Robotics, MAKOPLASTY, and Marketing Gimmicks

MAKOPLASTY and other so-called “robotics” have yet to prove their benefit in total knee and hip replacement despite their 10-year presence in the orthopedic marketplace. Numerous studies fail to show any substantial clinical benefit for pain relief, speed of recovery or durability of total joints. Most studies that support their use are industry-sponsored and conducted by surgeons who are paid a consulting fee to use the technology. In fact, MAKO uses a 13 year old knee implant with outdated sizing options. The MAKO requires that extra holes be drilled into the bone to attach tracking instruments. This causes more pain and can, occasionally, lead to fractures of the bone through these holes..

While robotically assisted procedures have proved valuable in general surgery and urology (prostate surgery) using the DaVinci Robot, there is a world of difference between the DaVinci and the MAKO in terms of technical sophistication. The DaVinci is truly a robot: it is remote, autonomous and controlled by the surgeon distant from the surgical field. The MAKO is a hand-controlled cutting tool whose claims of  improved sizing and positioning of implants have not been borne out. It is not truly robotics.

Proponents of the MAKO rationalize the additional expenditure of thousands of dollars per case claiming “less pain and faster recovery”.This would be a clear advantage if it were true. In fact, MAKO total knees have been shown to produce more pain and a slower recovery when compared to the AVATAR approach. AVATAR patients walk out the door in less than 8 hours with over 70% able to recover in the comfort of home on the day of surgery. The vast majority of MAKO joints in our community spend at least one night in the hospital. When compared to AVATAR® recovery, MAKO recovery is  slower and more painful.

The first video shows a recent patient going home just 2 hours after a personally customized but non-robotic left total knee replacement and five months after his right total knee replacement. The second video shows another patient just two hours after a total knee replacement, up, walking and ready to head home. These are the rule, not the exception with AVATAR®.

A.V.A.T.A.R.: Alignment of Vital Assets to Accelerate Recovery.  AVATAR® is an outcomes-focused, customized approach to joint replacement that focuses on all critical aspects that promote a rapid and optimal recovery. Surgery is a complex process and surgical technique is just one of many vital pieces of the outcomes puzzle. AVATAR® works by navigating   all aspects of the surgical experience including patient education, preoperative physical preparation, customized surgery, multimodal pain management, modern anesthetic techniques, up-to-date implant systems, select physical therapy, continuous passive motion and close contact with the patient in the postoperative period. The synergy from aligning all assets that contribute to great outcomes is far more important than any single technological innovation during the surgical process.  This is how great outcomes are achieved

For “less pain and faster recovery”,  AVATAR® is superior to MAKO. Kudos to “robotics” for a great marketing gimmick. Five Pinocchio’s for science. Results speak for themselves

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