Robot Period in Total Knee and Total Hip Prosthesis; Makoplasty

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Robotic surgery Makoplasty, used in knee and hip surgeries in Liv Hospital Ulus, provides easier, less painful, more successful and more reliable solutions. Thanks to the space technology Makoplasty used in Liv Hospital Ulus, most appropriate and most anatomic prosthesis can be applied to the knee and hip. The prosthesis applied on the patient with Makoplasty technology provides many benefits to the patient. 


Ideal Result

Computer assisted surgery forms the basis of the robotic orthopedics interventions that we use today. Main purpose is to create a virtual 3 dimensional model of the patient with MRI and computer assisted tomography, plan the intervention and even perform the virtual operation through this application. This way it is possible to present the patient the ideal result with ideal planning before the intervention. 
 

The patient goes back on their daily life much quicker.

For the patients to continue their daily life activities faster and healthier, to faster get back their functions like walking, climbing stairs, operating a vehicle after knee and hip arthroplasty operations, they require rehabilitation therapy after the operation. 
 

What is MAKOplasty?

MAKOplasty is a surgical robot system that is developed for joint prosthesis surgeries. It consists of a robotic arm that operates connected to a computer. MAKOplasty technology is designed for the surgeons to help provide a personalized surgical experience to their patients by relying on their own personal diagnosis and anatomies. 
 

Higher satisfaction

MAKOplasty method began to be used in 2007 with partial knee prosthesis and followed with total hip in 2011 and total knee prosthesis in 2016. For its accuracy and sensitivity whether in planning the surgery or in placing the prosthesis parts, it is considered as the biggest advancement since the year 1968, the year total knee prosthesis began to be applied in the world. Two of the most important factors determining the success of arthroplasty surgeries are determining the prosthesis size appropriate for the person and implementing the prosthesis fully anatomically. With MAKOplasty method, the surgeon can choose the appropriate sized prosthesis before surgery and implement this prosthesis the most accurate way during the surgery. The fact that these characteristics increase the lifespan of the prosthesis in the long term also increase the patient satisfaction in early postoperative period compared to conventional methods is supported by studies.
 

Measurement done by robotic arm during surgery

One of the most important advantages of surgeries performed with MAKOplasty are the balance and length values received live during the surgery. With the robotic measurements, the surgeon can ensure ligament balance in knee prosthesis and leg length equalization in hip prosthesis during the surgery without any errors. 
 

How does MAKOplasty work?

Pre-operative planning 

First step is patient specified surgical planning. Before the surgery, a computer tomography scan is performed to develop a three dimensional virtual model of your knee or hip joint. Your doctor uses the results to evaluate your bone structure, the severity of the disease, joint line and peripheral bone and soft tissues. MAKOplasty engineers, working together with your surgeon, prepares the surgical plan by detecting the most appropriate size, localization and line for your prosthesis with specific planning done for you through tomography sections. It means that your surgery is virtually completed before actually being completed.

During knee surgery 

Origin point of Makoplasty robot is partial knee prosthesis surgery. For these types of prosthesis to work properly, they need to fully harmonize with the site they are going to be placed in three dimensional plane. It is impossible for this to be done with two dimensional cuts performed in standard procedure. With the robotic method preparing the site where the prosthesis will be placed by sensitively sculpting it instead of cutting, fully compatible localization of the prosthesis on the bone is ensured. For the prosthesis parts to be placed in conventional knee prosthesis surgeries, the standard cut blocks are used as a guide. These blocks are placed on the bone by the surgeons taking in hand some anatomical reference points. Even a few degree of fault performed during this procedure can prevent the prosthesis parts to be fully compatible with the place they are placed. Eventually the targeted joint movement is not ensured and problems like discontentment after surgery, early wearing and loosening can occur. 
Conventional blocks are not used in the cuts realized to place prosthesis parts in the MAKOplasty method. Robotic arm gets your surgeon to execute these cuts flawlessly. It is very important that ligament balance is present in the natural movement of the knee joint. Ensuring ligament balance in knee prosthesis surgery is as important as the placement of the prosthesis. Mako delivers real-time data to your surgeon during robotic prosthesis surgeries. With the help of these data, your surgeon can continuously evaluate your new joint's movement and tension during surgery and try to reach the perfect result by adjusting your surgical plan if they wish. This way, postoperative complaints that can occur such as balance problems, looseness feeling and rattle are prevented. 
In the last term, in a scientific study conducted on comparison of MAKOplasty® robot assisted total knee prosthesis and conventional total knee prosthesis, it has been revealed that robotic prosthesis provide four times more sensitive average cut and three times more accurate implant placing.

