Knee replacement surgery (also called arthroplasty) is offered to people with severe knee pain due to osteoarthritis or other conditions that affect the knee joint such as rheumatoid arthritis, gout, a knee injury or knee deformity. It is a routine and highly effective procedure that entails removing the damaged joint and replacing it with a prosthetic implant. Every year in England and Wales more than 70,000 knee replacements take place and the number is increasing all the time [1].
A total knee replacement involves removing the entire knee joint and replacing it with a prosthetic implant. With a partial knee joint, only the damaged sections of joint are replaced, leaving the remainder of the natural joint intact. The majority of total knee replacements are performed on people aged 65 plus.
Developments in knee replacement surgery
The first partial knee replacement took place in 1976 [2] after the procedure was pioneered at the University of Oxford. Since then, there have been many advances in prosthetics manufacturing to improve performance and longevity of the artificial knee joint. Modern implants are made of metal alloys, ceramic material and strong plastics. Currently, most replacement knee joints last more than 20 years and offer major improvements in quality of life to recipients.
Mako robotic-arm assisted knee replacements
There have also been major developments in surgical procedures and one of the most notable of these was the introduction of Mako robotic-arm assisted knee replacements, an innovative technology developed by Stryker. The first Mako partial knee replacement was performed in June 2006 while the first Mako total knee replacement took place in June 2016.
More than a million Mako total knee replacements have been performed since the technology was introduced 10 years ago [3] and many leading orthopaedic surgeons now offer Mako alongside conventional knee replacement surgery.
Mako total and partial knee procedures are very similar to traditional knee replacements but with some important additional benefits. Both entail cutting away damaged tissue and bone and resurfacing the joint with a prosthetic implant. However, Mako’s unique computer technology enables the surgeon to create a detailed pre-surgical plan, using a 3D model of your unique knee joint anatomy created from CT scans. During the surgery itself, Mako’s innovative robotic arm helps to guide the surgeon to stay within the pre-defined boundaries of the plan, ensuring only damaged or diseased tissue is removed.
Surveys show that Mako patients experience less post-surgical pain than with conventional knee replacement surgery. Recovery times are faster because patients spend less time in the operating theatre and there is less damage to soft tissues during surgery. Having a detailed pre-surgical plan enables precision positioning of the prosthetic implant. This results in greater comfort, improved mobility and an overall better quality of life for the patient. Consequently, satisfaction levels among Mako patients tend to be higher.
The fact that prosthetic implants do eventually wear out means that some patients will require further surgery in the future to replace the worn-out implant. This is referred to as revision knee replacement surgery and the risk of complications tends to be higher than with primary knee replacement surgery. Mako allows the orthopaedic surgeon to preserve as much of the patient’s healthy bone and tissue as possible, which is an important advantage when it comes to revision knee replacement surgery.
Choosing between Mako and conventional knee replacement surgery
While Mako knee replacement surgery offers many benefits, it is not suitable for everyone. You may not be able to have a Mako knee replacement, for example, if you are unable to have a CT scan for any reason, if you already have a knee implant, if you have had previous surgery that distorted your knee anatomy or if you have an infection or ligament damage. As with any type of surgery, it is important to understand the pros and cons and to discuss your particular circumstances with an orthopaedic surgeon so you can make an informed decision.
Professor Joseph Queally offers both conventional and Mako knee replacement surgery. Contact our team to discuss your options.
What can I expect from a Mako knee replacement?
Prior to surgery you will be given a CT scan. This will be used to create a detailed 3D virtual image of your knee from which your surgeon will develop a pre-operative plan. On the day of surgery, your knee replacement will be performed under general anaesthetic so you will be asleep throughout. After surgery you will be encouraged to stand up and walk around as quickly as possible so you can get used to your new prosthetic knee.
What is the prognosis after knee replacement surgery?
Around 90% of patients benefit from a significant reduction in pain after knee replacement surgery, according to the American Academy of Orthopaedic Surgeons.
Sources
[1] https://www.nhsinform.scot/tests-and-treatments/surgical-procedures/knee-replacement/
[2] https://www.nuffieldhealth.com/article/40-years-of-the-oxford-knee
[3] https://www.stryker.com/us/en/joint-replacement/systems/mako-total-knee.html
