The newspaper where I’m employed has been carrying an advert from a local hospital touting the advantages of a surgical technique called Makoplasty, which it advertises as being less invasive than traditional surgical methods.
“Come on in for a seminar on this new procedure,” the advert invites.
A comment on this seems in order, since I have recent experience with this procedure.
Makoplasty is orthopedic surgery using robotics. A machine controlled by a physician armed with a computer uses a robotic arm to do whatever it is it’s supposed to do, and supposedly does it with great precision, efficiency and effectiveness.
In my case, the procedure was a partial knee replacement. And in my case, this was done at the hospital that now is running the Makoplasty advert.
Four years ago, I underwent a total knee replacement using the traditional method – the knee is opened with a 12-inch incision and the surgeon goes to work manually. This is not easy stuff, but I worked at recovery and was home in 36 hours and out hiking Scotland’s moors, without discomfort, in four weeks.
Two months ago I had a partial replacement in my remaining knee done by the same surgeon and at the same hospital, but this time using Makoplasty. I was home in about 30 hours. But recovery has been very difficult indeed, with discomfort levels that remain much higher and more prolonged than I experienced in my previous surgery.
What got me thinking about all this, I think, was this business of Makoplasty supposedly being “less invasive.”
Yes, the incision required for this procedure is much smaller than for the older type procedure – 4 inches longitudinally atop the kneecap instead of 12. But Makoplasty also required, at least in my case, a pair of small incisions above and below the knee, four in total. I’m not sure, but I suspect that each pair were for a drain and a camera, two pairs. The traditional surgery did not require these.
As far as I can tell, that’s the big difference – those four small incisions and the shorter major one. Once the knee is open and visible, the surgeon still has to grind away material to resurface the ends of the joint and prepare those ends to accept whatever appliance he’s installing in the knee. What does it matter how this is done? What does it matter if this is done by a robot or by hand and eye? However you slice it, it’s still somebody in there grinding away, filing away, on your bones. There will be consequences of this.
As I’ve noted, my recovery from this procedure has been nowhere nearly as rapid as recovery from the older, supposedly more invasive, procedure. Mind you, I continue to have complete faith in my surgeon, one of the very best in the business. It’s just that knee surgery is tough.
So here’s my take: If you’re pondering knee replacement and your physician says he/she plans to use Makoplasty, be aware. Makoplasty may indeed have its advantages. It may indeed work wonders for some people. I do not think it did that fo rme,. But reduced invasiveness - I mean really, truly, reduced invasiveness - that isn’t one of them. That, I think, is corporate hype.
If I had it to do over again, knowing what I now, I think I’d have lobbied for use of the traditional method for my partial replacement, the method in which a very skilled orthopod like mine does everything by hand. I don’t know if that would have aided my recovery. But I doubt it would have been much worse.
-JFT
