MIS "Minimally Invasive Surgery" and Robotics
High-Tech Tools for your Surgeon

Components of Computer-Assisted Robotic Surgery

• Navigation: Advanced computer-assisted surgical solutions that greatly enhance the precision and accuracy of hip and knee replacement surgeries.
  
  
• Robotics: Thru computer-assisted surgery, surgeon obtains 3-D visualization allowing greater visibility, corrective alignment and balance of the implant joint.

Joint replacement surgery with the aid of a Navigation System helps improve the results of your procedure. The System empowers surgeons to accurately fit new implant components specifically to the anatomy of the body, potentially giving you:

• More exact implant placement
• Extended life of the implant
• Optimal joint positioning which restores mobility
• Decreased possibility of a revision surgery
• Faster recovery
• Improvement in your quality of life

Navitrack® Navigation System (ORTHOsoft)

Think of a Navigational System as an assistant to surgery, providing your surgeon with extra support and guidance. The System helps your surgeon more precisely align your knee implant with computer imaging. Most importantly, with a Navigational System your surgeon is able to better optimize the implant’s alignment according to the structure of your body.

Computer-Assisted Surgery also facilitates Minimally Invasive Surgery (MIS) because it acts as an extension of the surgeon’s eyes and hands. It helps surgeons operate more effectively through a smaller incision.

Minimally Invasive Hip Surgery: A Patient's Perspective Listen to BoneSmart® Founder Richard Warner's radio interview in which he discusses his experience with both Minimally Invasive Robotic Assisted Hip Replacement and traditional Hip Replacement surgeries. Listen to Richard

Robotic Assistance and Partial Knee Replacement

MAKO Surgical Tactile Guidance System (TGS™) (MAKO Surgical Corp.)

Recently, the FDA has approved the use of robotic guidance systems to assist your surgeon with removing and resurfacing only the arthritic part of a knee without sacrificing your entire knee joint. This "least invasive" procedure is performed through a 2-3 inch incision and allows your surgeon to preserve as much of your natural bone and tissue as possible. For patients with only unicompartmental osteoarthritis, this can be a good alternative to total knee replacement. As one of the least invasive knee surgeries performed, this procedure offers a smaller incision, less scarring and blood loss, a shorter hospital stay and the ability to return to everyday activities much sooner than with traditional knee replacement surgeries.

Facilities Incorporating Robotic Assistance

JFK Memorial Hosp. incorporates the MAKOPlasty Surgical Guidance System

JFK Memorial Hospital in Indio, California offers partial knee replacement patients (unicompartmental osteoarthritis) the latest in available technology with the MAKOPlasty computer-assisted robotic system.

Minimally Invasive Surgery Commentaries

Patient Expectations: Faster Recovery & Less Discomfort

Research in musculoskeletal science has brought about revolutionary changes in the ability to deliver high quality life-altering joint replacement procedures. Recent advances have introduced better bearing materials to reduce wear and greatly increase serviceable life. These new materials have been improved to such a degree that many young and active patients can avoid revision of their prosthesis for the rest of their lives. Better designs have increased stability and function so the implant also feels more natural to the patient.

Recent trends have focused on improved rehabilitation and pain management to accelerate post-surgery recovery. Employing new surgical techniques to reduce the size of the incision and damage to underlying structures has been the primary advance toward this goal. These new techniques are known as MIS or Minimally Invasive Surgery. While these improvements have a real theoretical advantage, there are several things to keep in mind. First, at 3 months following surgery, there seems to be no difference in the comfort and function of patients having conventional surgery and those having an MIS procedure. With limited visibility afforded to the surgeon, MIS techniques have a risk of increased complications including sub-optimal device placement. This can negatively impact the long term-success of the replacement as well as it’s short-term function.

