Slide 1: Mako Total Knee 2.0 SmartRobotics Overview deck
Mako Total Knee 2.0 SmartRobotics™ Overview deck JR-MTKA-COMM-649454-Rev-1
Slide 2: JR-MTKA-COMM-649454-Rev-1
JR-MTKA-COMM-649454-Rev-1
Slide 3: Evolution of Mako SmartRobotics
Evolution of Mako SmartRobotics™ Stryker acquires First Mako Mako First Mako MAKOSurgical Total Hip Third Total Knee Mako Total Mako Total Mako Total Corporation Restoris MCK procedure Restoris generation Knee 2.0 case Hip 4.0 Hip 4.1 Partial Knee Hip Mako Partial Mako System System System Knee 3.0
Slide 4: Leading a robotics market
Leading a robotics market 120+ Mako Total Knee peer-reviewed published manuscripts 6 Mako Total Knee surgery experience 40 years 500k+ have been performed* 30 Mako Total Knee procedures 20 58% cementless mix* Robotic knee 10 54% implanted robotically* Triathlon knees 0 2017 2018 2019 2020 2021 2022
Slide 5: The experience you deserve. The outcomes you expect.
The outcomes you expect. The experience you deserve. JR-MTKA-COMM-649454-Rev-1
Slide 6: Mako Total Knee 2.0
Mako Total Knee 2.0 Control and Intuitive confidence design Triathlon New Cementless Digital Tensioner Functional knee CT-based positioning™ technology JR-MTKA-COMM-649454-Rev-1
Slide 7: Three core features Mako Total Knee 2.0
Three core features Mako Total Knee 2.0 3D CT-based planning Dynamic joint balancing AccuStop™ haptic technology JR-MTKA-COMM-649454-Rev-1
Slide 8: Mako Total Knee 2.0 Functional Knee Positioning
Mako Total Knee 2.0 Functional Knee Positioning™ + + + 3D CT-based preoperative plan Intraoperative assessment Intraoperative planning + + Tensioning AccuStop™ haptic technology Trialing (Midresection only) JR-MTKA-COMM-649454-Rev-1
Slide 9: Prioritizing surgical efficiencies
Prioritizing surgical efficiencies Mako Park Digital Tensioner Cementless Preoperative implant sizes Intuitive balancing Cut advancements Surgeon preferences JR-MTKA-COMM-649454-Rev-1
Slide 10: Setup
Setup JR-MTKA-COMM-649454-Rev-1
Slide 11: Femur pin and array placement
Femur pin and array placement Extra-incision Intra-incision JR-MTKA-COMM-649454-Rev-1
Slide 12: Tibia pin and array placement
Tibia pin and array placement Extra-incision Tibial tubercle Intra-incision Tibial keel outline JR-MTKA-COMM-649454-Rev-1
Slide 13: Planning preferences
Planning preferences • The surgeon can set their own personalized implant parameters in the surgeon preferences to customize the workflow. Resection depths and rotational limits are two examples. • If a value goes outside these bounds, a notification appears on the planning screen as a blue box arou
Slide 14: CT-based planning
CT-based planning JR-MTKA-COMM-649454-Rev-1
Slide 15: 3D CT-based planning
3D CT-based planning • Mako’s 3D CT-based planning allows you to see more of your patient’s unique anatomy and virtually plan Triathlon in the coronal, transverse and sagittal planes for each patient.1 • Functional knee positioning™ is achieved by use of the 3D CT-based preoperative plan based on th
Slide 16: Functional planning guidelines
Functional planning guidelines • The functional planning guidelines enable the surgeon to prioritize the attributes of the knee that have the most impact on function, before and after assessing the soft tissue laxities. • Follow the counterclockwise sequence on the implant planning screen to complet
Slide 17: Multiple saved plans
Multiple saved plans • The surgeon can save multiple plans within a patient’s session file and has the ability to balance each individually before choosing the final plan. • Allows surgeons to evaluate different decision-making hierarchies efficiently and simply. Plan 1 Plan 2 JR-MTKA-COMM-649454-Re
Slide 18: Bone registration
Bone registration JR-MTKA-COMM-649454-Rev-1
Slide 19: Bone registration
Bone registration • Surgeon completes bone registration on the femur and tibia by collecting points on the surface of the patient’s bones. This step confirms that the CT-based model is aligned to the patient’s anatomy within 0.5mm. JR-MTKA-COMM-649454-Rev-1
Slide 20: Deformity and laxity assessment
Deformity and laxity assessment JR-MTKA-COMM-649454-Rev-1
Slide 21: Initial Assessment
Initial Assessment • The surgeon can capture the native deformity and the corrected deformity to assess the limb, and then capture the extension and flexion laxity data. • The medial and lateral compartments in extension and flexion can be assessed together or separately; this is customizable in sur
Slide 22: New Digital Tensioner to assess ligament laxity
Mako Total Knee 2.0 features a new Digital Tensioner to assess ligament laxity • No additional instrumentation or hardware. • Medial and lateral compartment laxity in both flexion and extension can be captured independently and measured every 0.5mm. • Audible and visual guidance during ligament asse
Slide 23: Why the Digital Tensioner?
