1. Mako-Robotic Assisted Total Knee Arthroplasty
Brian F. Moore MD
4/14/18

2. Joint replacement market
2017 US joint replacement procedural forecast1
Reference:
1. Millennium Research Group Table 16: Large-Joint Reconstructive Knee Implant Procedures, by Product Type, US, , Table 20: Primary TKA Implant Procedures, by Approach, US, , and Table 33: Primary THA Implant Procedures, by Approach, US, (Mako Total Knee Capital Deck)

3. 1 in 5 patients are currently not satisfied with their total knee replacement outcomes13
This study was based on 1703 eligible patients who underwent primary TKA from June 2001 to
December Ontario Joint Replacement Registry
Did not specify but appears physcians practice is in canada
MAKTKA-PRE-42_13895

4. Number of TKAs performed increasing exponentially
Dilemma
Number of TKAs performed increasing exponentially
Revision rate increasing in conjunction
Patient age decreasing yet expectations/demand increasing
Failure mode changing
Early revisions increasing
MAKTKA-PRE-33_12288

5. Evolution of planning & execution Orthopaedic technology
Static plan
1950s
1990s
Navigated execution
2000s
Navigated freehand power tools
MKOSYM-PRE-2_11246
Over the last 50+ years there has been an evolution in orthopedics surgery. Started with static with x-rays which is currently still used.
Moving forward into the 90s, Navigation which improved the accuracy of implant alignment, but still only represents 10% of procedures.
Stryker investigated Navigated freedhand power tools that are similar to what some of our competitors are doing with navigated burrs and cutting guides. Based on this experience, Stryker decided to go down a different path and acquire Mako.
Stryker believes Robotic Arm Assisted Surgery is the future.
2000s
Robotic-arm assisted surgery

6. Stryker's knee continuum of care
Early stage knee pain
Knee arthroscopy
Mid-stage OA
Late-stage OA
Total knee replacement
Unicompartmental knee replacement
Lateral
Medial
Patellofemoral knee replacement
Medial Bicompartmental knee replacement
Treatment
Mako is a tool that can facilitate increased opportunity to treat the right patient with the right procedure

7. Enhanced Planning Mako Total Knee
CT based 3D based model of the patient’s bony anatomy
Ability to manipulate the implant based on key anatomic landmarks
MAKTKA-PRE-33_12288

8. Dynamic joint balancing
Mako Total Knee
Dynamic joint balancing
Real time/ dynamic assessment of the patient’s ligament tension, flexion/extension gaps, limb alignment
Intra-operative adjustments can be made to the preoperative plan in both flexion and extension before bone preparation
MAKTKA-PRE-33_12288

9. Mako Total Knee Robotic-arm assisted bone preparation
Stereotactic boundaries are created that assist the surgeon in executing the femoral and tibial resections to plan
These boundaries also help protect the essential anatomic structures of the knee
MAKTKA-PRE-33_12288

10. Triathlon Total Knee System18 19 9
MAKTKA-PRE-33_12288 16 10 17 20

11. Post Op Recovery PT/OT evaluation within 4 hours of surgery
Multimodal pain control with either a Peri-articular Injection or an indwelling adductor canal block
Majority of our TKA patients are discharged to home the following day after surgery
Home Nursing and Home Physical Therapy for the first 1-2 weeks at home
4-6 weeks of outpatient Physical Therapy to reach/maintain goal ROM and quad strengthening