February 8, 2022

Mako SmartRobotics: The Latest Surgical Technology in Hip and Knee Replacement

Central Indiana Orthopedics recently hosted a webinar where orthopedic surgeons Drs. Brent Damer and David Graybill discussed hip and knee arthritis, treatment options and the benefits of Mako SmartRobotics™ robotic-arm assisted technology, the latest in hip and knee replacement surgery.

CIO was the first orthopedic practice in the region to utilize Mako SmartRobotics for hip and knee replacement, and we are proud of our leadership in providing state-of-the-art and personalized care to all of our patients. To date, we’ve helped over 1,000 patients get back to doing what they love with Mako-assisted surgeries.

Although Mako technology has been around for approximately 15 years, it’s not surprising that we receive a lot of questions about how the robot assists the surgeon during a procedure, benefits of the technology and what recovery is like after surgery. To learn more, you can read a list of the most frequently asked questions we receive about Mako, or you can watch the full webinar below.

(Dr. Graybill begins with a history of Mako/CIO, and then discusses arthritis, hip anatomy and hip replacement. At 20 minutes, Dr. Damer discusses knee anatomy and knee replacement, and at 37 minutes he discusses recovery after surgery.)

What is Mako SmartRobotics™?

Mako SmartRobotics is an innovative surgical tool for many suffering from painful arthritis of the knee or hip and enables our patients to have a more predictable experience when undergoing joint replacement surgery. The technology combines 3D CT-based planning software with AccuStop haptic technology, so the surgeon can know more about the patient’s anatomy before and during surgery, and only allows the surgeon to cut within pre-planned guidelines, preserving tissue and saving healthy bone.

What are the benefits of Mako joint replacement?

The main benefits include:
1. Implants are placed in a perfect anatomic position for each patient, enabling better post-surgical movement and flexibility
2. The surgeon is able to cut less bone, which causes fewer trauma and reduced risk of surgical complications
3. With fewer trauma, the patient typically experiences less pain, uses less pain medication and in general recovers quicker

Does the robot actually perform the surgery?

No. The surgeon operates the robot while the robot guides the surgeon’s cuts. During surgery, the surgeon references to a computer screen as a guide. The robot will not allow the surgeon to operate outside of the predetermined boundary.

What is the process of a Mako procedure?

First, we obtain a CT scan of the affected joint prior to surgery, which allows the surgeon to have an exact 3D replica of the affected joint. That CT data is loaded into the robot prior to surgery for the surgeon to plan the procedure. Once in surgery and the joint has been exposed, the surgeon uses a process called registration, which links the patient’s anatomy live to the CT scan loaded in the computer. It involves touching the bone around the joint in about 40-50 spots with a small device that the robot can see, and registering those points. The points on the bone that have been identified tell the robot more about the patient’s unique anatomy. The surgeon is able to see virtually where to make cuts, position components, etc., before actually starting the procedure. So, that’s what allows the surgeon to get the components in the perfect position, resulting in a safer procedure and minimal release of soft tissues.

What procedures can be performed with Mako technology?

Mako technology can be used for total hip and total/partial knee replacement procedures.

What conservative treatments are available to try before joint replacement surgery?

Conservative treatments to consider before surgery include oral anti-inflammatories, such as Tylenol, joint steroid injections and physical therapy.

What can I expect during recovery from a Mako joint replacement?

Although every individual is unique and every treatment plan is different, general recovery times include in-hospital recovery for 1-4 days (unless it’s performed as outpatient), daily activities may be resumed 3-6 weeks following surgery and recovery to full activity is 6-12 months.

What activities can I participate in after joint replacement?

Activities that place excessive stress on the replaced joint should be avoided, such as skiing, running, contact sports, basketball and jumping.

How long has Central Indiana Orthopedics been using Mako technology?

CIO was the first orthopedic practice in the region to utilize Mako technology with our first robot installed in our Muncie outpatient surgery center in 2016 and a second robot installed in our Fishers outpatient surgery center in 2019. As the orthopedic surgeons of Ascension St. Vincent Anderson and Fishers hospitals, our surgeons use the robots they purchased in 2020 (Fishers) and 2021 (Anderson).

Can the procedure be performed as outpatient?

Absolutely. We’ve been performing Mako hip and knee replacement as an outpatient procedure since our first robot was installed in 2016. Should our patients need a joint replacement in a hospital setting, we can perform those procedures at Ascension St. Vincent Anderson and Fishers Hospitals.

What surgeons at Central Indiana Orthopedics are certified to perform Mako procedures?

The following board-certified orthopedic surgeons are certified in Mako technology: Drs. Brian CamilleriRyan CieplyBrent DamerDavid GraybillJoseph JermanP. Jamieson Kay, Thomas Salsbury and Nimu Surtani.

What training is required for a surgeon to become certified in Mako technology?

Every surgeon who wants to operate using Mako technology must complete additional training, which typically includes hands-on training in a lab operating on cadavers, and completing classwork. Most importantly, a surgeon who is certified in Mako technology is already a trained joint replacement surgeon and performs numerous traditional joint replacements per year.

How do the risks compare between a Mako joint replacement and a traditional joint replacement?

Essentially, the risk profile is the same between a Mako robotic procedure and traditional joint replacement procedure.

What is considered a successful result?

With any joint replacement, we would consider a successful result to be a happy patient. Our goal is for the patient to return to the activities they loved doing prior to when the joint became arthritic and painful.

Is there an additional charge to insurance for Mako procedure?

Patients will not see any additional charge for the Mako procedure, as it is charged the same as a traditional joint replacement.

How will I know I’m ready for surgery?

At CIO, we tell our patients: when you’re ready to get your joint replaced, you’ll know. You’ll be miserable enough that you just can’t stand it. You’ll find yourself avoiding things you really like to do, such as walking significant distances, stair climbing, trouble with sleep, stopping hobbies. We understand that surgery can be a difficult decision, so we let the patient make that decision, which typically comes after conservative treatment has already been tried. Our goal with any surgery is to get the patient back to what they loved doing before the joint became arthritic and painful.

How can I learn more or schedule an appointment?

If you are interested in learning more about Mako technology, visit ciocenter.com/mako/. To schedule an appointment, call 800-622-6575 or Chat with us at ciocenter.com.