Why the Digital Tensioner? • Ligament tension can be subjective.2 • The digital tensioner has been shown to have excellent intra-user repeatability3 (ICC ≥0.96) and inter-user reproducibility3 (ICC ≥0.90)3 minimizing subjectivity and potentially leading to a more predictable surgery. JR-MTKA-COMM-64
Slide 24: Digital Tensioner – how it works
Digital Tensioner – how it works… As the surgeon applies tension to the ligaments and opens each 1 compartment, an audible and visual cue will be provided every 0.5 millimeters. As the surgeon opens a compartment, they may reference the audible cues. Once the surgeon finds the end stop of the ligame
Slide 25: Intraoperative implant adjustments
Intraoperative implant adjustments JR-MTKA-COMM-649454-Rev-1
Slide 26: Intraoperative planning
Intraoperative planning • The laxity information is transferred to the implant planning page to allow the surgeon to balance the knee. • The balancing page provides all the necessary information on one page, including the ability to balance the knee in CT view. • The surgeon can balance the knee in
Slide 27: Intraoperative planning – targets
Intraoperative planning – targets When balancing, consider the following target ranges:* • Extension medial: 0-0.5mm • Extension lateral: 0-0.5mm • Flexion medial: 0-0.5mm • Flexion lateral: 0-1mm *This is a recommendation. The deformity, flexion contracture and hyper extension of each individual kn
Slide 28: Intraoperative planning features
Intraoperative planning features Multiple plans Full limb view • Utilizing the multiple plan feature, the surgeon can • The surgeon can reference the overall limb alignment, balance the plan in different ways. native and corrected deformity values in full limb view. JR-MTKA-COMM-649454-Rev-1
Slide 29: Intraoperative planning features
Intraoperative planning features Resection values Anchor points • Toggle between laxity values and display the • Preset anchor points are provided to help maximize resection values by clicking the button on the and streamline implant adjustments. right. JR-MTKA-COMM-649454-Rev-1
Slide 30: AccuStop haptics
AccuStop™ haptics JR-MTKA-COMM-649454-Rev-1
Slide 31: AccuStop haptic technology
AccuStop™ haptic technology • Constrains the saw within a virtual boundary that is established by the surgeon’s patient- specific plan • Is no longer limited by cutting blocks and manual techniques • Allows the surgeon to accurately execute the final plan4 while protecting soft tissues5 when compare
Slide 32: Mako Total Knee 2.0 – bone prep features
Mako Total Knee 2.0 – bone prep features Mako Park Advancing cuts Extended boundaries JR-MTKA-COMM-649454-Rev-1
Slide 33: AccuStop haptic technology
AccuStop™ haptic technology • The surgeon can advance through their cut sequence by double clicking the MICS trigger or pressing the foot pedal. • Default extended boundaries can be pre-set in preferences and the narrow saw blade can be used for all cuts. JR-MTKA-COMM-649454-Rev-1
Slide 34: Mako Park
Mako Park • Mako Park ensures that the Mako System is positioned into the most optimal spot for cutting. This will allow the surgeon to access each cut with ease and complete bone prep efficiently. JR-MTKA-COMM-649454-Rev-1
Slide 35: Trialing
Trialing JR-MTKA-COMM-649454-Rev-1
Slide 36: Trialing
Trialing • The new trialing page allows the surgeon to capture the patient’s final alignment as well as the final extension and flexion laxities, utilizing the digital tensioner. • The surgeon can utilize the sagittal and transverse preset views to ensure the medial and lateral translations and shuc
Slide 37: Triathlon Cementless Knees: Improved efficiency and outcomes
Triathlon Cementless Knees Improved efficiency and outcomes8-11 • Over 1 million Triathlon Cementless knees Minimum of 3.2mm have been implanted since cleared in 2013 and poly and fused make up over half of the Mako Total Knees poly/ metal Single radius and dwell implanted in the U.S6 association po
Slide 38: Mako Case Information
Mako Case Information JR-MTKA-COMM-649454-Rev-1
