Why I now use Mako for all my DAA hips

Message from Timothy Lovell, MD

Providence Physician Services & Sacred Heart Medical Center - Spokane, WA

In my early experience with Mako Total Hip, I have already seen several benefits that have enhanced my current THA workflow. After witnessing the benefits that Mako Partial Knee and Mako Total Knee helped me provide to my patients, I decided it was time to ask my hospital to add the hip application and use Mako Total Hip in my Direct Anterior practice. Since I have been using the Total Knee application for two years and Partial Knee application for over 5 years, using a CT scan to pre-plan my hips was an easy transition. For each patient, I am able to customize the size and placement of the components by using the three-dimensional scan based on the patient’s anatomy and then use the robotic-arm to execute my plan with a high degree of precision.1

In my experience, I have found that using the robotic-arm to perform acetabular reaming and impaction has improved the initial fixation of the acetabular component. The use of the CT scan allows me to use a single reamer which also saves time and increases efficiency in my OR, as my hospital does not need to open an entire tray of reamers. The Mako System provides visual and haptic feedback during reaming and impaction which helps gives me confidence that I am removing the bone I have planned to remove2 and placing the cup accurately according to my plan.3 Mako Total Hip allows me to intra-operatively make adjustments with real time feedback to help me achieve my goal of hip length and offset for each patient.4

I have seen many advantages using Mako and the DAA approach. I have the ability to measure my neck cut based on my preoperative plan. I have been able to initially reduce and now eliminate fluoroscopy, so myself and the staff no longer have to wear lead. Without fluoroscopy, we can reduce the amount of traffic in and out of the operating room, and do not need to interpret the fluoroscope views or adjust the c-arm. We save time by not having to move the c-arm in and out over the patient. I also do not have to worry about the parallax effect with fluoroscopy, and the potential inaccuracies associated with it.5,6 While intraoperative fluoroscopy can be used to provide intraoperative feedback, the Mako System has been shown to be more accurate to plan.7

In my opinion, the ability to plan surgery virtually and use the robotic-arm to help me carry out that plan is truly revolutionary.


  1. Elson L, Dounchis J, Illgen R, Marchand R, et al. Precision of acetabular cup placement in robotic integrated total hip arthoplasty. Hip Int 2015; 25(6):531-536.
  2. Suarez-Ahedo, C; Gui, C; Martin, T; Stake, C; Chandrasekaran, S; Christopher, J; Domb, B. Robotic-arm assisted total hip arthoplasty results in smaller acetabular cup size in relation to the femoral head size: A Matched-Pair Controlled Study. Hip Int. 2017; 27 (2): 147-152.
  3. Illgen r., Bukowski B., Abiola R., Robotic- assisted total hip arthroplasty: Outcomes at minimum two-years follow up. Surg Technol Int. 2016 Oct.
  4. Jerabek SA; Carroll KM; Maratt JD; Mayman DJ; Padgett DE. Accuracy of Cup Positioning and Achieving Desired Hip Length and Offset Following Robotic THA. 14th Annual CAOS Meeting, June 18-21, 2014, Milan, Italy.
  5. Masionis P, Jonusas J, et.al. Accuracy of predictive magnification factor for pre-operative templating in total hip arthroplasty. MOJ Orthopedcis & Rheumatology. Vol 10 Issue 2, 2018.
  6. Kniesel B, Konstantinidis L. Digital templating in total knee and hip replacement: an analysis of planning accuracy. International Orthopaedics
  7. Domb B, Redmond J, Louis S, Alden K, Daley R, LaReau J, et al. Accuracy of component positioning in 1980 total hip arthroplasties: a comparative analysis by surgical technique and mode of guidance. The Journal of Arthoplasty. 30(2015)2208-2218.