GEORGE NEWS - A first for South Africa, Mediclinic George set the scene for the first Mako Smart Robotics arm to be used to perform a frontal hip replacement surgery under the supervision of local orthopedic surgeon, Dr Nic van der Watt.

It was a successful anterior hip replacement surgery (performed from the front of the leg), which Van der Watt conducted using the Mako Smart Robotics device. The patient, who wishes to remain anonymous, is recovering well.

Entering the hip from the front is not commonly done in hip replacements as it is a procedure with a high learning curve and technical aspects for which not many surgeons are trained.

 However, it has several benefits for the patient, and this is where the Mako device comes in. Van der Watt says the device minimises the human factor in respect of the placement of components. "With careful planning and execution, this offers reproducible results. I can now confidently recommend this surgery to my patients."

He spent a year in Belgium, where he received training in the use of the Mako at Orthopedie Roeselane and gained experience in the theatre at the AZ Delta hospital complex.

A precious parcel arrives. Dr Nic van der Watt and Carla Barton of Stryker with the Mako robotic device.

An operation with the robotic device requires considerably longer preparation time. A CT scan of the hip, providing a three-dimensional image, is done, unlike a regular procedure where an X-ray image is used.

Detailed planning is then carried out, enabling the surgeon to work very precisely - up to half a millimetre. The surgeon also benefits from real-time computer images during the surgery, meaning the components of the prosthesis can be optimally placed.

"The robotic arm provides more stability when placing the prosthesis, so the surgeon has more control. This means a better outcome for the patient's movement and a longer lifespan for the prosthesis."

Van der Watt says that although anterior hip replacement is a longer surgery than lateral or posterior approaches, a smaller incision is required, reducing scars, and there is a lower risk of dislocation. "An accurate leg length is possible, and there is no cutting of surrounding muscle tissue, resulting in faster recovery during the first few weeks. The patient can start moving earlier without restrictions."

An expert team is required for such an operation. "George Anaesthetist Group, Garden Route Radiology, a theatre team, and two representatives from the manufacturer, including a specialist in the Mako, were part of the team.

Van der Watt has used the Mako robotic arm in 37 other surgeries since it arrived in George in October of last year. It is manufactured by Stryker and was introduced in South Africa three years ago. Only 14 of these devices are available in South Africa.

It is being used in, among others, Pretoria, Johannesburg, Cape Town, Durban and Bloemfontein.

Dr Nic van der Watt during a knee replacement operation using the Mako robotic device.

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