Mako™ Robotic-Arm Assisted Technology Enhances Joint Replacement Surgery Outcomes and Patient Experience

Intro: This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here’s Deborah Howell.

Deborah Howell (Host): Hello and welcome to the show. I’m Deborah Howell, and today we’ll see how Mako, a robotic-arm assisted technology, is bringing a new level of precision to treating patients with knee and hip pain. Our guest is Dr. Andrew Wassef, an orthopedic surgeon and medical director at MemorialCare Joint Replacement Center at Long Beach Medical Center. Welcome, Dr. Wassef.

Andrew Wassef, MD: Thank you, Deborah. How are you? I appreciate you having me on the show today.

Deborah Howell (Host): Doing well, and it’s great to have you on. I want to start, if it’s okay by you, by asking: what are some of the common reasons that cause people to hold off on joint replacement surgery?

Andrew Wassef, MD: Well, I think probably one of the more common reasons is the fear of the unknown. I think educating yourself goes a long way. There are, you know, millions of people affected by painful joints, and a lot of people really wait until they are so debilitated that they've drastically decreased their activity levels due to the pain. And sometimes it's really just fear holding them back. Other reasons I think is that people are often questioning how precise the surgery is and what their outcomes will be, and they may have known someone who has had a suboptimal outcome and so they, you know, they worry that that might be the case for them as well. And so it's, I think, the natural fears and also the lack of knowledge of what's available for them.

Deborah Howell (Host): Right. And then how do you determine if someone is a candidate for joint replacement surgery?

Andrew Wassef, MD: Well, really, I think that's highly dependent on what the patient's symptoms are. I think if, you know, you're having occasional joint pain but you're still able to perform all your normal activities and you're able to live your life well, then you probably aren't a great candidate. I think people that are really good candidates are people that are really starting to become afflicted with the pain on a daily basis. And they're starting to make decisions every day based on their knee pain or their hip pain, and they're saying, "I'm not going to exercise today," or "I'm not going to go out dancing," and "I'm not going to do this." And it's really when you start changing your normal activities due to the pain on a more normal basis is I think when you're really starting to look at joint replacement.

Deborah Howell (Host): Okay, that’s a good benchmark. What advances or new technology is now available for people considering joint replacement surgery?

Andrew Wassef, MD: Well, I think over the last 50 years there's been incremental growth in the technological advances and, really, the biggest advance that we've had over the last several years has been the Mako robotic-arm assisted surgical technology. Bringing robotics into the field of surgery and drastically increasing our precision and also just our knowledge going into the surgery has really changed the way that we do surgery with joint replacements and has also changed the way our patients recover and their successful outcomes.

Deborah Howell (Host): And now for people who are undecided about surgery, how can Mako technology impact their decision-making?

Andrew Wassef, MD: Well, you know, I really think that every person who is thinking about joint replacement should always do their due diligence and really research it and understand what they are signing up for and also understand their options. So with the Mako technology, it's really taken the unknown out of the equation, which is excellent for not only us surgeons but also for our patients. The ability to know exactly what size we're putting in and exactly what the patient's anatomy is prior to the surgery gives us a very high level of confidence that we can put the prosthesis in in a perfect way to make sure that they have the most optimal outcome possible, which will hopefully equate to having a very long and, you know, active life with their joint replacement. And, really, at the end of the day, the reason for doing these surgeries is to try to, A, resolve pain and also, B, keep people active. We really want to make sure that we keep our patient population active and out of pain so that they can do all of the things that they normally enjoy doing.

Deborah Howell (Host): Absolutely. That’s called living. How is Mako enhancing the joint replacement surgery experience for patients?

Andrew Wassef, MD: For Mako, what we do prior to surgery, we obtain a CT scan. And that CT scan gives us a wealth of knowledge of the joint that we are operating on, and it actually gives us knowledge about the other joints in the body and helps give us a very, very defined roadmap of how we should proceed. The beauty of it is that we are actually able to use it in live-time surgery and make changes on our surgical plan based on what we're seeing. So it's really changed the paradigm and changed the way that we think about doing knee replacement and hip replacement surgery. I’ll say it's taken a significant degree of error out of the equation here. So the most common complications that we worry about with joint replacement surgery are now really significantly resolved with the robotics and with the Mako technology and having that information prior to surgery as well as during surgery. Still the surgeon making decisions, but we are able to really hit our target perfectly every single time. So instead of us having a day where we may not be as precise as normal, it's really we're just not seeing that anymore because every day is just as precise as the next and we're able to really, really hit our target every time.

Deborah Howell (Host): That’s pretty amazing as a patient. So what kind of outcomes are being reported after joint replacement surgery with Mako?

