Mako® Robot For Knee Replacement: Better Results?

Are you considering a total or partial (unicompartmental) knee replacement? Are you looking for information on Mako robot-assisted operations?

I’ve written this article to help you make the right decision!

♻️ Last update: July 28, 2024.
👩‍⚖️ Declaration of financial interests: none directly related to the subject. My complete declaration of financial interests is in the legal notice section.
Written by Nelly Darbois, physiotherapist and scientific editor

What is the Mako robot?

Robots for orthopedic knee surgery have been evaluated in clinical studies since the 1990s. The number of studies will increase in the 2020s, as shown in the graph below:

The Mako robot is one of the robots used for knee replacement surgery.

The robot is called Mako, after the company that originally developed it: Mako Surgical Corporation. This company is now part of the Stryker Corporation.

The term “robot” refers to a precision mechanical device that is precisely controlled by a computer. This is an operation in which the robot assists the surgeon, rather than doing everything for him or her. For example, the robot will :

• create a 3D model to determine the exact location of the joint surfaces to be replaced, based on simple imaging of your knee;
• plan where the holes are to be made in the femur bone, where the replacement is to be inserted;
• adjust the position of the implanted replacement, etc.

In doing so, we hope to :

• The medical team: reducing time and improving comfort;
• On the patient side: improved recovery, better results. We’ll take a closer look at this point later in the article.

There are other brands of robots to assist with knee replacement, such as the ROSA Knee.

Which hospitals and surgeons are equipped in France?

Hospitals and clinics regularly publicize the installation and use of the Mako robot on their websites and in the media.

According to my research, there is no list of all the facilities or surgeons equipped in France.

If you’d like to consult someone equipped with the robot, you’ll need to contact the secretariats of the orthopedic surgery departments near you one by one to find out whether they are equipped with the robot.

Here is a list of equipped facilities (last updated: July 2024):

• 06 – Nice : clinique Saint-Georges
• 13 – Aix en Provence : Hôpital privé de Provence, Clinique Axium
• 13 – Marseille: Hôpital Saint-Joseph, Clinique Juge
• 17 – Saint Georges-de-Didonne, polyclinic Saint-georges
• 30: Nimes University Hospital
• 31 : Toulouse : Médipôle Garonne clinic
• 33 – Bordeaux : Clinique Tivoli
• 34 – Montpellier: Saint-Jean clinic
• 38 – Grenoble University Hospital
• 42 – Saint-Etienne University Hospital
• 57 – Metz : Robert Schuman Hospital
• 59 – Lille : Hôpital privé / clinique la Louvière
• 62 – Berck sur mer : Institut Calot
• 69 – Hospices civils de Lyon
• 74 – Annemasse : Pays de Savoie private hospital (Ramsay Santé)
• 45 – Paris – APHP
• 80 – Sommes : Amiens-Picardie University Hospital

How much does a Mako-assisted knee replacement cost?

To my knowledge, these are mainly orthopedic surgeons practicing in sector 2 who operate with the robot. This means they can charge extra fees, which may be covered in full or in part by your complementary health insurance.

Before any operation, your surgeon is obliged to give you an estimate clarifying the cost of the entire operation: material, “labor”, consultations, examinations, hospital stay, etc.

You can then send this estimate to your mutual insurance company to find out how much you will have to pay in addition to the amount covered by your health insurance and your mutual insurance company.

According to the 20minutes.fr article, the price of a Mako operation would be €350 to €400 more than conventional knee replacement surgery (which generally costs several thousand euros).

As the rates for extra charges are not fully regulated, it’s reasonable to assume that there may be big differences depending on who you consult.

What results can you expect from robot-assisted versus non-robot-assisted surgery?

For the year 2024 alone, there are around ten academic publications summarizing published studies on the gains (or otherwise) achieved for patients when using a robot (assisted arthroplasty) versus without when fitting a knee replacement (conventional, non-assisted arthroplasty).

Efficiency of robot vs. non-robot intervention

Here’s a summary of scientific studies evaluating results with all types of robot.

Reference	What is the study about?	Conclusions
Zabat 2024	Carry out statistical analyses of data from clinical trials to see whether the results found are reliable or not	Their results call into question the robustness of conclusions about the superiority of robotic systems, meaning that robot use is not necessarily better than conventional methods based on current data.
Zhang 2024	Summarize the results of clinical trials conducted in China since 2015	Better scores on knee evaluation tests after surgery, but uncertain impact on post-op pain, functional results and cost-benefit ratio
Alrajeb 2024	Results from 7 studies including a total of 1942 patients	Post-operative anatomical alignment is better with robotics. But clinical and functional results and complication rates are similar.
Hoveidaei 2024	Results from 5 studies including 1060 people operated on with a unicompartmental knee prosthesis	Three studies found no difference in patient satisfaction after robot-assisted surgery, but two found higher satisfaction. The meta-analysis showed that robot-assisted surgery improved patient satisfaction.
Fu 2024	Results from 12 studies involving 2,863 patients (total and partial replacement)	Compared to manual surgery, robotic surgery can produce more precise prosthetic alignment, but this does not lead to better clinical results.
Hoveidaei 2024	Results from 17 studies including 1148 patients operated on with unicompartmental or total replacement	No difference in short- and medium-term patient satisfaction between conventional and robotic methods.
Sarrel 2024	Results from 21 studies	Patients who underwent robotic arm-assisted arthroplasty had shorter stays and lower 90-day care expenses.
Migliorini 2024	Results from 7 studies involving 1198 people	Post-operative anatomical alignment is better with robotics.

How I interpret this from my experience as a physiotherapist and critical reader of articles: you probably don’t recover better or faster if you’re operated on with a robot than without.

Mako’s efficiency compared to other brands

There is a study comparing the effectiveness of the MAKO vs. ROSA robot, which can also be found in France (e.g. at the Clinique du Ter in Brittany). Here are its conclusions:

Both systems are highly accurate in restoring native posterior condylar offset, joint line height and patella height in total knee arthroplasty, with no significant difference between the two robotic systems.

Put simply: there was no difference in results between the 2 robots.

The comparison did not, however, look at the functional results obtained by the patients: pain, recovery of knee flexion, length of hospital stay, etc. The results were compared with those obtained by the patients themselves.

Source : Mayne 2023

How do you know what’s best for you?

This article is simply intended to provide you with some information to help you make your decision. The surgical procedure used is just one of the criteria to be taken into account when deciding to undergo surgery.

Here are some other possible criteria:

• the proximity of consultations and hospitalization to your home;
• whether or not the surgeon is affiliated to sector 1 (with no excess fees);
• the clinic or hospital where the operation and subsequent stay will take place, including the expected length of stay and whether or not the patient will be able to go to a rehabilitation center afterwards;
• the trust you have in your doctor or physiotherapist, who may refer you to a particular practitioner, etc.

And maybe you’ll have other criteria of your own to consider 🙂 !

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That’s all I wanted to say on the subject! Any questions or comments? See you in comments!