Mako Robotic-Arm Surgical System for Precise Joint Replacement

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

Deborah Howell (Host): And welcome to the show. I am Deborah Howell, and today we'll be talking about the benefits of Mako robotic arm surgery for precise joint replacement. Our guest is Dr. Timothy Gibson, orthopedic surgeon and medical director of MemorialCare Joint Replacement Center at Orange Coast Medical Center. Welcome, Dr. Gibson.

Timothy Gibson, MD: Thanks, Deborah.

Deborah Howell (Host): Glad to have you on the show. The demand for hip and knee joint replacement is expected to rise significantly over the next decade in the US. So, Dr. Gibson, why would someone need a joint replacement surgery for their hip or their knee?

Timothy Gibson, MD: Well, the most common reason would be painful and disabling arthritis of one of those joints. And there can be a number of reasons why that would develop. Some of it's just plain wear and tear osteoarthritis. Some people have rheumatoid arthritis or an inflammatory type of disease where their body attacks itself and wears out the joint. Some have had injuries, and that's where a lot of the growth is coming from is people that have been active, kind of baby boomers who had an old meniscus tear or old ACL or ligament injury to the knee, and then they had surgery years ago, and then they went back and maintained their active lifestyle, and now then it wore out. So there's a number of reasons, but the bottom line is a joint becomes stiff, painful, and the surface, the cartilage, the shiny smooth surface becomes worn to where they need to have it resurfaced with some metal and plastic.

Deborah Howell (Host): Got it. I have to laugh because you picked my two sports injuries exactly. The meniscus tear and the ACL replacement. So I may be coming to see you.

Timothy Gibson, MD: It's in your future.

Deborah Howell (Host): It is. Oh my gosh. That was a little spooky. Okay, what is the Mako robotic arm surgical system and what benefits does it provide to the surgeon and to patients?

Timothy Gibson, MD: Well, the Mako is, it's a new way of figuring out how to put a hip or a knee replacement in more perfectly. So, there have been forms of navigation in the past where you have, you do some measurements in the surgery and then you talk to a computer and then it helps you guide, do some cuts, but you do the cuts yourself. Whereas with the Mako, we are able to do a CAT scan of either your hip or your whole leg depending on what's being done, a hip or a knee replacement. And the CAT scan gives us a full three-dimensional image of your body part before the surgery. Then in surgery, we are able to do things where we can map out your leg in the OR and then sync it to the computer so that now the computer knows where your leg is in space. So if I were to bend your hip or rotate it, the computer, I can see it on the TV screen. So I can now see your leg in three dimensions.

Deborah Howell (Host): Wow

Timothy Gibson, MD: So once we map it out, we can then, before we commit to doing anything, we can put what are called templates or guides of the femur or thigh bone piece and the tibia or shin bone piece, we can put them in position on the computer screen, stress your ligaments, put your knee through a range of motion and see where it fits best. And then so we can rotate it in three dimensions so it fits perfectly. So then once we know where it fits, we then, the computer then speaks to the robotic arm. So we sync the robotic arm to the computer. And then instead of, you know, kind of the way we used to make our cuts and then we would release ligaments to fit the box, basically. Now we can determine where we want to cut and then it's complicated, but then the computer arm tells us where to do the cuts. And we make all these decisions before based on the 3D model. So that's what's so different.

Deborah Howell (Host): It's always better to have a good roadmap, right?

Timothy Gibson, MD: Right. So the robotic arm in space knows where the leg is. If I were to bend the knee, the arm moves with it. If I were to rotate the knee, the arm moves with it. They're synced. So it's, to me it's amazing. I mean, when I first saw it, I just couldn't believe it. And I was very interested when I first saw it, then once I really saw a true live surgery, I was all in. And I think it's really the next step in how we're going to treat people with, especially the knee, but the hip it has an application also. It's really unbelievable what it can do. And every time when you're done, it just, it just seems to fit perfectly every time. So we're pretty excited.

Deborah Howell (Host): That is a true advancement. And this is the first time I really understood what the Mako machinery and capabilities really are. So thank you for that colorful and illustrative example because now I get it in my mind and I hope all our listeners do too. So what is the difference, doctor, between a partial knee replacement and a total knee replacement?

Timothy Gibson, MD: Well, a total, first of all, a total, we're not cutting out your knee and throwing it away. Some people have a perception that we're cutting out big chunks of bone. So we're resurfacing. There are three compartments of your knee. There's the inner compartment, the outer, and then under the kneecap. So on a total, you're resurfacing all three. So the total is replacing the total compartments. A partial, often people only have pain on the inside of the knee or under the kneecap or on the outside, and the other two compartments are okay. So with a partial, on select patients, and you have to select them properly, you can do a smaller operation where you only replace one-third of the joint instead of the whole thing. It's a smaller incision. I mean the pain is really not much at all. And essentially no blood loss to speak of. And it's a much more rapid recovery on the right patient. So you're doing the similar thing, only replacing that bad part, not all three parts. So some people have all three bad and you just can't do it. But if the right patient is chosen, they can do great.

Deborah Howell (Host): And what if you have two out of three?