Andrew Wassef, MD: Well, what we first found at MemorialCare Long Beach Medical Center when we began the robotic-assisted surgeries was, A, a significant decrease in the overall pain reported by patients. We were seeing a much quicker recovery, we were seeing patients spend less time in the hospital setting, and this is actually taking, you know, patients of mine personally that I've done with and without and just comparing the ones that we did with even at the very initial beginnings of the robotics we were finding better outcomes right away. And I think that was the most shocking situation is that, you know, with most technology there's a learning curve, but with this technology, even right away, the outcomes were better, and they just continue to improve. So we're seeing patients having a quicker recovery, you know, necessitating less physical therapy and having an overall better experience with their joint replacement. And also being much more confident because they're able to really know beyond a shadow of a doubt that our measurements are extremely precise.

Deborah Howell (Host): Oh, that’s all good news. Now, is Mako only for older adults?

Andrew Wassef, MD: No, definitely not. I would actually argue that Mako is almost geared towards the younger population. You know, what we have found, especially with hip replacements and also with knee replacements, the mechanics greatly affect the longevity. And that is really important when you're talking about a total knee replacement in a 50-year-old patient. That's, we really, really want to hit the bullseye and make sure that the mechanics are perfect in order to ensure the ultimate capacity of the implant and make sure that it lasts as long as possible. And same with hip replacement; it's extremely important to have the positioning of the implants just right to really maximize the lifespan of the joint replacement. So I think there's definitely no age limit, young or old, with Mako; I think it's a technology that really, really helps everyone.

Deborah Howell (Host): That’s great. Now, you know, a lot of people both old and young believe they have to live in pain and wait for a total joint replacement. So how does Mako partial knee change that approach to the culture of joint replacement surgery?

Andrew Wassef, MD: Well, I will say that partial knee replacements historically have been, you know, looked at initially with some scrutiny because it was found that if they weren't put in really well, they tended to fail early and that was a real problem. What we've seen with the Mako robotic-arm assisted partial knee replacements - and this is actually data that is available in the registries, which mean that these are datas that are looked at by really compiling all the patients that have had surgeries and comparing - and it is very clear that the robotic-assisted partial knee replacements are far superior and have a much, much lower failure rate. What that equates to is that I'm much more comfortable telling a patient who is young and active that, "You know what? You are going to be an excellent candidate for a partial knee replacement because I know that I can put this in perfectly every single time and we can have a great result." And I think that waiting until the arthritis is so progressed is really a paradigm shift. Previously, I think we used to just accept that people will become less active and people use canes and walkers, and that was just the end of it until you really couldn't bear it. And really what we found was that there was an optimal window of opportunity for treatment at which point people had the best outcomes. And when you went far past that area and became much more debilitated, the muscles decondition, the bones decondition, and the outcomes are not as optimal as if you kind of take care of the problem before it's far gone.

Deborah Howell (Host): And this is just joint only; it’s not ligament. So, in other words, like if a person like me, I have no meniscus at all in my left knee, would a partial knee with Mako have any impact on my knee?

Andrew Wassef, MD: Well, I hope your knee, Deborah, isn't giving you too much pain. However, I would say what we see with patients who've had a meniscus surgery in the past - and have you had an arthroscopic surgery?

Deborah Howell (Host): Yes. They took out the meniscus.

Andrew Wassef, MD: Okay. And that's a very typical scenario that we find. And when you remove the meniscus - and even without removing it, once it's torn, it's really not doing its job anymore and it's a great bumper cushion and it really helps distribute weight, but once it's torn, it's no longer effective, which predisposes you to early arthritis. So people that I think are really excellent candidates for partial knee replacements are exactly your scenario where you've had a meniscus tear and a meniscus surgery and maybe did well for several years and now starting to have pain, and we find a lot of times isolated arthritis in one area. And those really are I think the perfect candidates for a partial knee replacement.

Deborah Howell (Host): I’m suddenly very happy I have your phone number, Doctor. What would you say to someone who’s avoiding joint replacement surgery?

Andrew Wassef, MD: Well, you know, I tell people all the time, a knee replacement or a hip replacement is still a large surgery. We have found ways to really minimize the pain and really increase the safety of it. And I think at MemorialCare Long Beach Medical Center we've done an excellent job of really creating the highest standard in joint replacement surgery. And really you need to take fear out of the equation and you have to understand what you want. And I think the first thing is mental acceptance and knowing that this is a surgery that is available and it's a very successful surgery that can be performed very precisely, especially with the robotic-assisted surgery, and that you should really start to research and understand the options. And, you know, once people do, I've really never had a patient that said they wish they didn't do surgery; it's usually people saying, "I wish I did my hip or knee replacement earlier."

Deborah Howell (Host): Right. And how can people learn more about joint replacement surgery options at Long Beach Medical Center?

Andrew Wassef, MD: For more information about the Mako robotic-arm assisted surgery and, really, all other joint replacement procedures at MemorialCare Long Beach Medical Center, please visit memorialcare.org/lbjointreplacement.

Deborah Howell (Host): I love it. We want to thank you so much, Dr. Wassef, for being on our show today. It’s been great talking to you and so informative.

Andrew Wassef, MD: Thank you, Deborah. Appreciate it. You have a great day.

Deborah Howell (Host): You might be hearing from me. Take care. To listen to this podcast or for more information, visit memorialcare.org/lbjointreplacement. Thanks for listening and have yourself a fantastic day.