The medical industry is constantly developing, with breakthroughs in research and advancements in technology creating an ever-changing landscape for patients and practitioners. One of the doctors on the cutting edge of the improvements being made in orthopaedic surgery is Newcastle-based surgeon Dr Stuart Mackenzie.
Specialising in hip and knee surgery and trauma surgery, and with a strong interest in difficult and revision hip and knee replacements, Dr Mackenzie is leading the way in the use of robotic technology during orthopaedic procedures in the Hunter.
The University of Newcastle graduate completed his training locally through the Australian Orthopaedic Association program and was awarded a Fellowship of the Royal Australasian College of Surgeons (Ortho) in January 2011.
Since then he has spent time honing his surgical skills both locally and overseas, with a year-long Fellowship in Adult Hip and Knee Reconstruction at the University of Alberta and the Royal Alexandra and Misericordia hospitals in Edmonton, Canada.
He went on to complete the prestigious Exeter Hip Fellowship at one of the leading hip replacement hospitals in the world - the Princess Elizabeth Orthopaedic Centre in Exeter, England – before spending six months working in the USA at the Shriners Hospital in Portland, Oregon.
Since returning to Australia, Dr Mackenzie has established a firm footing in the Hunter, working in both the public and private hospital systems at John Hunter Hospital and Lingard Private Hospital.
“I was attracted to surgery in general because I enjoy the procedural side of medicine as well as the patient interaction,” Dr Mackenzie said.
“Orthopaedic surgery was particularly appealing because of the very clear and concrete progression from problem to treatment to solution.
“Patients can easily see the benefit that they gain from an operation and are often very grateful for the huge change it makes in their lives. I find this very satisfying.”
Keen to stay abreast of the latest advancements in his field, in October 2016 Dr Mackenzie became the first surgeon in Newcastle to perform robot-assisted orthopaedic surgery. After undertaking specialised training in Sydney, Dr Mackenzie used the Stryker Mako robotic system at Lingard Hospital to successfully complete the region’s first robot- assisted partial knee replacement and the first robot-assisted total hip replacement.
“The orthopaedic industry is changing very quickly and not always for the better,” Dr Mackenzie said.
“The use of new technologies such as MRI and three-dimensional imaging for better imaging of joints has been very helpful in diagnosing some patients and in planning surgery. Using computer technology known as navigation to improve the accuracy of positioning artificial joints in surgery has also been a big advance. The extension of this to using robotic technology is probably the single biggest advance that I have seen.
“I have been using robotic-assisted surgery since October 2016. I was the first surgeon to perform robotic-assisted surgery in Newcastle.
“For each type of operation, I have had to go to Sydney to do a course involving both the theory of using the robot and practice using the robot for performing surgery. Without doing this training, a surgeon is not able to have access to the robot for surgery.”
There are a number of steps involved in using the robotic technology for the procedure. A Computer Tomography (CT) scan is taken of the diseased joint and used to generate a 3D virtual model of the patient’s unique anatomy.
After being uploaded into the Mako system software, the model is used to create a personalised pre-operative plan that allows the position of the prosthetic components to be calculated to within 0.2 millimetres of their ideal location.
During surgery, Dr Mackenzie uses the patient-specific plan to guide the Mako robotic-arm while positioning the prosthesis components, providing a more accurate placement and alignment of the implant than can be achieved with traditional methods.
Dr Mackenzie said there were many advantages to using robotic technology during orthopaedic surgery, with the technique able to be used for both total and partial knee replacements, as well as a total hip replacement through either a posterior or direct anterior approach.
“There are a number of benefits of robotic-assisted surgery,” he said.
“It uses a 3D computer model to greatly increase the accuracy with which the surgeon can plan a joint replacement. This plan can then be easily adjusted during the operation if necessary based on further information gathered about the ligaments and other structures during the surgery.
“The robot then assists the surgeon to be much more accurate with preparing the bone and placing the artificial joint components than traditional techniques.
“We know that, especially with the positioning of the cup in a hip replacement, we’re actually not nearly as good at doing that accurately as we’d like to think. There have been many studies that have shown that using traditional methods; we position the cup outside what we call a safe zone about 30 percent of the time.
“The robot has been shown to be much more accurate at positioning that cup where it should be and where we want it to be, which should lead to a decreased risk of complications like a dislocation.”
While the use of robotic technology is still quite new in Australia - the first knee replacement was only completed two years ago in April 2015, with the first hip surgery undertaken a year later – Dr Mackenzie believes patients will increasingly use it for many years to come.