Robotic surgery in knee and total hip replacement surgeries is a technology that uses robotic systems in the planning and execution of surgical procedures. This technology enables surgeons to perform more precise and personalized interventions. By evaluating the patient’s anatomical structure based on 3D tomography scans, it enables the selection of the most suitable prosthesis for the individual and the placement process to be planned before surgery and controlled during surgery. With the help of robotic arms and infrared receivers, perfect bone cuts are made while ligament balance is achieved in the position closest to the natural knee. Robotic surgery offers advantages such as more accurate positioning, less soft tissue damage, and a faster recovery process in knee and hip replacement surgeries, enabling patients to regain their health quickly.

Özel Hayat Hospital Robotic Surgery Era in Knee and Hip Replacement

Özel Hayat Hospital offers easier, painless, successful, and reliable solutions with the robotic surgery method used in knee and hip surgery (the most advanced robot in the field of orthopedics). Thanks to space-age robotic surgery technology used at Özel Hayat Hospital, the most suitable and anatomically appropriate prostheses can be applied to the knee and hip. At Özel Hayat Hospital, four orthopedic specialists, including an associate professor with extensive experience in arthroplasty, are capable of performing robotic surgery procedures.

Ideal Results in Orthopedics with Robotic Surgery
Robot-assisted surgery forms the basis of the robotic orthopedic procedures we use today. The main goal is to create a virtual 3D model of the patient’s bone anatomy using computed tomography, plan the procedure, and even perform a virtual application using this model. This makes it possible to offer the patient ideal results through ideal planning prior to the procedure.

The application of robotic surgery for prosthetic surgery, compared to traditional surgery, enables patients to return to their daily activities more quickly and healthily after knee and hip prosthetic operations, and to rapidly regain functions such as walking, climbing stairs, and driving.

What are the advantages of robotic surgery in knee and hip replacement?
It is a surgical robot system developed for joint replacement surgery. It consists of a robotic arm connected to a computer. Robotic surgery is designed to help surgeons provide patients with a personalized surgical experience based on their specific diagnosis and anatomy.

Higher Satisfaction with the MAKOplasty Method
The system continues to grow in popularity worldwide and undergoes continuous development. Recently, the number of surgeries performed with this system worldwide has exceeded 1 million, and more than 1,500 robotic arm-assisted orthopedic surgical systems are actively used in approximately 34 countries. With 16 years of surgical experience, it has over 300 clinical publications and over 1,300 patents.

While the system can perform all basic arthroplasty surgeries, including total hip, total knee, and partial knee replacements, it continues to evolve, making it possible for future use in ankle, shoulder, and spinal surgeries.

Among the factors determining the success of arthroplasty surgeries, the most important are determining the appropriate prosthesis size for the individual and placing the prosthesis anatomically correctly. With the MAKOplasty method, the surgeon can select the appropriate size prosthesis for the patient before surgery and place it correctly during surgery.

How Are Measurements Taken with the Robotic Arm During Robotic Surgery?
A significant advantage of operations performed using the MAKOplasty method is the balance and length data obtained live during surgery. During surgery, the surgeon can accurately achieve ligament balance in knee prostheses and leg length equalization in hip prostheses using robotic measurements.

Pre-MAKOplasty Method Planning
The first step before surgery is to perform a computed tomography scan to develop a three-dimensional virtual model of your knee or hip joint. Your doctor uses the results to evaluate your bone structure, joint alignment, and the surrounding bone and soft tissue structures. MAKOplasty engineers also work with your surgeon to prepare the surgical plan by determining the most appropriate size, placement, and alignment of your prosthesis through customized planning based on the CT scan images. In a sense, your surgery is virtually completed before the actual procedure.

How is Robotic Knee Surgery Performed?
The starting point for the Makoplasty robot is partial knee replacement surgery. For these types of prostheses to function properly, they must fit perfectly into the area where they will be placed in a three-dimensional plane. This is impossible to achieve with the two-dimensional incisions made in standard procedures. With the robotic method, which prepares the area where the prosthesis will be placed by carefully sculpting rather than cutting, the prosthesis is positioned to fit the bone perfectly. In traditional knee replacement surgeries, standard incision blocks are used as guides for placing the prosthesis components. These blocks are placed on the bone by the surgeon, taking into account certain anatomical reference points. Even a few millimeters of error during this process can prevent the prosthesis components from fitting perfectly. As a result, the desired natural joint movement cannot be achieved, and postoperative dissatisfaction, early wear, and loosening problems may occur.

In the MAKOplasty method, traditional blocks are not used for the incisions made to place the prosthetic components. The robotic arm allows your surgeon to make these incisions with precision. Proper ligament structure is very important for the natural movement of the knee joint. In knee replacement surgery, it is as important to ensure proper ligament balance as it is to position the prosthesis correctly. During robotic prosthesis surgeries, Mako transmits real-time data to your surgeon. With the help of this data, your surgeon can continuously evaluate the movement and tension of your new joint during surgery and, if necessary, adjust your surgical plan to achieve the best possible outcome. This helps prevent post-surgery issues such as balance problems, a feeling of looseness, and clicking sounds.

In a recent scientific study comparing MAKOplasty® robot-assisted total knee replacement with traditional total knee replacement, it was demonstrated that robotic prostheses achieve four times more precise average cuts and three times more accurate implant placement.

