Dr. Muhsin Dursun explains that the Mako robotic surgical system combines patient-specific 3D tomography planning, AccuStop haptic technology, and a robotic arm controlled by the surgeon on the same platform. While other robotic knee replacement systems like ROSA also offer precise planning and measurement support, Mako stands out, particularly with its tomography-based three-dimensional modeling and haptic structure that physically restricts the surgical instrument from going outside the planned area.
Not all robotic knee replacement systems are created equal.
When robotic knee replacement surgery is mentioned, one might think all systems work the same way. However, the imaging methods, surgical plan preparation techniques, and bone cutting control methods of robotic surgical systems on the market differ.
Mako and ROSA are advanced systems that assist surgeons in knee replacement surgery. Neither system performs the surgery independently. The selection of the prosthesis, the preparation of the surgical plan, the execution of bone cuts, and the management of the operation are all under the control of the orthopedic surgeon.
Mako’s most distinctive feature is its combination of a three-dimensional plan generated from patient computed tomography (CT) images with AccuStop haptic technology. Stryker describes the Mako SmartRobotics system as a structure that brings together 3D CT-based planning and haptic control on the same platform.
At Mako, planning begins with 3D tomography.
In the Mako robotic knee replacement procedure, computed tomography (CT) scans of the patient’s leg and knee are used. These images are then converted into a personalized three-dimensional model showing the patient’s bone structure using specialized software.
This model is not a ready-made or average knee image. It shows the patient’s own femur, tibia, joint surfaces, and anatomical features.
The surgeon is working on this three-dimensional model;
- The size of the prosthesis to be used,
- The position of the prosthesis on the bone,
- The placement angle of the prosthesis,
- The amount of bone to be removed,
- Knee deformity,
- joint spaces
They can evaluate it before the surgery.
Mako’s CT-based planning allows for surgical preparation not only with standard measurements but also with three-dimensional data showing the patient’s actual bone anatomy.
How is imaging performed in the ROSA system?
The ROSA Knee system is also a robotic platform that offers patient-specific surgical planning and in-operation measurement support.
ROSA can operate in image-based or non-image-based mode, depending on the surgeon’s preference. In image-based planning, a three-dimensional digital model can be prepared from standard X-ray images. In non-image-based use, the anatomical points of the bone are introduced to the system during surgery to create a surgical plan.
This flexibility is one of ROSA’s advantages. However, in Mako’s approach, planning is based from the outset on a detailed three-dimensional bone model created from the patient’s CT scan data.
The Difference in Imaging Between Mako and ROSA
Mako’s fundamental approach:
Computed tomography → patient-specific 3D bone model → preoperative prosthesis plan
At ROSA, however, it depends on the system and the surgeon’s preference:
X-ray-based planning or non-image planning where anatomical points are recorded during surgery.
Both methods can provide the surgeon with numerical data. Mako’s advantage is that it allows for detailed modeling of the patient’s bone anatomy via tomography before surgery.
Mako’s Most Important Difference: Haptic Boundaries
One of the key features that distinguishes Mako from many other robotic surgical systems is its AccuStop haptic technology.
Before the operation, the surgeon determines the area where the bone incisions will be made on a three-dimensional model. This plan is transferred to the robotic arm during the operation. The range of motion of the robotic arm is also limited according to this plan.
If the surgical instrument approaches outside the predetermined area, the system helps to physically restrict movement. Therefore, haptic limits are not just a warning line displayed on the screen; they create a real range of motion that the surgeon feels while using the robotic arm.
According to Stryker, AccuStop haptic technology supports the surgical instrument’s operation in a designated area based on a CT-based plan.
How does a virtual firewall work?
Haptic technology can be thought of as an invisible safety zone created around the bone.
The surgeon freely guides the robotic arm through the planned area. When the instrument moves beyond the boundary, the system restricts its movement. This helps the surgeon to execute the predetermined incision plan in a controlled manner.
The robot does not make decisions on its own or perform surgery in place of the surgeon. The haptic system is a technological control mechanism aimed at minimizing deviations from the surgeon’s planned procedure.
How are bone incisions made at ROSA?
In the ROSA Knee system, the robotic arm assists in positioning the cutting guide according to the plan created by the surgeon. The surgeon performs bone cuts based on this guidance.
ROSA’s current technologies focus on surgical planning, anatomical point identification, tracing, and positioning of the incision guide. The system can also provide data on knee stability and range of motion during surgery.
The fundamental technical difference here is this:
Week
The robotic cutting instrument, controlled by the surgeon, is used within the working area defined by haptic boundaries.