During hip surgery 

Hip prosthesis: The part in the femur, called the "femoral stem", consists of four parts that are head section adapted to this section, the section in pelvis that we call acetabular piece, interface between the head and the acetabular piece called the "liner". For this four piece system to function properly, the parts must be placed in ideal angles. The positioning of the femoral part during surgery is relatively easy, and the acetabular section, which requires three-dimensional planning, is challenging for the surgeons. Any errors in this section may cause early wear of the prosthesis as well as dislocation of the hip.
Thanks to Makoplasty robot, the surgeon can place the prosthesis parts inside the bone flawlessly in the angles they are supposed to be. Just like in the knee, the most appropriate prosthesis size is determined by planning through pre-operative tomography, and this prosthesis determined is used during surgery. The perfect alignment of the prosthesis that is placed in the bone with the most appropriate angle eliminates the problem of dislocation.  

What should the patient expect after surgery?

After robotic prosthesis surgery, our physiotherapists accompanied by your doctors get you up on your foot and help you take your first steps. Post-operative period is completed with minimum pain with the help of routinely used epidural catheter. The patients who generally stay in the hospital for a few days have the ability to get up from the bed, go to toilet and take a stroll around the house without assistance with a rapid and effective rehabilitation program. 

Early recovery after MAKOplasty

Minimal invasive surgery; it means the surgery being performed from smaller cuts, which equals to less damage on tissues. This way the patients have less postoperative pain and mobilization can be ensured much easier. Makoplasty method provides the prosthesis to be placed with smaller cuts compared to standard surgeries. Since normal tissues are damaged less, the recovery process is shorter. The patients who feel less pain after the operation naturally consume less painkillers and this way their kidney and liver functions are preserved. The duration of staying in the hospital shortens and this way the unwanted risks such as infection are prevented. The patients can go back to their active living in a shorter time.
 

Who are the best candidates for MAKOplasty total knee and hip prosthesis?

• Ablation in articular cartilage, deformation formation in the knee, the legs taking an "O" shape by facing inwards
• Pain that is especially formed with activity in hip or knee joint and below or outside the kneecap, night pain and deterioration in sleep quality
• Hardness and limitation is joint movements, not being able to fully open or close the knee 
• Gait disturbance, shortening of healthy and painless walking distance, balance loss
• Complaints not responding to non-surgical treatments like resting, weight loss, physical treatment and anti-inflammatory medications
 

What is the physical life in prosthesis realized with MAKOplasty method?

The most important factor determining the physical life of a prosthesis after prosthesis surgery is wearing. The response of body to wearing particles forming over time can cause losses in the bone surrounding the prosthesis and loosening of the prosthesis. The more particles are formed, the more risk of loosening is present. 

Two basic ways of reducing wearing are using high technology products and place these products to ensure perfect conformity. The closer the prosthesis placement to the natural joint structure, the lower the wearing. This way wearing time and naturally the physical life of the prosthesis is extended.

MAKOplasty technology provides the most durable prosthesis that can be obtained, by achieving the perfect conformity and guarantying quality of the prosthesis.  
 

What are the advantages of MAKOplasty method? 

• Detection of most appropriate prosthesis size and localization sites with preoperative planning
• Completion of bone cuts flawlessly during surgery without using conventional cut blocks
• Ensuring perfect joint balance, which is very important for knee prosthesis surgery, with live data during the surgery
• Better and longer performing joint structure thanks to the impeccable harmony achieved
• Full fixation of natural movement gap in the joint and hip
• Maximum preservation of healthy bones and tissues
• Shorter duration of staying at hospital and more rapid rehabilitation after surgery
• Quicker recovery and returning to active life