Hip Replacement Surgery
A hip replacement consists of four parts: the femoral stem, which is the part inside the thigh bone; the head, which is adapted to this section; the acetabular component, which is located in the pelvic bone; and the liner, which is the interface between the head and the acetabular component. For this four-part system to function properly, the components must be positioned at ideal angles. While positioning the femoral component during surgery is relatively straightforward, the acetabular component poses a challenge for surgeons as it requires three-dimensional planning. Errors in this area can lead to premature wear of the prosthesis and may also cause the hip to dislocate.

Thanks to the Makoplasty robot, the prosthesis components can be placed inside the bone at the correct angles without error. Similar to knee surgery, we determine the most suitable prosthesis size for the patient through preoperative tomography planning and use this prosthesis during surgery. The prosthesis, which is placed in the bone at the optimal angle, achieves perfect alignment, thereby eliminating the risk of dislocation.

What Can Patients Expect After Robotic Prosthetic Surgery?
On the same day as robotic prosthetic surgery, our physical therapists, accompanied by your doctors, will help you stand up and take your first steps. With the help of the multimodal analgesia protocol, the postoperative process is completed with minimal pain. With a fast and effective rehabilitation program, patients who typically stay in the hospital for a few days are able to get out of bed without assistance, use the restroom, and move around the house when they are discharged.

Early Recovery After MAKOplasty
Minimally invasive surgery means that the surgery is performed through smaller incisions, causing less damage to normal tissue. As a result, patients experience less pain after surgery and can move more easily. With the Makoplasty method, the recovery period is shorter than with standard surgery because less damage is done to normal tissue. Patients who experience less pain after surgery naturally use fewer painkillers, which helps protect kidney and liver function. Hospital stays are shorter, and the risk of unwanted complications such as infection is also reduced. Patients can return to their active lifestyles more quickly.

Who are the best candidates for MAKOplasty total knee and hip replacement?
• Wear and tear of joint cartilage, formation of deformities in the knee, often causing the legs to turn inward into an “O” shape
• Pain in the hip or knee joint, under or outside the kneecap, especially during activity, night pain, and impaired sleep quality
• Stiffness and limited joint movement, inability to fully extend or flex the knee
• Gait abnormalities, reduced distance of pain-free walking, loss of balance
• Symptoms that do not respond to non-surgical treatments such as rest, weight loss, physical therapy, and anti-inflammatory medications

What is the lifespan of prostheses made using the MAKOplasty method?
The most important factor determining the lifespan of a prosthesis after prosthetic surgery is wear and tear. The body’s natural response to wear particles that form over time causes bone loss around the prosthesis and loosening of the prosthesis. The more particles that form, the greater the risk of loosening.
There are two main ways to reduce wear: using high-quality, high-tech materials and placing these materials in such a way that they fit perfectly. The closer the prosthesis placement is to the natural joint structure, the less friction there is. This extends the wear period and, consequently, the natural lifespan of the prosthesis.
MAKOplasty technology provides the longest-lasting prostheses available to our patients by ensuring both perfect fit and prosthesis quality.

What are the advantages of the MAKOplasty method?
Determination of the most suitable prosthesis size and placement during preoperative planning

• Accurate completion of bone cuts during surgery without using traditional incision blocks
• Perfect joint balance, which is very important for knee prosthesis surgery, is achieved using live data during surgery
• A joint structure that performs better and lasts longer thanks to the perfect fit achieved
• Full restoration of the natural range of motion in the knee and hip
• Maximum preservation of healthy bone and tissue
• Shorter hospital stay and faster rehabilitation after surgery
• Faster recovery and return to an active lifestyle

Are all robotic systems the same?
The characteristics and results of different robotic systems used for robotic surgery are not the same. In systems that were first introduced and recognized as active robots, the surgeon’s contribution to bone cuts is limited to the emergency stop button. Once the bone structures are defined for the robot, the robot performs all incisions on its own. These systems are not preferred today due to unwanted soft tissue complications, and such robots are not available in our country. In semi-active robotic systems, the robot prevents incisions from exceeding planned limits, but the incisions are performed by the surgeon. Examples of this group of robots in our country include the MAKO (Stryker) and Navio (Smith & Nephew) systems. In the final group are passive robots, which guide the incisions to the desired area but do not impose any restrictions, allowing the surgeon to perform the incisions as desired. An example of a passive robot in our country is the Rosa (Zimmer Biomet) system.

The differences between the three robotic systems available in our country are as follows.

Stryker MAKO system
Before surgery, a CT scan is taken of both legs, and planning is carried out on a 3D model of the joint. This model is then introduced to the robot after surgery, and incisions are made. Thanks to its haptic feedback feature, the robot provides audible and mechanical warnings as it approaches defined boundaries and does not allow it to exceed these boundaries. The system is available for total hip, total knee, and partial knee replacements. Soft tissue balance control is possible at every stage of the surgery.

Smith & Nephew Navio system
Preoperative planning is performed using X-ray images, and during surgery, certain points are introduced to the robot to create a virtual knee model, and incisions are made on this virtual model. The robot stops working when it goes beyond the desired limits, but there is no haptic feedback. There are total and partial knee replacement systems, but no hip system. Soft tissue balance control is possible.

Zimmer Rosa system
Preoperative planning is performed using X-ray images, and during surgery, specific points are introduced to the robot to create a virtual knee model, and incisions are made on this virtual model. The robot only guides the incision to the appropriate area and has no effect on the incision itself. There is no haptic feedback or limitation. The system is only available for total knee replacement.