ROSA
The robotic arm provides support for positioning the cutting guide according to the plan and for taking surgical measurements.
These two systems approach the same goal using different robotic methods.
Why can Mako make bone cuts more controlled?
In knee replacement surgery, the level and angle of the bone to be removed are crucial. An incision that is too large or made at the wrong angle can affect the position of the prosthesis and the stability of the joint.
At Mako, bone cuts are planned on a three-dimensional tomography model before surgery. The surgeon can assess potential outcomes beforehand by slightly altering the placement of the prosthesis or the level of the incision.
During surgery, haptic technology helps the surgical instrument to work only in the designated bone region.
The combination of these two elements constitutes Mako’s core strength:
See first
The patient’s bone anatomy is examined using a three-dimensional tomography model.
Then Plan
Prosthesis size, placement, and bone cuts are determined digitally.
Implement the plan in a controlled manner.
Haptic boundaries help the surgical instrument remain within its intended working area.
Mako is not just a measurement system.
One of the most common misconceptions about robotic surgical systems is the belief that all devices only perform measurements or navigation.
In addition to providing the surgeon with measurement data during surgery, the Mako system controls the movement of the robotic arm via haptic limits. This establishes a direct link between planning and execution.
In other words, the system doesn’t just show the surgeon “where the incision should be.” It also helps to limit the working area of the robotic instrument according to the created plan.
What are the scientific results of Mako and ROSA?
While Mako has strong technological features, it would not be accurate to say that it is “more successful than ROSA in all conditions” from a scientific perspective.
Studies comparing Mako and ROSA have reported that both systems can provide high accuracy in the placement of knee replacement components. Some direct comparisons have shown no significant difference between the two systems in terms of alignment accuracy and one-year clinical outcomes.
These findings do not negate Mako’s technological advantages. However, the information given to the patient must be honest: Mako’s superiority lies not in guaranteeing a definitively better clinical outcome for every patient, but in combining CT-based three-dimensional planning and haptic control in a powerful surgical workflow.
Key Features of Mako
3D Model Created from Real IT Data
The patient’s own bone anatomy is evaluated in three dimensions before surgery.
AccuStop Haptic Technology
The surgical instrument is physically restricted from operating outside of a predetermined bone zone.
Integration of Planning and Implementation within the Same System
The plan created before the surgery is executed via the robotic arm.
Pre-detection of Bone Cuts
The surgeon can assess the level and angle of the incisions and their effect on the placement of the prosthesis before surgery.
Maintaining Surgeon Control
Mako is not an automated surgical system. The robotic arm is guided by the surgeon, and all surgical decisions are made by the physician.
Does the Mako Robot perform the surgery on its own?
No. The Mako robotic surgical system does not perform surgery on its own.
Surgeon;
- He examines the patient’s three-dimensional model,
- Choose the prosthesis size.
- He plans the bone cuts,
- It assesses joint balance.
- It controls the robotic arm.
- He inserts the prosthesis.
Mako provides the surgeon with support in planning, measurement, visual guidance, and haptic motion restriction.
Therefore, the correct expression is not “knee replacement surgery performed by a robot,” but rather “knee replacement surgery performed by a surgeon with the assistance of a robotic arm.”
Which is the best robotic system?
A robotic system simply because it looks bigger, is newer, or has more features, doesn’t automatically translate to better patient outcomes.
In surgical success;
- Choosing the right patient,
- The surgeon’s experience with the system,
- Proper positioning of the prosthesis,
- Ensuring balance in the bonds,
- Infection control measures,
- Post-operative rehabilitation
Many factors play a role together.
Both ROSA and Mako are systems that can offer the surgeon significant measurement and planning support. Mako’s distinct technological advantage is that it combines detailed tomography-based 3D planning, a robotic arm under the surgeon’s control, and haptic cutting boundaries in a single system.
Mako Robotic Knee Replacement in Adana
In Adana, the process for patients scheduled for Mako robotic knee replacement surgery begins with a detailed orthopedic evaluation. Not every knee pain or osteoarthritis requires replacement surgery.
For patients deemed suitable for surgery, a personalized three-dimensional bone model is created from tomography images. The surgeon plans the size of the prosthesis, bone cuts, prosthesis placement, and knee balance on this model before the operation.
During surgery, the Mako robotic arm and AccuStop haptic technology help the surgeon execute their plan in a controlled manner. This allows the surgical procedure to be performed according to the patient’s own bone anatomy, rather than a standard model.
