MAKOplasty: Is a Partial Knee Replacement Right for You?
If half of your knee is worn out and painfully arthritic, one of your treatment options is to have a partial knee replacement, also known as a MAKOplasty. "MAKO" is the name of the robotic device that assists the surgeon in resurfacing the knee. This robotic-assisted technique is fairly new; however, the concept of replacing half the knee has been around since the mid 1970’s when Dr. Marmor invented the "Marmor" knee. Prior to robotic assistance, nearly 40-50% of those that had unicompartmental knee arthroplasty reported poor outcomes. The prevalence of poor outcomes did not detour the orthopedic surgeons from pursuing the concept of partial knee replacements, they just need to find a better way to do it. (1)
The advent of robots in the operating room has renewed interest in this technically demanding surgery. Robotic-assisted surgery holds the promise of better precision and accuracy which would eliminate many sources of error that caused the failure of earlier attempts to do partial knee replacements. With the advent of robotic assisted knee resurfacing, surgeons and facilities smelled money with the baby boomer generation knocking on the door.
Looking at the promotional campaign of MAKOplasty surgery is a textbook for good marketing. They prey on the demand for shorter recovery times and good-as-new expectations with statements like, "results in natural feeling knee" and "minimally invasive". The MAKOplasty marketers also feed into an individual’s desire for having something tailor-made and customized. All the while, the traditional total knee replacement is being chastised as being "less precise" and causing "significant loss of healthy tissue". It is no wonder why surgeons have people lined up to sign on the dotted line.
What does the medical research have to say about all this hype for MAKOplasty partial knee replacement? There is really not very much research about the long term or short term benefits to this new surgery. Comments like, "Further research is needed" and "not shown to improve patient outcomes" and "controversial" should really cause someone to pause before agreeing to have this done to their knee. (2) (3) One individual stated that "For these reasons, I decided to forego the partial and when I’m ready have the full knee replacement done." And there are plenty of people that are wishing they had decided the same thing instead of signing up for the MAKOplasty knee surgery because they feel worse than they did before the surgery and are even more disabled.
Although, there are also people that have had this new surgery done and are doing quite well. The risk of a poor outcome is very real indeed and the gamble may not be worth it for you. Despite what the surgeon or advertisements say, there are no guarantees that your surgery will result in a natural-feeling, good-as-new knee. Because of the lack of research, the actual odds of a good result from a MAKOplasty are unknown. Is that a gamble you are willing to make?
(1) Plate, J.; Mofidi, Ali; "Unicompartmental Knee Arthroplasty: Past, Present and Future"; Joint Implant Surgery and Research Foundation; Chagrin Falls, Ohio; August 2012
(2) Werner, S.; Stonetreet M.; Jacofsky D.J. "Makoplasty and the accuracy and efficiency of robotic-assisted arthroplasty"; Surg Technol Int., 2014 March; 24:302-6
(3) Roche M.; "Robotic-assisted unicompartmental knee arthroplasty: the MAKO experience"; Orthop Clin North Am 2015 Jan;46(1):125-31
Other articles of interest:
Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.