Robotic-assisted hip surgery becoming a thing of the present

Robotic-assisted hip surgery is an innovation that was a pipe dream, even just 10 years ago. However, we’re now firmly at a point where it’s integral to many surgeons work. 

Leading consultant orthopaedic surgeon Mr Daniel Phillip Thomas, who was the first in Wales to implant a new hip using a robotic arm last November, tells us all about advanced Stryker Mako technology used for this procedure.  He details how it’s significantly improved the procedure for both the patient and surgeon, as well as how it works, its benefits and how long the hip implants last.  

What exactly is Stryker Mako robotic-assisted surgery?

It’s a technology developed for knee and hip replacements. It allows orthopaedic surgeons to pre-plan the procedure using the software, and then perform the operation. This is done by guiding the robotic arm to remove arthritic bone and damaged cartilage precisely, and replace with an implant that’s designed to replicate the joint.

Who is eligible for the surgery?

It’s designed for patients who have degenerative joint disease of the hip, either non-inflammatory or inflammatory. Anyone who requires joint replacement could be clinically eligible for this procedure. However, this technology isn’t available in all hospitals yet.

Does osteoarthritis a major cause of hip pain?

Yes. It’s sometimes called degenerative arthritis because it’s a ‘wearing out’ condition that involves broken down cartilage that covers the bones. When this takes place, the cushioning cartilage at the end of the femur might have worn down. This makes walking painful as bones rub against each other.

What are the pros and cons of total hip replacement surgery?

The procedure involves the removal of arthritic bone and damaged cartilage, and then replacement with hip implants designed to replicate the hip joint. The end of the thigh bone is replaced with a metal stem and an artificial ball. This ball is secured to the top of the stem. The hip socket is fitted with a metal cup lined with durable polyethylene.

Joint replacement surgery can help people in various ways.

They can return, without pain and stiffness, to everyday activities like:

• walking;
• bending;
• sleeping, and;
• driving.

There are risks, as with any surgical procedure involving anaesthetic, but these are all explained clearly beforehand. Complications can include:

• infection;
• thrombosis;
• dislocation, and;
• leg length discrepancy.

Accuracy is increased with the robotic method. Plus, it can reduce but not eradicate the risk of the last two complications above.

How do pre-surgery scans help with precision surgery?

The CT scan which is taken of the joint is used to make a 3D virtual model of the patient’s unique anatomy. It’s then loaded onto the Mako system software and used to create a personalised pre-operative plan. The patient-specific plan helps provide more accurate placement and alignment of implants during surgery.

What happens during robotically-assisted surgery?

The robotic arm is guided by the surgeon, while preparing the hip socket and positioning the implant based on the patient-specific plan. When the surgeon prepares the bone for the implant, the robotic system guides them within the pre-defined area. It also helps to prevent the surgeon from moving outside the planned boundaries.

Does the robotic arm actually perform the surgery?

No, the surgery is performed by an orthopaedic surgeon. They then use the surgeon-controlled robotic-arm system to pre-plan the procedure and to position the implant in the hip socket. The system allows the surgeon to make adjustments to leg length and tension, in order to plan the surgery as necessary.

What’s involved in recovery?

Recovery is usually quick, and patients are up and bearing weight a few hours after surgery. They should be able to return to everyday activities within a few months. The exact amount of time depends on the patient’s health and the extent of the surgery. Every patient will have different results and recovery time will vary. Often, patients that have a hip replacement can return to driving within four to six weeks.

Can knee pain be eased by a total hip replacement?

Many patients originally see their doctor with knee pain. It’s relatively common for hip pain to be referred to the knee. However, there’s usually associated hip stiffness and the knee is normal-looking and moving with no problem.

How long do the hip implants last?

Individual results vary and a hip replacement lasting a lifetime isn’t certain. You will be advised by your doctor and physiotherapists on how to best maintain your activities, in order to potentially prolong the implant’s lifespan. It’s key to maintain a healthy weight and avoid high impact activities as well.

To arrange an appointment with industry-leading and skilled orthopaedic surgeon Mr Thomas, visit his Top Doctors profile.