Prof. Dr. med. Fritz Thorey is a leading figure in the fields of hip and knee surgery and joint replacement. As a specialist in hip and knee joint replacement, as well as sports surgery and sports traumatology, he has earned an excellent international reputation. His expertise is evident not only in the numerous awards and honors he has received, but also in his daily work, during which he performs approximately 750 surgeries per year.
At the ATOS Clinic in Heidelberg, Prof. Dr. Thorey serves as chief physician at the “IZO – International Center for Orthopedics,” which has made a name for itself worldwide through its outstanding achievements in joint replacement surgery. Particularly impressive is the patient-centered care, which is the focus here. The clinic places great emphasis on close collaboration between the various departments, as well as with private practitioners and partner hospitals.
The ever-increasing demands for mobility and athleticism have also changed the requirements for joint replacement surgery. Prof. Dr. Thorey has taken on this challenge and is continuously developing innovative and muscle-preserving methods in endoprosthetics. Thanks to his work, patients can lead active and pain-free lives even after hip and knee replacement surgery.
In addition to his clinical work, Prof. Dr. Thorey is also active in research. He publishes regularly in international journals and has already been honored with numerous research awards. His research contributes to the continuous improvement of treatment methods in endoprosthetics, and patients worldwide benefit from these results.
Through his outstanding expertise and tireless dedication, Prof. Dr. Thorey has made the IZO at the ATOS Clinic in Heidelberg one of the leading centers for orthopedics. Patients from all over the world trust in the cutting-edge medical care and holistic support they receive at the IZO.
The editorial team of the Leading Medicine Guide had the opportunity to speak with Prof. Dr. Thorey specifically about robotics using the MAKOplasty system in hip and knee joint replacement.
The use of robotic technology in hip and knee joint replacement—particularly through procedures such as those performed with the MAKOplasty robot—marks a significant advance in orthopedic surgery. By enabling precise and personalized procedures, this innovative technology leads to improved patient care and long-term outcomes.
“Among the technical challenges in hip and knee joint replacement is, first and foremost, the precise placement of the prosthetic components. Incorrect alignment can lead to uneven stress on the joint and, in the long term, to complications such as loosening, instability, or premature wear of the prosthesis. Modern technologies such as computer-assisted navigation systems or robot-assisted surgery are therefore used to improve the accuracy and consistency of implant placement. Furthermore, the implants must provide an optimal fit and function, enabling the patient to achieve natural range of motion. This requires careful selection of implant designs and materials that meet the individual needs of each patient. Advances in materials science have led to implants that are durable, resilient, and biocompatible, which has improved the long-term outcomes of joint replacement surgery. It is then important to perform surgery in a way that is as gentle on the tissue as possible, which means using minimally invasive approaches. It should also be noted that the knee joint is less forgiving than the hip joint—here, a knee replacement must be inserted with even greater precision. This is also because the knee has a ligament-guided hinge joint, which presents greater challenges, whereas the hip is a ball-and-socket joint. We obtain all the necessary information for proper and successful surgical planning through X-rays, and sometimes through an MRI or CT scan. These imaging studies reveal the effects of any previous surgeries or whether the patient has deformities such as bowlegs or knock-knees. We then consider whether the use of robotic assistance is appropriate to achieve better results. If there are no misalignments, we can perform the procedure very effectively using conventional methods without robotic assistance. “For all joints that deviate from the norm, robotic assistance is generally of great benefit,” explains Prof. Dr. Thorey at the beginning of our conversation.
During and after surgery, various complications—such as infections, thrombosis, or nerve injuries—must be carefully monitored and treated. Early intervention and a multidisciplinary approach are crucial for minimizing the risk of complications and enabling successful rehabilitation.
The use of robotics with MAKOPlasty in hip and knee arthroplasty has revolutionized the possibilities of orthopedic surgery.
The MAKOPlasty system is a highly advanced, robot-assisted surgical system used in hip and knee joint surgeries. It enables the surgeon to perform procedures with exceptional precision and control. Before the surgery, a detailed 3D model of the affected joint is created based on the patient’s CT scans. This model helps the surgeon plan the surgery precisely and determine the optimal positioning and alignment of the implants. The system consists of a robotic arm equipped with specialized surgical instruments capable of performing highly precise movements. The arm is controlled by the surgeon, while the system monitors the movements in real time and corrects them as needed. This ensures exact execution of the surgical plan and minimizes errors. The MAKO software, which is part of the system, supports preoperative planning and provides continuous monitoring and adjustment of instrument movements during the procedure. This software also allows for intraoperative adjustments to respond to unexpected circumstances. A visualization unit, consisting of a monitor and the corresponding imaging systems, provides the surgeon with a clear and detailed view of the surgical field and the 3D model. This significantly improves the precision and safety of the procedure. The instrument system includes a range of specially developed surgical tools that can be attached to the robotic arm. Thanks to the high precision and improved control during surgery, surrounding healthy tissue can be better preserved and the joint’s natural range of motion maintained. This often leads to a faster recovery and better long-term outcomes for patients.
