When arthritis leads to joint replacement, and how a robot can help

Anita performing a surgery using the MAKO

Arthritis in our knee joints is certainly nothing new. In fact, the latest figures suggest around 18% of the population experience some form of arthritis. What is new, however, is the way we’re treating it – in particular, when the patient finds their way to the operating table.

Dr Anita Boecksteiner, Orthopaedic Surgeon at St Vincent’s Private Hospital, has spent almost 20 years in private practice and has seen thousands of arthritis sufferers, and performed many operations for this disease including joint replacement surgery. “When a patient presents with arthritis, non-surgical treatment methods are explored first. When those techniques fail, we look to joint replacement.”

However, in the last few years, the method of performing joint replacement has seen the introduction of the MAKO technology – robotic-arm assisted surgery – into Australia and Dr. Boecksteiner has been at the forefront, now using MAKO in quite a widespread capacity for the past 12 months, particularly for total and partial knee replacement surgery.

When quizzed about MAKO, what it was, and how it helps, Anita explained, “MAKO technology is a high-tech planning tool and surgical guide, that helps us on the day. A CT scan of the patient, which is performed some days before, is produced in 3D, and I am able to simulate the replacement operation on that computer image – plan where I want the cuts to be, test how much bone with greater precision, that I need to remove, and match the tightness of the patient’s ligaments. I am effectively doing and testing about 90% of the operation before the patient is in theatre, and before I cut any of the bone.”

The benefits of such technology for the surgeon are really quite exciting. As Anita explained, much of it comes down to accuracy. “With traditional knee replacement surgery, complications can come from the new knee being not quite the right fit, but using MAKO technology, this variation in how the new knee is put in, is reduced. This provides a custom fit for the patient –it allows me to be much more precise.”

The primary beneficiaries of MAKO technology, however, are the patients. Anita shared, “Because patients are getting more of a custom fit and less soft tissue interference with their knee replacements, I’m seeing patients moving a lot quicker. Anecdotally, patients at 2 weeks often look and feel like they’re 4-6 weeks ahead of a traditional knee replacement recovery.”

St Vincent’s Private Hospital was the first hospital in Victoria, to have MAKO technology available, and Dr Boecksteiner was quick to adapt to the technology. She has been an advocate of its use ever since. “It’s also very stimulating for me as a surgeon. The 3D minute-by-minute feedback is extremely useful. I find using the MAKO very informative in that regard, as you’re able to learn all of the nuances of that particular patient’s anatomy: it makes the operation very interesting.”

Whilst results are at times difficult to assess immediately with new technology, all signs point north. After 6-7 years of MAKO technology being used in the USA, the results are all positive. Anita pointed out, “Partial knee replacements have been shown in studies to wear out quicker than full or total knee replacements, but the studies of Partial Knee replacements, using MAKO are showing these last longer.”

It’s amazing to think that we’ve reached the point in time when robotic technology is assisting our surgeons with important impact. It raises the question of what comes next? Dr Boecksteiner explained that, robotics are being used in performing and planning many different surgical operations in other specialties. The future remains very interesting indeed, as Anita explained, “The next piece of tech we have to look forward to are holograms! Surgeons will wear Virtual Reality glasses which display the 3D X-ray models, and our virtual manipulation of them, in front of our eyes – this technology is already out there. However, the biggest and most significant progress will most likely come when we find out how to replace and repair the damage in joints with stem cells –the precision required to do this may very well require robots too!”

Dr Anita Boecksteiner is a consultant orthopaedic surgeon, who specialises in limb and joint reconstruction treatments; of the Knee, Shoulder, Hip and Ankle/Foot, focusing on repair, reconstruction, preservation of cartilage and joint function, and effective validated surgical treatments for arthritis, sports injuries, trauma, non-unions, and congenital defects.  

Dr Boecksteiner’s consulting room is located at:
260 Moreland Road
Brunswick VIC 3056
Phone: (03) 9385 3000

Website: www.drboecksteiner.com.au