Prof. Dr Fritz Thorey is a leading figure in the field of hip and knee surgery and joint replacement. As a specialist in hip and knee endoprosthetics, 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 prizes he has received, but also in his daily work, in which he performs around 750 operations per year.
At the ATOS Clinic Heidelberg, Prof. Dr Thorey is a senior consultant at the “IZO – International Center for Orthopedics”, which has made a name for itself worldwide through its outstanding achievements in endoprosthetics. Particularly impressive is the patient-centered care, which is the focus here. The clinic places great emphasis on close collaboration between the various specialist departments, as well as with GPs and partner hospitals.
The ever-increasing demands on mobility and physical activity have also changed the requirements for joint replacement surgery. Prof. Dr Thorey has taken up this challenge and is continuously developing innovative and muscle-sparing methods of 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 awarded numerous research prizes. His research contributes to the continuous improvement of treatment methods in endoprosthetics, and patients worldwide benefit from the results.
Through his outstanding expertise and tireless commitment, Prof. Dr Thorey has made the IZO at the ATOS Clinic Heidelberg one of the leading centers for orthopedics. Patients from all over the world place their trust in the cutting-edge medicine and holistic care they receive at the IZO.
The editorial team of the Leading Medicine Guide spoke to Prof. Dr Thorey specifically about the use of robotics with the MAKOplasty system in hip and knee arthroplasty.
The use of robotic technology in hip and knee arthroplasty, particularly through procedures such as those using the MAKOplasty robot, marks a significant advance in orthopedic surgery. Through precise and personalized procedures, this innovative technology enables improved patient care and long-term outcomes.
“One of the technical challenges in hip and knee arthroplasty is the precise placement of the prosthetic components. Incorrect alignment can lead to uneven loading of 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 offer an optimal fit and function, enabling the patient to achieve natural freedom of movement. This requires careful selection of implant designs and materials that meet the individual requirements 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 operate 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 prosthesis 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 good and successful surgical planning from X-rays, and sometimes also from an MRI or CT scan. These imaging studies allow us to identify the effects of any previous operations or whether the patient has deformities such as bow legs or knock-knees. We then consider whether the use of robotics is appropriate to achieve better results. If there are no misalignments, conventional methods without robotics work very well. “For all joints that deviate from the norm, robotic assistance is generally of great benefit,” explains Prof. Dr Thorey at the start of our conversation.
During and after the operation, various complications such as infections, thrombosis or nerve injuries must be carefully monitored and treated. Early intervention and a multidisciplinary approach are crucial to minimizing the risk of complications and enabling successful rehabilitation.
The use of robotics with MAKOPlasty in hip and knee arthroplasty has revolutionised the possibilities of orthopedic surgery.
The MAKOPlasty system is a highly advanced, robot-assisted surgical system used in hip and knee joint surgery. It enables the surgeon to perform procedures with exceptional precision and control. Before the operation, a detailed 3D model of the affected joint is created based on the patient’s CT scans. This model helps the surgeon to plan the operation 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 if necessary. This enables the surgical plan to be executed with precision and minimizes errors. The MAKO software, which forms 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 be made in response to unexpected circumstances. A visualization unit, consisting of a monitor and the relevant 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 comprises a range of specially developed surgical tools that can be attached to the robotic arm. Thanks to the high precision and improved control during the operation, the 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 the case of the knee joint, in addition to the positioning of the joint, the preparation of the bone where the implant is to be placed is crucial, particularly when it comes to partial prostheses, known as ‘sliding prostheses’. “These aren’t quite so easy to insert, and this is where I see the greatest advantage of robotics,” explains Prof. Dr Thorey, describing the necessary planning prior to a procedure with robotic assistance:
“The CT scan serves as the basic information; it is imported by a technician from the robotics company, and preliminary planning of the operation takes place, which is discussed with the surgeon shortly before the procedure. During the operation, the CT scan is then ‘matched’ to the bone, so that the robot knows exactly where the patient, or rather the bone to be operated on, is located in space. Everything is also measured again during the operation, and the expected outcome is checked. In terms of time, this is manageable. The discussion with the technician takes about 2 minutes, and we need a few minutes to adjust the robot. This negligible delay is nothing compared to the highly precise result that is achieved. Nor can it be compared to the effort required by, say, a Da Vinci robot. There are far more settings to take into account there. We opted for the MAKO Plasty system because it is the highest-quality system available for hip and knee arthroplasty, and many patients come to us specifically because they know we use it.”
“A particular challenge when operating with MAKOplasty is that additional sensors must be attached to the joint being operated on. These must be drilled firmly 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 of joint placement, so to speak, with slightly more soft tissue damage, which is necessary due to the placement of the sensors. Of course, there is a theoretical risk here that the bone could fracture at these sites if the procedure is not carried out carefully or if the bone is already very brittle. The use of MAKO makes more sense for knee joint surgery, which is also reflected in the figures: “Worldwide, over 90% of knee joints are operated on using MAKO, whereas for the hip it is only 10%, as precise X-ray-guided and conventional surgery can be performed here,” says Prof. Dr Thorey, adding a comment on the frequency of MAKO’s use in Germany:
“The system has been around for ten years, although it was initially used exclusively in the USA. 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 proportion of cases at our hospital. It is likely that the system will increasingly be found in designated centers for special cases in Germany with the relevant expertise. In any case, it should be organized so that knee and hip joint operations are only carried out where there is a high volume of such procedures. It is unacceptable for a patient to undergo hip surgery in a hospital where only 20–50 such operations are performed each year, and these are usually carried out by different doctors. Personally, I perform around 500 hip operations a year on my own; that is on a completely different scale. A certain degree of centralisation therefore makes perfect sense. However, it would have to be organized in such a way that, ultimately, those who are good and achieve a high level of patient safety prevail, just as in a normal competitive environment.”
Post-operative rehabilitation following hip or knee replacement surgery is crucial for a successful recovery.
These measures usually include physiotherapy, early mobilization, pain management, support and counseling, as well as long-term care. Physiotherapy plays a central role in restoring joint mobility, strengthening the muscles and improving gait. Shortly after the operation, 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 to facilitate their 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 advice from an interdisciplinary team comprising doctors, physiotherapists, nurses and, where appropriate, psychologists. This team is on hand to answer questions, alleviate fears and support the patient on their road to recovery. Post-operative rehabilitation does not end with discharge from hospital. Long-term care and regular follow-up appointments are important to monitor the success of the operation, detect any potential complications at an early stage and provide 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 operation was performed with or without MAKO.
Outlook
“What the MAKO system cannot yet handle are revision surgeries. That will certainly come in due course and would make perfect sense. The system is not yet approved for this, not even in the USA. What will certainly be added to MAKO in the future is its use in spinal and shoulder surgery, and the system will undoubtedly also be enhanced with AI (Artificial Intelligence). In the Heidelberg area, we at the ATOS Clinic are the only clinic to have a MAKO system, which enables us to offer our patients high-quality treatment,” says Prof. Thorey positively, 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 surgery!
