Robotic-Arm Assisted Joint Replacement

Drs. Jeffrey Davis (left) and K. David Moore with the Mako Robotic-Arm Surgery System.

The surgeons at Andrews Sports Medicine & Orthopaedic Center are the first in Birmingham to use Stryker's Mako Robot-Arm Assisted Surgery System in total knee, partial knee and hip replacements. This robotic technology increases accuracy in joint replacement procedures.

The initial system was installed at St. Vincents Birmingham in August and has been so successful a second robot is already in use.

Surgeons Jeffrey Davis, MD and K. David Moore, MD both give the robot high marks in improving quality of care.

"I've been doing these operations for 25 years," Moore said. "And there have certainly been incremental improvements in implants and the way we care for patients, but this is the biggest step forward I've seen. After using the robot for a very short period of time, doing it the conventional way feels antiquated now. This is going to be an important step forward in terms of results and -- in all likelihood -- in how long these implants last."

"From a standpoint of reproducibility and accuracy, this beats anything we presently have," Davis said. "It provides us an opportunity to get it right nearly 100 percent of the time. Studies show that accuracy matters."

Moore agreed. "We know historically when implants are aligned appropriately, they last longer. To the degree that this allows us to be more precise, it should translate into better longevity," he said.

Davis said his first cases took 15 to 25 minutes longer with the robot, but his surgery time is coming down as he and the staff become more comfortable with the new technology. Proponents of the system say the time is neutral.

In order to use the robot technology, patients get a CT scan prior to the operation, which the doctor uses to map out a plan. At the time of surgery, the surgeon uses the CT template to confirm that plan. "That's what takes a little longer," said Davis. "You use a probe to touch the bone and tell the navigation system where the bone is relative to the CT scan."

Arrays, or sensors, are placed into the bone so the surgeon can see measurements in real time. "The saw blade then cuts exactly in the plane that was predetermined," Davis said. "I'm able to watch the screen and the soft tissue and see while I'm cutting the bone. It allows me to follow my preoperative plan within a millimeter. I'm still doing the surgery, pushing the buttons and squeezing the triggers and controlling it. The Mako is keeping me in the exact angle and plane."

Because the technology is still relatively new, there are not yet firm numbers, but early indicators reflect a quicker patient recovery. "We've made a lot of strides in the way we take care of total knee patients and manage their pain," Moore said. "It's a much better operation for the patient than a few years ago. It is early in our experience with the Mako, but in patients where I've done one knee with the robot and one without, they have almost universally preferred the robot. Because we are able to take care of some of the ligaments and balance issues almost before we start the surgery, it's easier on the patient."

Six surgeons at Andrews Sports Medicine (Drs. Cain, Davis, Emblom, McGough, Moore and Ryan) have become certified on the Mako system by performing surgery on cadavers, follow by a certification course at another surgical facility. The technology has been so well received that initial scheduling was an issue. The second robot, which was put into use in mid-November, has alleviated the scheduling delays and enables all their surgeons to more easily make use of the technology.

"We have tried to be on the cutting edge of orthopedics, whether it's sports medicine or joint replacement, for the history of Andrews Sports Medicine," said Moore. "I think the key is to do it in a careful fashion. We want to appropriately evaluate new technology before we bring it to our patients, but when something is as clear an improvement as this is, we certainly want to bring it to our patients as quickly as possible. Now we've got the benefit of experience and technology to make the best outcome."


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Andrews Sports Medicine; Andrews Sports Medicine & Orthopaedic Center; Stryker's, MD; joint replacement procedures; total knee replacement; partial knee replaceme, MD; K. David Moore
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