“One of the main advantages lies in the precision achieved through robot-assisted surgery. By using high-resolution imaging and precise navigation algorithms, the MAKOPlasty robots can monitor and adjust the exact placement of prosthetic components in real time. This reduces the risk of misplacement and improves the long-term stability of the implants. In knee surgery, in addition to the positioning of the joint, the preparation of the bone—where the implant will be placed—is crucial, especially when it comes to partial prostheses, known as “slide prostheses.” “These aren’t quite as easy to insert, and this is where I see the greatest advantage of robotics,” explains Prof. Dr. Thorey, describing the planning required before a robot-assisted procedure:
“The CT scan serves as the basis for planning; it is imported by a technician from the robotics company, and a preliminary surgical plan is developed, which is discussed with the surgeon shortly before the procedure. During the surgery, the CT scan is then ‘matched’—that is, aligned—with the bone so that the robot knows the exact 1:1 spatial location of the patient or the bone being operated on. Everything is also measured again during the surgery, and the expected outcome is verified. In terms of time, this is manageable. The discussion with the technician takes about 2 minutes, and we need just a few minutes to configure the robot. This negligible time delay is insignificant compared to the highly precise result that is achieved. Nor can this be compared to the effort required by, say, a Da Vinci robot, which involves many more adjustments to be taken into account. We chose the MAKO Plasty system because it is the highest-quality system available for hip and knee joint replacement, and many patients specifically come to us because they know we use it.”
“A particular challenge during surgery with MAKOplasty is that additional sensors must be attached to the joint being operated on. These must be drilled securely into the bone. This means there are additional small incisions where the probes are inserted and attached to the bone. You pay for the greater precision in joint placement, so to speak, with a slightly higher risk of soft-tissue damage, which is necessary due to the placement of the sensors. Of course, there is a theoretical risk that the bone could fracture at these sites if the procedure is not performed carefully or if the bone is already very brittle. The use of MAKO makes more sense for knee joint surgeries, which is also reflected in the statistics: “Worldwide, over 90% of knee replacements are performed using MAKO, while for the hip the figure is only 10%, since precise, X-ray-guided and conventional surgery is possible in this case,” says Prof. Dr. Thorey, who also comments on the frequency of MAKO use in Germany:
“The system has been around for ten years now, though it was initially used exclusively in the U.S. It remains to be seen whether it will become standard practice in Germany, as the system is also very expensive. In any case, we are seeing an increasing share of its use at our hospital. It is likely that the system will be used increasingly in designated centers for special cases in Germany that have the appropriate expertise. In any case, it should be organized so that knee and hip joint surgeries are performed only at facilities with a high volume of such procedures. It is unacceptable for a patient to undergo hip surgery at a hospital where only 20–50 such surgeries are performed annually—and where they are usually carried out by different doctors. Personally, I perform around 500 hip surgeries a year on my own—that’s on a whole different level. A certain degree of centralization therefore makes perfect sense. However, it would have to be organized in such a way that, in the end, those who are skilled and ensure a high level of patient safety prevail, just as in a normal competitive market.”
Postoperative rehabilitation following hip or knee replacement surgery is crucial for a successful recovery.
These measures typically include physical therapy, early mobilization, pain management, support and counseling, as well as long-term care. Physical therapy plays a central role in restoring joint mobility, strengthening muscles, and improving gait. Shortly after surgery, the patient is encouraged to move the affected joint and take their first steps to prevent complications and promote healing. Effective pain management is important to ensure the patient’s comfort and facilitate participation in rehabilitation. This may involve a combination of pharmacological and non-pharmacological approaches to effectively control pain. During the rehabilitation phase, patients receive support and guidance from an interdisciplinary team consisting of physicians, physical therapists, nurses, and, if necessary, psychologists. This team is there to answer questions, alleviate fears, and support the patient on their path to recovery. Postoperative rehabilitation does not end with discharge from the hospital. Long-term care and regular follow-up visits are important for monitoring the success of the surgery, detecting potential complications early, and providing further support to the patient as needed. Overall, the more precise placement of the prosthesis and the reduced tissue trauma associated with robotic surgery can lead to a faster recovery and improved outcomes. The type and duration of rehabilitation do not differ depending on whether the surgery was performed with or without MAKO.
Outlook
“One thing the MAKO system cannot yet handle is revision surgery. That will certainly come in the future and would make perfect sense. The system is not yet approved for this purpose, not even in the U.S. Another area where MAKO will certainly be expanded in the future is its use in spinal and shoulder surgeries, and the system will undoubtedly be enhanced with AI (artificial intelligence) as well. In the Heidelberg area, we at the ATOS Clinic are the only clinic that has a MAKO system, which allows us to offer our patients high-quality care,” says Prof. Thorey optimistically, and with that, we conclude our conversation.
Thank you very much, Professor Dr. Thorey, for the interesting insights into the use of robotics in hip and knee joint surgeries!