Slide 39: Mako Case Information Plan and Anatomy
Mako Case Information Plan and Anatomy There are six tabs: 1. General 2. Osteophytes 3. Releases 4. Cuts and implants 5. Timer 6. Plan and Anatomy JR-MTKA-COMM-649454-Rev-1
Slide 40: Mako Case Information Plan and Anatomy
Mako Case Information Plan and Anatomy Allows the surgeon to view case- related info pertaining to the selected implant plan and the patient’s anatomical dimensions. JR-MTKA-COMM-649454-Rev-1
Slide 41: Clinical evidence
Clinical evidence JR-MTKA-COMM-649454-Rev-1
Slide 42: Mako Total Knee 2.0: The outcomes you expect
Mako Total Knee 2.0 The outcomes you expect… Greater precision to Less pain, fewer Improved early Improved mid-term plan meds recovery survivorship Studies have shown 3D Patients experienced less Patients hit postoperative In the Australian Registry, CT planning and haptic pain,16 and required less
Slide 43: Mako Total Knee 2.0: the experience you deserve
Mako Total Knee 2.0 …the experience you deserve. Confidence and Intuitive design New Digital Accurate 3D CT control Tensioner registration In a cadaveric study, 95% In a cadaveric study, 84% A cadaveric study has A cadaveric study has of users surveyed reported of users surveyed reported shown excel
Slide 44: Confidence and control
Mako Total Knee 2.0 Confidence and control • After a cadaveric lab, three established, high-volume surgeons were asked to compare their experience of the new Mako Total Knee 2.0 software to manual total knee arthroplasty.20 • The surgeons reported new Mako Total Knee 2.0 software provided overall in
Slide 45: Intuitive design
Mako Total Knee 2.0 Intuitive design • After a cadaveric lab, established, high-volume surgeons were asked to compare their experience of the new Mako Total Knee 2.0 software to manual total knee arthroplasty.20 • Surgeons found overall use of RATKA was intuitive and were satisfied with overall use
Slide 46: Digital Tensioner - repeatability
Mako Total Knee 2.0 Digital Tensioner - repeatability • A cadaveric study has shown that when using the digital tensiometer average variation between use by the same surgeon was 0.31mm.3 • Intraclass correlation coefficient (ICC) analysis showed excellent repeatability (ICC ≥ 0.96)3 • Repeatability
Slide 47: Digital Tensioner - reproducibility
Mako Total Knee 2.0 Digital Tensioner - reproducibility • A cadaveric study has shown that when using the digital tensiometer average variation between use by different surgeons was 0.6mm.3 • Intraclass correlation coefficient (ICC) analysis showed excellent reproducibility (ICC ≥ 0.90).3 • Reproduc
Slide 48: Accurate 3D CT registration
Mako Total Knee 2.0 Accurate 3D CT registration • A cadaveric study has shown that manually selecting rotational landmarks intraoperatively resulted in increased error compared to digitally selecting preoperatively using a 3D CT scan.21 • Greater reliability of landmark identification was observed i
Slide 49: Thank you
Thank you JR-MTKA-COMM-649454-Rev-1
Slide 50: References
References 1. Bhimani SJ, Bhimani RB, Feher A, Smith LS, D’John ML, Malkani AL. Accuracy of preoperative implant sizing using 3D preplanning software for robotic-assisted total knee arthroplasty. Presented at: American Association of Hip and Knee Surgeons (AAHKS) Annual Meeting; November 2-5, 2017;
Slide 51: References
References 11. Nam D, Lawrie CM, Salih R, Nahhas CR, Barrack RL, Nunley RM. Cemented Versus Cementless Total Knee Arthroplasty of the Same Modern Design: A Prospective, Randomized Trial. J Bone Joint Surg Am. 2019 Jul 3;101(13):1185-1192. doi: 10.2106/JBJS.18.01162. PMID: 31274720; PMCID: PMC6641115
Slide 52: A surgeon must always rely on his or her own professional clinical judgment
A surgeon must always rely on his or her own professional clinical judgment when deciding whether to use a particular product when treating a particular patient. Stryker does not dispense medical advice and recommends that surgeons be trained in the use of any particular product before using it in s