As such, patients need to be open minded and have an appreciation that optimally placed implants trump a fast recovery time. In joint replacement procedures the surgeon must negotiate his/her way through or around muscles and tendons and then cut away bone from the hip or knee and a replacement implant is attached to the bone. Make no mistake, this is not minimally invasive surgery. It is actually MAXIMALLY invasive and is probably the source of the vast majority of post-operative discomfort. My philosophy is to do the surgery as safely and as effectively as possible through the smallest incision possible. With that I would suggest that we refer to replacements performed through small incisions as Minimal Incision Surgery. This is probably the most accurate assessment of our current techniques and should temper patient expectations that these procedures will give you the hip or knee you had 20 years ago a week after the surgery. Although recoveries are much faster these days, the body does require some time to make repairs. Stressing those repairs before an adequate degree of healing has occurred may jeopardize the long-term success of the implant, or, more commonly, serve to disappoint a patient with expectations that are too high.

Jonathan P. Garino, MD
Associate Professor
University of Pennsylvania School of Medicine

A Surgeon's Perspective: Minimally Invasive Hip & Knee Surgery

Hip and knee replacement using minimally invasive surgery (MIS) methods is of keen interest to surgeons and patients.  Improvements in technique and surgical instrumentation allow today’s surgeons to insert prosthetic hip and knee joints using shorter skin cuts with less surgical trauma, resulting in fewer days spent in the hospital.  Patient demand and competitive pressures on surgeons have almost guaranteed that MIS techniques are the future.  What should you, as a prospective patient, know about MIS hip and knee replacement surgery to make a safe and appropriate choice for yourself?   

You should know that MIS hip and knee replacements are still in evolution.  Accurate information and data are hard to come by.  Patients usually learn about these techniques on promotional web sites, from companies who advertise implants directly to consumers, and from local surgeons claiming to be “the first” to perform a certain operation.  In truth, hip and knee replacement, and the surgical techniques associated with them have been around for decades.  Today, we have better implants, improved instruments, computer navigation technology, and vastly improved anesthesia techniques that have radically changed joint replacement surgery.  But very few, if any, surgeons today can truly claim to be the first to perform a surgical procedure.

And, despite the improvements mentioned above, the risks of surgery remain a reality.  MIS hip and knee replacement do not eliminate risk.  In fact, surgery with a shorter incision can introduce new risks and complications.  Unless the surgeon has particular interest, training, and experience in MIS hip and knee replacement, it is best to stick with traditional techniques, despite the longer recovery time.  The key goal that cannot be compromised is the excellent proven outcome of prosthetic hip and knee replacement for the patient.  What is the point of minimally invasive surgery if you need another operation soon after the first?

Our goal is to disseminate honest and complete information on the pros and cons of minimally invasive surgery as it relates to hip and knee replacement.  In experienced hands, these procedures have superb short term outcomes, with faster recovery, less pain, and shorter down time.  But not all surgeons can deliver these results.  Research the issue, ask questions, speak with your surgeon, carefully weigh your options, ask more questions, kick the tires, and make a decision.  In the years to come, implants, surgeons, and techniques will change ever faster, delivering more benefits, more risk, more promise, and better ultimate outcomes to patients.  MIS hip and knee replacement will be with us for a long time.  Let us know how we can help you make an informed choice.

B. Sonny Bal MD, MBA
Associate Professor, Department of Orthopaedic Surgery
at the University of Missouri Health Sciences Center

Your next step: Discuss these options with your surgeon, or use our Clinic Locator to find a orthopedic clinic in your area.

We also invite you to visit our Public Forum to discuss options and share experiences with others.

A note about Manufacturers and their Products The BoneSmart® mission is to provide consumers with easy to understand un-biased information about joint replacement materials and patient options. However, it is important to note that each of the major manufacturers of joint replacement implants promote variations in design that make each of their products unique in some fashion. We encourage you to spend some time exploring manufacturer product offerings via their respective websites. Use the information you obtain from this research to discuss with your surgeon which particular implant might be best for you. The major joint implant manufacturers are: Biomet, CeramTec, ConforMIS, Inc., DJO Surgical, Wright, Stryker and Zimmer

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This website provides patient awareness as it pertains to new and enhanced materials for hip or knee implant surgery.  It is important to note that no specific implant material or procedure is right for every patient.  The purpose of knowing your implant options is so that you, the potential candidate for implant surgery, will have an awareness of your options so as to discuss these choices with your surgeon. Implant images are provided courtesy of various orthopedic manufactures and are rotated without favor from time to time. Please return periodically to this site for updates.