Total Hip Replacement surgery has come a really long way since its beginning. More than 450,000 total hip replacements are performed annually in the U.S. according to the Agency for Healthcare Research and Quality. Hip replacements are one of the types of operations that have changed a lot since its first inception. The earliest recorded attempts at hip replacement occurred in Germany in 1891, with results presented at the 10th International Medical Conference. Back then, ivory was used as a replacement tool, and since then, many things have changed in the process. In the modern age, hip replacement surgeries increasingly leverage robotic arms to assist in surgeries for precision and optimal outcomes.

Today, we’re going to look at the history of hip replacement surgery and how the surgery has changed over the years. We’re going to look at modern hip replacement, its benefits, results and what your options may be if you are currently in need of this operation.

History of Total Hip Replacement Surgery

In 1981, for patients whose hip joints had been destroyed by tuberculosis, professor Themistocles Glück presented the use of ivory to replace femoral heads in the hip. After this, in the 19th and 20th centuries, surgeons experimented with interpositional arthroplasty and specifically in placing various tissues (such as fascia lata, skin, pig bladders submucosa) between hip surfaces of arthritic hip joints. It wasn’t until 1925 that American surgeon Marius Smith-Petersen created the first-ever mold arthroplasty. This technique creates a new contact surface in the joint by using a hollow hemisphere that fits over the femoral head, and his mold arthroplasty was made of glass. Even though glass is a biocompatible material, its fragility could not handle the forces of the hip joint and was found to shatter. This lead Smith-Petersen and then Philip Wiles to turn toward stainless steel matched with bolts and screws, to hold it into place on the joint.

The first-ever metal-on-metal prosthesis was used in 1953 by English surgeon George McKee. While this method proved itself effective, it grew unpopular by the mid-1970s because of the local effects of metal particles found during revision surgery for prosthetic failure. The modern total hip replacement surgery didn’t come around until the 1960s coined by orthopedic surgeon Sir John Charnley who worked at the Manchester Royal Infirmary. His low friction arthroplasty consisted of three parts: a metal femoral stem, a polyethylene acetabular component and acrylic bone cement – which was borrowed from that of dental practice. In principle, this method is almost identical to the prostheses used today. Beyond the prosthesis used in today’s surgery sessions, the technology behind the hip replacement process has grown as well. This kind of surgery has since begun to use robotic arm assistance to get the best possible results for patients. This is a method called Mako Robotic Arm surgery and is used by a handful of the nation’s leading orthopedic surgeons.

The Introduction of Mako Technology in Hip Replacement

Integrated Orthopedics specializes in Mako Robotic-Arm Assisted Replacement Surgeries. In 2004, Mako Surgical was started and founded by Rony Abovitz, Maurice Ferre M.D, and other members of Z-KAT, Inc. team. Together, this team was developing a novel haptic robotic system for medical applications. One example of this was their Whole Arm Manipulator which was first developed at MIT and then at Barrett Technology. This creation led them to their design and fabrication of the Mako Robotic Arm. In 2006, Martin Roche, M.D, performed the very first MAKOplasty Partial Knee Replacement Procedure. This company hit major milestones and completed giant achievements within its first year of commission, and by 2008, the team had performed 500 MAKOplasty procedures. By 2009, they had performed 1000. And by 2012, they had performed more than 23,000 procedures.

In total hip replacement surgeries using Mako SmartRobotics, a robotic-arm assisted surgery machine uses three principal elements to perfect the process and to create better outcomes for patients in need. These three elements are the use of 3D CT-based planning, AccuStop haptic technology, and insightful data analyses.

Mako has become a highly trusted surgery method and has achieved some high accolades:

• Over 14+ years of robotic-arm assisted surgery in experience with Mako SmartRobotics.
• Over 145+ published, peer-reviewed articles and studies have been published about the surgery system and its success.
• In over 26 countries and every state in the contiguous United States, over 850 systems have been installed and used for this practice.
• 1,000+ United States and foreign patents and patent applications have been established.
• More than 300k+ Mako procedures have been performed, at this time.

Beyond the accolades above, Mako has also received awards for the work it has done over the past years, since its start. Here are some of their awards and accolades throughout their beginning years:

• 2010- Research and Development Magazine R&D: Robotic 3D Visualization Surgical Tool Award for their RIO Robotic Arm Interactive Orthopedic System.
• 2010- Gold Medical Design Excellence Award
• 2010- South Florida Business Journal: The Fast Tech Award for being one of the fastest-growing technology companies in South Florida
• 2011- Deloitte: No.1 on the Technology Fast 500 as the fastest growing technology company.
• 2011- South Florida Business Journal: Fast Tech Award as one of the 25 fastest-growing technology companies in South Florida.
• 2011- Technology Services Industry Association: CSSEC Award for loyal, customer-focused staff members presented.
• 2011- MarketTools: ACE Award (Achievement in Customer Excellence).
• 2012- South Florida Manufacturers Association: South Florida Manufacturer of the Year.

How Does Mako Robotic Total Hip Replacement Surgery Work?

But how does Mako robotic hip surgery work? Is it safe and is it recommended? Why would robots be involved with replacement surgery? Total Hip Replacement is done by removing the arthritic or damaged hip bone and cartilage and replacing it with an implant to reduce pain and restore motion and functionality of the hip, leg and surrounding joints.

In Mako Total Hip Replacement Surgery, the surgeon has to begin with a full CT scan of the hip joint. This is done by collecting many different X-rays taken at various angles that can assist surgeons to see what they wouldn’t be able to with a standard or basic X-Ray procedure. This data collected from the CT scan is used to generate a 3D model of the patient’s unique anatomy.

