MAKO: a technical system profile

In brief

• MAKO combines preoperative CT, a patient-specific 3D model, optical tracking and a robotic arm.
• The surgeon approves the plan, registers anatomy and controls the instrument; the platform makes no clinical decisions.
• AccuStop creates a haptic boundary constraining instrument movement relative to the plan.
• Total Knee, Partial Knee and Total Hip are distinct applications; their functions and evidence cannot be pooled.

Architecture

MAKO is a family of Stryker joint-replacement applications. The FDA description of Total Knee lists a robotic arm, cutting system, optical detector, computer, software and instruments. Its defining workflow starts with CT: software reconstructs individual anatomy and the surgeon plans component size and position.

Official materials cover total and partial knee arthroplasty and total hip arthroplasty. These are not one identical process. Knee planning addresses resections, component position and balance; hip planning may include component orientation, centre of rotation, length and offset. Compatibility and indications depend on application, implant and market.

From model to theatre

In theatre, landmarks are registered and matched to the CT model. Optical tracking follows bone and instruments. The surgeon verifies registration, assesses the joint and may revise the plan. “Dynamic balancing” describes measurement and modelling support, not an autonomous selection of ligament tension.

During bone preparation, the surgeon holds an instrument connected to the arm. The haptic volume resists movement outside the approved area. This is not autonomous cutting. Exposure, soft-tissue protection, instrument control and any decision to stop or change technique remain with the surgical team.

Typical sequence

1. The indication is established clinically, outside the platform.
2. Protocol CT is reconstructed into a 3D model.
3. The surgeon creates the plan.
4. Trackers are placed and anatomy registered and verified.
5. Anatomy and balance are assessed; parameters may be changed.
6. The surgeon prepares bone inside the haptic boundary.
7. The team verifies the result and completes the operation safely.

Exact steps depend on the application version and local instructions.

Evidence and limitations

What the platform measures

MAKO links CT geometry, a component plan and tracked object position. It can display planned parameters and constrain the instrument relative to a permitted volume. These are spatial features of the operation. They do not measure pain, satisfaction, biological healing or future implant wear. Even close plan execution must be interpreted within the surgeon’s chosen strategy.

The CT model is also a representation of anatomy at a particular time. In theatre, the clinician relates it to the exposed joint and evaluates soft tissues that cannot be reduced to the bone reconstruction. If operative findings require a change, the surgeon revises the plan; preserving the original numbers is not an objective in itself.

Terminology and comparison

“Personalised planning” means calculation against individual anatomy, not a guaranteed individually superior result. A “haptic boundary” is a software-mechanical working constraint, not a substitute for vision and physical soft-tissue protection. A claim of “accurate resection” must identify the reference plan, measurement method and tolerated error.

A comparison with a CT-free platform should separate imaging burden, model construction, working-device function and supported applications. A Total Hip result cannot characterise Total Knee, and a difference in architecture is not evidence that one system is clinically better.

Team and data safeguards

The digital workflow adds checkpoints: correct patient and side, complete CT series, verified segmentation, stable references and final cut verification. These are active team tasks rather than assumed error-free background functions. If the digital display conflicts with clinical anatomy, the surgeon must follow safe verification and current manufacturer instructions.

A 2026 prospective observational study involved 55 patients at one centre treated by one surgeon. It reported 52 of 55 resections within 1 mm of plan. This is technical accuracy evidence from one series, not proof of less pain, fewer complications or revisions, or better implant survival.

MAKO requires CT, adding imaging and radiation exposure. Performance depends on image quality, segmentation, registration, stable tracking and team training. Haptic control cannot guarantee protection of every structure or eliminate error. US clearance does not demonstrate an identical configuration or availability elsewhere.

Plan accuracy is a surrogate measure. Diagnosis, anatomy, alignment philosophy, implant, experience, comorbidity and rehabilitation also influence clinical outcomes.

Common questions

Does the robot operate independently? No. The surgeon plans, guides the instrument and owns the decisions.

Is CT required? The described MAKO workflow is CT-based. A clinician determines appropriateness and protocol.

Does haptic control guarantee a better outcome? No. It concerns instrument control; outcomes need separate evidence.

Clinical context

This technical account cannot determine suitability for an individual. Patient-facing clinical information is kept separately on Zaur Ramzanovich Sulumov’s official website, while RoboOrthoClub retains an educational evidence focus.

Sources reviewed 8 August 2026; scheduled review August 2027. Author: RoboOrthoClub editorial team. Personal expert quotations require explicit approval; relevant conflicts must be disclosed.