 years follow up are the Depuy Sigma and the Zimmer Zuk. The respective success rates at 10 years are 94% and 91% respectively. This means that over 9 out of 10 patients are still functioning with their original prosthesis. The most common prosthesis being used currently is the Stryker Restoris, as the is used exclusively with the MAKO surgical robot. As this is a new technology only short term results are available. At 3 years follow up, the Stryker Restoris has a lower failure rate than the Depuy Sigma and Zimmer Zuk.
WHAT CAN I NOT DO AFTER ROBOTIC KNEE REPLACEMENT?
Robotic partial knee replacement is designed to get you back to your normal active life. You can work (including heavy manual work), walk, golf, cycle, swim, snow ski, play tennis, beach walk, bush walk and stay generally fit and active. Prolonged, high impact sport such as AFL, soccer, hockey and running are probably best avoided as will increase your risk of early implant failure.
WHEN CAN I DRIVE AFTER ROBOTIC PARTIAL KNEE REPLACEMENT?
This depends on the side of your surgery, whether your car is automatic or manual and how well you recover after surgery. As a general rule, when you can comfortably walk without crutches and are not taking strong (morphine based) pain killers you are safe to drive. This is between 4 – 6 weeks for most patients, but can be sooner.