# Robotic Systems and Navigation Techniques in Orthopedics: A Historical Review
## 2 Robotic Systems (RSs)
### Hands-On RS
#### 2.2.3 Mako (\(\leftarrow\)Rio)  
MAKO system (Stryker Corporation, Kalamazoo, MI, USA) (MAKO SmartRobotics website (accessed on 28 June 2023): [[https://www.stryker.com/us/en/joint-replacement/systems/Mako_SmartRobotics_Overview.html](https://www.stryker.com/us/en/joint-replacement/systems/Mako_SmartRobotics_Overview.html)]([https://www.stryker.com/us/en/joint-replacement/systems/Mako_SmartRobotics_Overview.html](https://www.stryker.com/us/en/joint-replacement/systems/Mako_SmartRobotics_Overview.html))) can be viewed as a new generation of the RIO (MAKO Surgical Corp., Fort Lauderdale, FL, USA) system, which means it is also a semi-autonomous system [10; 19]. Founded in 2004, MAKO Surgical Corp., together with its most notable products RIO (robotic arm interactive orthopedic system) and MAKOplasty (for partial knee and total hip arthroplasty), was acquired by the Stryker Corporation in 2013. MAKOplasty received FDA approval in 2014 for use in THA (MAKOplasty FDA 2014 file (accessed on 28 June 2023): [[https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K141989](https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K141989)]([https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K141989](https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K141989))).  
Being further developed and rebranded from the RIO, the MAKO system is an image-based system with haptic and auditory feedback. Preoperative CT images are acquired and used to conduct preoperative planning, which is further confirmed and adjusted intraoperatively based on the patient's true bone anatomy before executing the surgery [2]. A special feature of the MAKO system is a haptic technology named AccuStop that provides the auditory beep alert, tactile vibration feedback, and visual feedback with color changes. This haptic technology can assist surgeons in making incisions, saving soft tissues and healthy bones [9]. One drawback of the MAKO system is the high purchasing and surgical costs [9].  
Since 2021, the MAKO robots have been enhanced by integrating intraoperative sensor technology. MAKO is integrated with a computer navigation system, and it uses preoperative CT scans to generate a 3D model, then the robot arm is guided by the 3D model. MAKO is a human-robot collaboration system making use of user input and robotic guidance. Besides the haptic, visual, and audio feedback, it also provides virtual fixture (VF) protection and emergency auto-shutdown as a safety strategy. MAKO performed its first THA case in 2010 and received FDA (MAKO-THA FDA 2017 file (accessed on 28 June 2023): [[https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K170593](https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K170593)]([https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K170593](https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K170593))) approval in 2017. MAKO has also been used for UKA and TKA [19].  
The MAKO system is gaining more popularity in clinical practice for UKA, THA, and TKA. In addition to its long history of nearly two decades, there is a large body of research literature about the MAKO system [2]. Many studies have revealed the positive outcomes of using the MAKO system compared to manual techniques. For more clinical case study results on MAKO, please refer to [2].