Helping patients to regain their quality of life through improving their movement and reducing pain, surgeons at Gloucester's Winfield Hospital are now using state-of-the-art robotics technology to perform joint replacements with enhanced precision, confidence and consistency.
SoGlos sits down with orthopaedic consultant Rob Gleeson to find out more about Mako SmartRobotics, including how it works, the common misconceptions and the benefits, along with how he and the Winfield team support patients throughout their treatment journey, from initial consultation and surgery, all the way through to recovery.
Rob – what inspired you to become an orthopaedic surgeon?
My dad was a gastroenterologist, so medicine was very much part of my life growing up. I watched him work from quite a young age and he was undoubtedly the person who first inspired me to become a doctor.
At medical school, I found myself increasingly drawn towards surgery. I loved the practical side of it, the buzz of the operating theatre and the fact that what you do can make such a direct and immediate difference to somebody. I also loved the teamwork and the need to think on your feet when you’re under pressure.
Orthopaedics particularly appealed to me because I’ve always loved sport. One of the first consultants I worked for was Jonathan Webb, who had played rugby for England, and he certainly influenced me.
But it wasn’t simply about treating sports injuries or sportspeople. Many of the patients I see with arthritis are much older and may have given up sport years ago, but that passion for being active often remains. I think having that shared understanding of what it means to be active – and what it means when that ability is taken away – was one of the things that really drew me towards orthopaedics.
What is the most rewarding part of helping patients through their joint replacement journey?
It’s an enormous privilege to look after somebody with arthritis, particularly when pain has reached the point where it is really affecting their quality of life.
For me, that first consultation is incredibly important. It’s where you begin to understand the patient – not just what their X-rays show, but how much pain they are in, what they have stopped doing and what they would really like to get back to. Often a partner, family member or friend comes with them, and their perspective can be invaluable too.
And that journey doesn’t necessarily begin with an operation. I’ve looked after some patients for several years before we eventually decide together that the time is right for a joint replacement. Earlier on, my advice may be to carry on with non-surgical treatment and manage the arthritis for as long as that remains appropriate. Surgery should come when the pain and loss of function have reached the point where the potential benefits of a joint replacement justify taking that step.
That makes seeing the transformation afterwards all the more rewarding. At six weeks you often begin to see the optimism returning, and by a year I hear patients talking about travelling again, playing golf, ballroom dancing or simply doing everyday things without constantly thinking about their knee.
I never tire of hearing those stories. Knowing where somebody started, having gone through that journey with them, and then seeing them get back to the life they were missing is probably the most rewarding part of what I do.
What is Mako SmartRobotics, and how does it differ from traditional joint replacement surgery?
Mako allows us to plan and perform a joint replacement with an extraordinary degree of precision, but importantly, it also allows us to tailor that operation to the individual patient.
Before surgery, a CT scan creates a very detailed 3D model of the patient’s anatomy. Then, during the operation, I give the system additional information about how that particular knee moves, how the ligaments behave and how well balanced the knee is.
That’s important because no two knees are exactly the same. Rather than simply putting every knee into a standard textbook alignment, I can plan the replacement around that patient’s individual anatomy and soft tissues.
For me, that’s the exciting part: combining the surgeon’s experience and judgement with incredibly precise technology to perform a genuinely bespoke knee replacement.
What’s the biggest misconception patients have about robotic surgery?
Probably that the robot is doing the operation and the surgeon is somehow standing back and letting it get on with it!
Nothing could be further from the truth. The surgeon remains in control throughout the entire operation. I make the decisions, approve the plan and physically perform the procedure.
What Mako gives me is an extremely sophisticated tool to execute that plan with remarkable precision. It helps position the saw in exactly the right plane, controls how much bone is removed and helps protect the surrounding soft tissues.
I often explain it very simply: the surgeon is always in control, using the robotic technology as a tool to enhance accuracy and precision. The robot does not make decisions or perform the surgery independently, and our team at Winfield Hospital is there to support and care for you throughout your journey.
What’s one piece of advice you’d give patients to help achieve the best possible recovery?
Prepare for it — both physically and mentally.
A knee replacement is a significant operation and patients shouldn’t underestimate how tired they may feel afterwards or how much effort the rehabilitation requires. The surgeon and the technology are obviously important, but the person who ultimately has the biggest influence over the recovery is the patient themselves.
Before surgery, anything you can do to improve your strength, your range of movement and, where appropriate, lose some excess weight will help. Engage with the Winfield hospital physiotherapists, understand the exercises and know what the first few weeks are likely to involve.
Then go into it with a positive, determined mindset. Recovery takes work, particularly on the days when you’re tired and would rather not do the exercises. The patients who prepare well and really engage with their rehabilitation tend to give themselves the best chance of an excellent result.
If patients could know just one thing about you before meeting you, what would you want it to be?
I’d like them to know that they can talk to me.
Of course, I’d want patients to be reassured by my experience — knee surgery has been the focus of my career and is now essentially my entire surgical practice – but I think patients quite reasonably expect their surgeon to be experienced.
What matters to me personally is that people feel comfortable talking to me openly. I’ll give them a frank and honest opinion, explain things in straightforward language and hopefully we can have a bit of humour along the way.
When it comes to their operation, however, they’ll have my complete focus and commitment. And that doesn’t end when the operation is finished. If everything doesn’t go according to plan, I won’t disappear – I’ll be there to look after them and do everything I can to get them to the best possible outcome.
For more information about Mako SmartRobotics assisted surgery at Winfield Hospital, including how to get in touch about receiving treatment, visit ramsayhealth.co.uk/hospitals/winfield-hospital/treatments/orthopaedics/mako-smart-robotics-assisted-surgery.