Then, the surgeon will create a preoperative plan. The pre-operative plan is created from the 3D model they created, by loading it into the Mako system’s software. While this plan is automated by the system, it is also revised and looked over by the surgeon to ensure everything is correct and ready to go. In surgery, the surgeon locates points on the patient’s hip to load them into the Mako system, just as the 3D model was used for planning and in comparison to the joints on the 3D model.

Once the anatomy is fully registered to the 3D model, the surgeon can modify the plan, if desired. The surgeon uses the robotic arm as a tool, guiding it to remove the arthritic bone and cartilage on the hip during surgery. After this is done, the surgeon inserts the implant (a 3D Printed Titanium Acetabular Component hip implant) into the joint of the hip. The surgeon will analyze the movement allowed by the implant and if it is up to their expectations, the patient can begin their recovery journey.

3D Printed Titanium Acetabular Component Hip Implant

Some implants have the opportunity to wear out faster than others, so it is important that the surgeon uses the newest and best resources. Integrated Orthopedics uses 3D Printed Titanium Acetabular Component hip implants, which are often called “the gold standard” in not only innovation but also in outcomes for total hip replacement surgeries. Here are three reasons why they are highly recommended:

• 3D printed titanium acetabular component hip implants are early in-growth meaning the implant successfully grows into the bone. This results in a more stable and lifetime-lasting implant, as compared to other implant options.
• To match the natural shape of the femur bone for a consistent fit, this type of hip implant is made of hydroxy-appetite (HA) coated, dual-tapered titanium stem.
• Because the bone has grown into or onto the implant, they are not often prone to loosening.

Bikini “Barely There” Anterior Approach

Integrated Orthopedics’ Dr. Jacob Adams is one of few surgeons who specialize in using the direct anterior approach while combining this approach with the cosmetically appealing “bikini incision” method. Other surgeons might offer:

• Traditional posterior approach: This approach is an incision on the outer thigh, closer to the patient’s bottom. 
• Traditional anterior approach: This approach is an incision on the middle of the thigh, pretty center to a patient’s leg or slightly more forward, toward the patient’s pelvis.

The Bikini “Barely There” Anterior Approach is a special option and is highly recommended to patients because it is an incision on the crease between the thigh and pelvis, near the bikini line. This incision can barely be seen on the body because of the leg’s natural curvature and lines. It is also an easier incision, and eventually a cosmetically appealing scar, to cover up, even when wearing the most revealing clothing items, like swimsuits or underwear. The bikini approach is also beneficial to the patient because it is a muscle-sparing approach. This incision does not cut through any muscle but instead goes through the natural intervals between the muscles. And unlike a traditional approach, no staples or sutures are necessary.

Mako total hip replacement is also known as “Cut Less.” In studies, it has been shown that Mako surgeries result in less bone loss and soft tissue damage, reduced post-operative pain and greater preservation and upkeep of bone stock. Mako AccuStop haptic technology is used to guide and make exact cuts while procuring preciseness, meaning that soft tissue and healthy bone can be saved and preserved. 

Patient Recovery

Mako Total Hip Replacement has statistically better and more comfortable recovery for patients. In clinical studies, Mako hip replacement surgeries resulted in:

• More accurate placement and alignment of hip implants based on the surgical plan, as compared to other forms of total hip replacement operation.
• Less likelihood of hip dislocation later in a patient’s life.
• Reduced blood loss, overall.
• Replication of the feeling of a natural hip, as compared to those who received non-MAKO hip replacements.
• Preservation of healthy bones, as aforementioned.

Mako replacement surgery is specifically intended for patients suffering from osteoarthritis, traumatic arthritis, or avascular necrosis, rheumatoid arthritis, or post-traumatic arthritis. These patients often have severe pain or stiffness, and MAKO was made to help this. For those who haven’t benefited from medication, bracing, and joint fluid supplements and are ready to find their next step in treatment, Mako replacement surgery might be perfect.

It’s important to discuss with your physician if you are a candidate for Mako, as some conditions may make it a less viable option such as: neuromuscular disorders, specific infections, prosthesis fixation failure, those who have experienced complications with postoperative care of any sort in the past, or patients who have compromised bone stock in their body or skeletal immaturity. Additional possible contraindications include those with severe instability in their leg joints or those with excessive body weight. Before deciding if Mako is right for you, have a consultation with your doctor to look over your unique and vast medical history.

Ultra Modern Hip™ Replacement

At Integrated Orthoepdics, Dr. Jacob Adams, MD has taken the advancements in total hip replacement surgery as step further and developed the Ultra Modern Hip™ Replacement. This cutting edge approach combines the latest advancements in hip replacement surgery including: 

• Direct Anterior Approach: The “bikini” incision technique referenced earlier in this article that results in a cosmetically appealing barely there scar. 
• Mako Robotic Assisted Hip Replacement: Leveraging the Mako techology discussed in this article for superior precision and outcomes over traditional hip replacement surgery.
• State of the Art Implants: The use of 3D Printed Titanium Acetabular Component hip implants, the gold standard in innovation and outcomes for total hip joint replacement.

Learn more about the Ultra Modern Hip™ Replacement here. 

Schedule A Consultation Today

Integrated Orthopedics offers total hip replacement surgery through Dr. Jacob Adams, MD, a board-certified orthopedic surgeon. Dr. Adams is specifically trained in using the Mako system for Mako robotic assisted total hip replacement surgery. In your initial consultation, he will discuss all of your options and will take a look at what path is best for you, based on your unique anatomy and your medical history. It is very important that you talk to a specialist before making your choice to use Mako SmartRobotics for your surgery, because there are many variables that should be looked at before the surgery is set. Schedule a consultation with Dr. Adams today.