The macoplasty procedure is a robotic arm-assisted surgical procedure. It is mainly used for the implantation of
are used. It does not perform the operation independently, as one might assume from the term robot.
The Makoplasty merely provides valuable support before and during the operation. The robotic arm technology controls and precisely guides the surgeon's movements in the operating area, while an experienced orthopaedic surgery specialist continues to perform the operation.
The Makoplasty technology is based on
Macoplasty enables the surgeon to make bone incisions with the utmost precision. This is extremely important when implanting artificial joints.
In particular, the consideration and retention of the individual tension conditions created by the ligaments in the knee aregroundbreaking.
The reason for an artificial hip joint is often advanced osteoarthritis of the hip joint. Using macoplasty, the surgeon can machine the implant bed for the hip endoprosthesis very precisely with special milling cutters. The key factor here is the consideration of pelvic movements and the individual bone shape.
This incorporation of individual parameters helps the implants to function better and heal more quickly. At the same time, there is less discomfort compared to conventional surgical methods.
Functional units of the Makoplasty system
The Makoplasty system consists of three functional units
- Planning station,
- surgical navigation system with 3D camera and
- robotic arm with bone instruments.
Three Mako robotic arms from Stryker with various extensions. Right: Saw attachment for artificial knee joints. Center: ball milling machine for preparing the socket of a hip prosthesis. Left: fine milling machine for the high-precision implantation of sled prostheses © Stryker
Technology from the USA and Germany
The Makoplasty system was developed by the US-based Stryker Corporation, headquartered in Kalamazoo, Michigan. The company, which has been listed on the New York Stock Exchange since 1979, is responsible for the entire procedure, including the necessary instruments and computer programs.
Stryker is also responsible for the technical instruction and training of the orthopaedic surgeons who can offer Makoplasty in their clinics. In addition, a MAKO product specialist from the company accompanies every Makoplasty operation.
Following the takeover of the German implant manufacturer Leibinger, the company now has a head office in Germany. It maintains several production sites here.
Various diseases can damage the knee or hip joint to such an extent that it can no longer be treated. Patients then suffer from severe pain and restricted movement.
In such severe cases, an artificial joint can offer relief. A joint endoprosthesis allows the joint to move again without pain. The patient can lead a normal life again.
The decision to have an artificial joint is independent of whether you want to take advantage of the macoplasty procedure or prefer a conventional operation.
In a knee replacement, the surgeon must place the joint replacement in such a way that
- the ligament tension ratios on the knee,
- the leg axis and
- mobility
are optimally restored.
The precision achieved with the Makoplasty surgical procedure thanks to robotic assistance is already impressive. However, it is not the unique selling point of knee replacement with Makoplasty compared to conventional surgery. The most important advantage lies in the inclusion of the individual tension conditions in the knee.
In conventional surgery, the surgeon inserts the knee endoprosthesis according to anatomical experience. He then adapts the ligaments as closely as possible to the new knee conditions.
This implantation based on experience is no longer necessary with Makoplasty. Instead, the system calculates the optimum fit of the artificial knee joint. To do this, it measures the individual stability (unfoldability) of the ligaments. The position of the endoprosthesis is planned in such a way that the tension conditions after the operation correspond to the natural conditions before the knee arthrosis.
Compared to conventional surgery, patients can expect a faster healing process and improved function of the knee joint.
The optimal positioning of the endoprosthesis is also of the utmost importance in a hip joint replacement. The following are taken into account
- the range of motion,
- stability and
- the length of the leg.
Here too, the surgeonconventionally relies on two-dimensional X-ray images and places the endoprosthesis according to individual experience.
As with the knee endoprosthesis, Makoplasty also calculates the optimum fit when implanting an artificial hip joint. The computer includes the individual
- individual pelvic mobility (pelvic tilt when sitting and standing) and the
- bone shapes on the pelvis and thigh
are included. The calculations are also based on a three-dimensional image created using CT.
After the operation, you will benefit from faster healing and improved joint function.
Macoplasty further reduces the already low risk of complications associated with hip joint replacement, such as the risk of dislocation.
The overall macoplasty procedure consists of three steps, two of which are carried out immediately before the operation. Only the third step involves the actual operation.
Step 1: Precise assessment of the bony structures of the knee or hip joint
In the first step, a computer tomography (CT ) scan of the knee or hip joint is performed. The individual cross-sectional images are combined by computer to create a three-dimensional image of the bony structures of the knee/hip.
This image is necessary in order to fit the artificial joint optimally on the computer screen. The data forms the basis for guiding the surgical instruments and is important for determining the individual adjustments.
Step 2: Determining the individual adjustments
After the computer tomography scan has been taken, the knee replacement patient is given an anesthetic. The specialists then measure the individual ligament tensions when bending and extending the knee. For hip joint replacements, the pelvic tilt is measured while the patient is standing and sitting without anesthesia. The measurement is important for fine-tuning the alignment of the endoprosthesis.
The fine adjustment itself is carried out on the monitor. Even slight displacements and rotations of the artificial joint have an effect on
- the range of motion and the tension conditions in the knee or
- the joint stability of the hip.
The specialist thus virtually determines the optimum three-dimensional position of the joint part.
Step 3: Performing the operation
During the macoplasty, the surgeon receives feedback on the correct position of the instrument as the instruments are applied. The robotic arm enables the instruments to be positioned with an accuracy of less than ±0.5 millimeters and ±1 degree. At the same time, the surgical area can be seen enlarged on computer screens.
Thanks to these supports, the surgeon can make bone incisions or mills without damaging sensitive structures such as
ligaments.
The Makoplasty system therefore also offers major advantages in terms of surgical safety.
Aftercare following a joint replacement using the Makoplasty procedure is the same as for conventional joint replacement.
Exercise without heavy strain is very important for a speedy healing process. A healthy diet with natural and varied foods also promotes the healing process.
The surgical risks associated with a macoplasty are extremely low. They basically correspond to those of a conventional joint replacement.
Furthermore, the positions of the bony joint partners must be marked during the operation. Special marker pins are fixed in the bone for this purpose. This usually requires two small additional stab incisions (small stab-shaped incision in the skin). The radiation exposure of the computer tomography (CT) should also be mentioned.
As with any operation, there is a risk of infection: in theory, inflammatory germs can be introduced into the wound during the operation. This risk is minimized by appropriate hygiene measures in the clinics.