In Adana, Dr. Muhsin Dursun explains how he performs millimeter-precise calculations in Mako Robotic Surgery.
The Mako robotic surgical system helps in knee and hip replacement surgeries by analyzing the patient’s joint structure in three dimensions, enabling detailed calculations for bone cuts, prosthesis size, and prosthesis placement angle. Thanks to millimeter-level, personalized planning, the surgeon can execute the surgical plan prepared before the operation in a controlled and precise manner.
What is Millimetric Planning in Mako Robotic Surgery?
In knee or hip replacement surgery, simply replacing the damaged joint is not enough. The size of the prosthesis, its placement in the bone, its angle, and the amount of bone to be removed are also of great importance.
The Mako robotic surgical system allows for the three-dimensional evaluation of the patient’s joint structure, enabling pre-operative planning of these details. The surgeon can evaluate different options by making small adjustments to the prosthesis’s position and bone incisions via a computer screen.
Therefore, the phrase “millimeter-precise calculation” does not mean the robot makes decisions on its own. The calculations are performed based on data provided by the system, while the surgical plan is prepared and approved by the orthopedic surgeon.
Calculations begin with Computed Tomography.
Mako robotic surgery utilizes computed tomography (CT) scans of the patient’s knee or hip area. These images are converted into a personalized three-dimensional model showing the patient’s bone structure.
Every person’s bone structure is different. Joint angles, bone size, leg alignment, and the areas affected by osteoarthritis can vary from patient to patient.
Thanks to the three-dimensional model, the surgeon can:
- The anatomical structure of the bone,
- Areas where calcification is present,
- Leg and joint angles,
- The appropriate size of the prosthesis,
- The part of the bone that is planned to be removed
They can examine it in detail before the surgery.
The Mako SmartRobotics system uses three-dimensional IT-based planning in conjunction with haptic technology and data obtained during surgery.
How much bone needs to be cut?
In knee replacement surgery, specific sections of the damaged joint surfaces are prepared to create a suitable area for the prosthesis to be placed. The exact location and size of the incisions are planned in advance.
With the Mako system, the surgeon can evaluate the level and angle of bone cuts on a three-dimensional model. They can see before surgery how a small change in the position of the prosthesis will affect joint stability.
It helps prevent excessive bone removal.
The goal of the robotic system is not to cut as much bone as possible, but only to prepare the area determined in the surgical plan.
Mako’s haptic boundaries help the surgical instrument remain within the planned working area. This allows bone preparation to be performed according to the surgeon’s personalized plan. According to the manufacturer, AccuStop haptic technology supports working within the planned bone region using data obtained from CT images.
How are the angle and position of the prosthesis determined?
Choosing the correct size of knee replacement is just as important as the angle at which it is placed on the bone. Positioning the prosthesis in several different directions can affect joint movement and ligament stability.
The Mako system allows for the virtual placement of prosthetic components on a three-dimensional bone model. At this stage, the surgeon can determine the prosthesis’s placement;
- Its position, whether forward or backward,
- Its angle, whether inward or outward.
- Its level on the bone,
- The angle of rotation,
- Its effect on the joint space
can evaluate.
This planning is not based solely on fixed measurements. The patient’s bone anatomy and the condition of the ligaments around the knee are considered together. The Mako Total Knee system supports the evaluation of the positions of the prosthetic components in different planes through three-dimensional CT-based planning.
Joint stability can be measured during surgery.
The knee joint is not made up solely of bones. The ligaments surrounding the joint also play an important role in ensuring the knee moves in a balanced manner.
During surgery, the surgeon can assess the knee’s movement at different angles and the tension of the ligaments. This information is displayed on the system, allowing the pre-operative plan to be revised if necessary.
For example, by slightly altering the position of the prosthesis, the goal might be to create a more balanced space between the inner and outer sides of the knee.
The same measurement is not applied to every patient.
Just as a traditional garment doesn’t fit everyone the same way, a standard prosthetic design may not be equally suitable for every patient’s joint structure.
In Mako robotic surgery, planning is done according to the patient’s own anatomical data. When determining the prosthesis position, the surgeon evaluates not only the shape of the bone but also the condition of the ligaments and joint movements.
This personalized approach allows the surgery to be planned according to the patient’s actual joint structure.
Mako Robot Does the Calculation, Who Performs the Surgery?
The Mako system provides technological support to the surgeon during measurement, planning, and surgical execution. However, it is not a standalone robot that performs surgery on its own.
Surgeon;
- He examines the three-dimensional model,
- It determines the size of the prosthesis.
- He plans the bone cuts,
- It assesses joint balance.
- It controls the robotic arm.
- He inserts the prosthesis.
The Mako system helps the surgeon execute the prepared plan in a more controlled and precise manner. The robotic arm will not operate on its own unless the surgeon moves it.
Why is millimeter-precise calculation important?
In prosthetic surgery, small differences in size and angle can affect the placement of the prosthesis in the bone and the stability of the joint. Therefore, detailed planning before surgery is important.
The millimeter-level assessment offered by the Mako system;
It supports personalized prosthesis planning.
The appropriate prosthesis size and placement can be determined using a three-dimensional bone model of the patient.
Provides controlled bone preparation.
It helps the surgical instrument to work only in the area specified in the plan.
Improves the accuracy of prosthesis placement according to plan.
Bone cuts and prosthesis placement can be planned in detail before surgery. According to Stryker’s research, three-dimensional CT-based planning and haptic margins help to execute the surgical procedure more precisely according to the prepared plan.
It helps in assessing joint balance.
The balance of ligaments in different ranges of motion of the knee can be assessed during surgery, and the surgical plan can be adjusted accordingly.
Does Millimeter-Precise Planning Guarantee Surgical Success?
Robotic surgical technologies provide surgeons with valuable data during the planning and execution of surgery. However, no single device or surgical method guarantees complete success.
The success of the surgery depends on:
- The patient’s general health condition,
- Bone quality,
- The level of calcification,
- The surgeon’s experience,
- Appropriate patient selection,
- Post-operative physical therapy,
- Patient compliance with recommendations
Many factors play a role together.
The main contribution of the Mako robotic system is that it provides the surgeon with more detailed information about the patient’s anatomy and supports the controlled execution of the prepared plan.
Mako Robotic Prosthetics Planning in Adana
Not all patients with knee or hip osteoarthritis receive the same treatment. First, the patient’s pain, walking capacity, joint mobility, and limitations in daily life should be evaluated.
In Adana, when planning Mako robotic knee or hip replacement surgery, examination findings, X-ray images, and other necessary tests are reviewed together. For patients found suitable for replacement surgery, a three-dimensional model can be created using computed tomography to prepare a personalized surgical plan.
This plan allows for a detailed pre-operative assessment of bone cuts, prosthesis size, prosthesis placement, and joint stability. During surgery, the robotic arm and haptic boundaries help the surgeon to precisely execute the plan they have defined.
