South Africa
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Walking without pain again after robotic-arm assisted surgery

Melanie van Heerden is back on her feet after being the first person to have Mako robotic-arm assisted surgery at Netcare Blaauwberg Hospital, in the Western Cape.

“I dreaded going to the shops before I had my partial knee replacement. I was in constant pain and it was stealing from my quality of life. There were so many everyday activities that became virtually impossible for me,” recalls Van Heerden.

She said she was able to get up the day after her surgery assisted by the physiotherapist and started climbing stairs on the third day after the operation.

“My recovery has been amazing, and I only used crutches for the first two weeks after the surgery on my right knee. Next year I will have a procedure on my left knee — which used to be my ‘good’ knee but it’s now my ‘bad’ knee — and then I should be able to get back to normal activities. I am looking forward to getting into jogging or competing in long-distance walking races,” she said.

Dr Mark van der Kaag, an orthopaedic surgeon practising at the hospital, performed Van Heerden's procedure in March after becoming accredited earlier this year to perform total and partial knee, as well as hip replacements, using the Mako SmartRobotics™ surgical system.

“Essentially, this robotic surgical system provides additional safeguards to ensure the surgeon only works within the dimensions required for optimal precision. I am fully in control of this highly sophisticated tool at all times, as the robotic software and hardware elements only work as guided by the surgeon through the predefined three-dimensional surgical plan,” he said.

The system combines three key components — 3D CAT scan-based planning, AccuStop technology and insightful data analytics — into one platform.

According to Netcare, internationally the Mako robotic-arm surgical system has already translated into well-described patient benefits.

“One of the advantages is that the surrounding soft tissues and bone are preserved, as the system restricts cuts only to the specific dimensions required to achieve the placement and alignment of the prosthetic joint implants to match the patient’s anatomy.”

“There are three components to the knee joint, and in Melanie’s case, it was not necessary to replace the entire knee joint, and a partial knee replacement was all that was needed. Based on the detailed data of her CAT scan, we were able to map the surgery in advance with the planning software,” said Van der Kaag.

Van Heerden said she was excited when Van der Kaag said the robotic arm assisted surgery was an option for her. “Because I believe in using up-to-date technology, it is reassuring to have this option when you go for an operation like this,” she said.

Van Heerden said she was an avid runner and competed in the Two Oceans and various half-marathons before her knee problems.

“Now seven months after my partial knee replacement, I am cycling at the gym and I am building up by walking longer distances,” she said.

Van der Kaag aligns the virtual 3D knee and surgical plan to the patient’s actual knee in theatre, which sets the boundaries the surgeon will work within.

He validates the surgical plan and makes any necessary adjustments. The robotic arm system provides detailed visual, auditory and tactile feedback to assist the surgeon in removing the damaged section of bone, and accurately positioning and aligning the implanted prosthetic component.

Van der Kaag said the more precise the fit of the implanted joint, the more comfortable and stable the knee is likely to be.

“Other potential benefits include reduced post-operative pain and shorter recovery times, so it is an ideal option for people who wish to resume their daily lives as soon as possible.”

He said the ability to position the prosthetic knee more precisely often achieves a more natural feel to the knee, and allows patients to return to most of the activities they previously enjoyed.

Netcare said it has recently introduced this advanced option for patients requiring knee replacements in the Western Cape, after the demand seen in Gauteng for Mako robotic arm assisted surgery at Netcare Linksfield Hospital, where it has been used since 2019.

Jacques Du Plessis, MD of Netcare’s hospital division, said: “Developments in robotic-assisted surgery are ushering in a new paradigm in applying world-class technology to surgery, providing greater choice in the options available for patients. We look forward to seeing mobility restored for many more people so they can enjoy improved quality of life after hip and knee replacements.”