Timothy Gibson, MD: Well, that's controversial. Some people do what's called bicompartmental, where you do a partial on two of them. So you have to be careful. Otherwise, most of the time if you have two out of the three, you'll have the total.

Deborah Howell (Host): Yeah, just for safety's sake.

Timothy Gibson, MD: Yeah.

Deborah Howell (Host): Okay. How does using Mako for a joint replacement surgery differ from conventional joint replacement surgery?

Timothy Gibson, MD: Well, part of it is just your ability to, the CT makes a big difference. You know the patient's full anatomy before you go in. And just your feedback in surgery. You have live feedback of what you're doing based on the exact anatomy in surgery. Whereas when you don't have the Mako, you have kind of jigs and rods that go up and down the femur or the tibia and you're visually looking at it. And, you know, I mean, we all who do a lot of, those of us who do a lot of replacements, you know, have done a good job over the years, but there's just so much more direct feedback immediately based on a 3D CAT scan. So you're looking at your base, you're looking at a TV screen with a 3D image of the whole leg. So that's the biggest difference is very specific anatomic feedback of exactly what you're doing.

Deborah Howell (Host): And there are also recovery benefits to the patient, I'm imagining, who has a joint replacement performed using Mako, right?

Timothy Gibson, MD: Yeah, on a hip it's not as much because the incision is kind of the same and it just gives you more accuracy. But on a knee, you can definitely, I mean, several years ago there was a trend to try to do these mini incisions for a total knee. And with that, there were complications of ligament injuries and stretching skin and wound issues and malpositioned, not putting it in right because you couldn't see. With a robot, you don't need to see as much because you're just, once you do your measurements, it can tell you where to cut. So you can do it through a smaller window. So yeah, as far as like releasing ligaments or the exposure doesn't need to be as big, so the recovery tends to be much more rapid.

Deborah Howell (Host): Do you ever have that one little thought, boy, I really got to trust this machine to tell me where to cut?

Timothy Gibson, MD: You do, but, you know, with experience, you know, you're looking at it before, you know, you're in control of the blade. The machine isn't doing anything on its own as far as advancing or, you know, the saw blade doesn't go back and forth without you pulling the trigger. So you can do your visual checks before you commit to anything. And if something seems off, you can always do it the way you used to do it. So it's really just an additional tool. The robot has no ability to do anything by itself. And it's not like the Da Vinci where the doctor is in a room next to the patient. I'm in the same spot in the room as I am on a normal procedure. I control the saw completely. It just helps to align it and it also gives boundaries where you can't cut too far to damage something. So no, we have complete control. You don't trust, the robot is not just doing its own thing.

Deborah Howell (Host): Okay, it's not Westworld. All right. Okay, now is a robotic assisted joint replacement procedure suitable for anyone who needs a hip or knee replaced? And how would you know if you're a good candidate?

Timothy Gibson, MD: Well, anybody who's having a primary or a first-time replacement, I can't think of anybody who would not be appropriate for. If you had one that was loose or infected or not doing well, a revision, then those, at least so far, it's not really ready to go out. Some people are using it for those, but it's still in its infancy. But for a first-time replacement, I think pretty much anybody would be a candidate.

Deborah Howell (Host): Got it. My last question to you, doctor. This is newly acquired technology for the MemorialCare Joint Replacement Center at Orange Coast Medical Center. Why is it so valuable to offer this treatment option for joint replacement? And also, what should you look for when searching for an orthopedic surgeon?

Timothy Gibson, MD: Well, I think what the robot shows to me and what it should show to the community, I mean, first of all, the hospital system acquired a joint replacement program a few years ago to improve quality and outcomes, where they measure length of stay, complications, blood transfusions. So that was kind of phase one, where they really wanted to improve quality. So they were dedicated to the quality. And then we're at a point where all of our results are fantastic and we have our meetings and we wonder what's next, because I think this is the next evolution of joint replacement. And it shows the commitment that the hospital system has made to the community that they're going to be on the cutting edge, pushing to provide higher quality care, and when something's appropriate, they'll spend the money. Because it was an expensive item and the hospital really committed to it. And I think it really shows a commitment to the physicians as well as the community. As far as what you're looking for in a surgeon, you know, I think somebody who has a good reputation in the community. I don't know personally how patients look up doctors' results, but just a good reputation and experience with a high volume of replacements.

Deborah Howell (Host): And someone who's a pretty good gamer, right?

Timothy Gibson, MD: It's funny, because I do arthroscopic surgeries and it makes the robot easier to use actually, because if you know how to if you can do that kind of thing, it does help.

Deborah Howell (Host): That's what I've heard. Okay, thank you so much, Dr. Gibson, for being on the show. It's been great to have you on and really informative.

Timothy Gibson, MD: Thanks for having me. I appreciate it.

Deborah Howell (Host): And I might be knocking on your door soon.

Timothy Gibson, MD: Come on in, you're on your way.

Deborah Howell (Host): Okay. For more information or to listen to a podcast of this show, please visit memorialcare.org. That's memorialcare.org. I'm Deborah Howell. Thanks for listening and have yourself a wonderful day.