Published on January 14, 2020

Introducing the Mako System

Advancing joint replacement at Fisher-Titus.

In July of 2020, Fisher-Titus became the first hospital in the region to offer hip and knee replacements with Stryker's Mako System. Through our partnership with NOMS Access Orthopaedics in Norwalk, Dr. David Pocos and Dr. Jason Brown perform total hip, total knee, and partial knee procedures with the assistance of the Mako robotic arm.

Michelle Adams was the first patient to have a procedure with the Mako System at Fisher-Titus.


In June of 2020, Michelle was on vacation in North Carolina when her knee suddenly gave out going down a flight of stairs. Although she didn’t fall, she was in so much pain that she wasn’t able to walk to the beach the rest of her stay.

“I had trouble with my knee in the past,” Michelle said. “I had gotten injections at NOMS Access Orthopaedics which helped but this was different. It was more painful and I knew something had to be done.”

When she returned to Ohio, she scheduled an appointment with Dr. Pocos. They did x‐rays and determined she would need to have surgery to replace the knee.

Along the way, she learned that she would be the first to have her procedure done with the assistance of the Mako System.

“I was all for it. It’s something new and Dr. Pocos had been preparing for a year to operate with it,” said Michelle. “I’m very glad that I ended up having it done that way.”

The Mako System provides each patient with a personalized surgical experience based on their specific diagnosis and anatomy. With the system, the surgeon can use a virtual 3D model of the joint, from a CT scan, to create a surgical plan before surgery. This plan helps them determine the implant size, orientation, and alignment based on the patient’s specific needs.

How it works is with Mako’s AccuStopTM technology. The pre‐op plan defines an area in which the surgeon can operate. The technology keeps the robotic arm within the planned boundaries and guides direct, accurate cuts. Although the Mako system is often referred to as a robot, it cannot move on its own. The surgeon guides the robot’s arm to perform the surgery and the surgeon can adjust the pre‐op plan if needed once they are in the operating room. The surgeon has full control of the instrumentation during
the entire procedure.Ortho Robot

“The key to Mako is the reproducibility and planning,” Dr. Pocos explained. “A preoperative plan is generated based upon CT evaluation. I review the plan and I am essentially doing the surgery before the actual surgery. Prior to Mako, I would template preoperative x‐rays to identify proposed size of implants and alignment. I would then rely on alignment jigs, feel, and experience in the operating room to
accomplish the procedure. With the Mako, I am able to reproduce the preoperative plan with precision.”

Dr. Pocos adds, “The interesting thing about Mako is that the procedure is the same and the end goal remains the same. The steps are the same. How we analyze the information is different.”

In addition to creating a better surgical experience for surgeons, case studies suggest robotic‐arm assisted joint replacement may also be associated with decreased pain, improved early functional recovery, and reduced hospital stays for patients. There is also evidence suggesting patients required less opioids for
pain following surgery. Both of these benefits are likely due to the fact that robotic‐arm assisted joint replacement reduces bone and tissue trauma since operating is limited to the pre‐determined boundaries based on the damaged bone.

“Less retraction results in less trauma to the surrounding tissues,” Dr. Pocos said. “Patients have been pleased with their procedures thus far. The tissues have seemingly responded better. I have been very pleased with the outcomes. I am now using Mako on the majority of my hip and knee replacements.”

NOMS Access Ortho provider with patient.Michelle said her recovery has been relatively easy. She had her surgery on a Tuesday and went home the next day to stay with her son and his family. After three days of mostly staying in bed to rest, she was able to get up and walk with a walker and start in‐home therapy by Friday.

“It’s amazing that you can walk on a knee that was just replaced!” Michelle noted.

Michelle credits a lot of her recovery to her kids, grandkids, the therapists, and the robotic‐assisted procedure.

“A friend of mine is looking into having surgery,” said Michelle. “I told him, the robotic thing is the way to go.”

Michelle was back to work in accounts payable just one month after her surgery. Now she’s looking forward to spending time with her three kids and five grandkids–especially watching them play sports.

“That’s why I wanted to get it fixed,” Michelle explained. “I wanted to be able to go and watch them in the stands at their games."

About Orthopaedic Surgery at Fisher-Titus

Our surgical team performs many types of specialized orthopaedic surgery, including:

  • Procedures on knees, hips, shoulder, and elbows
  • Total joint reconstruction (arthroplasty)
  • Fractures
  • Hand and wrist surgery, including carpal tunnel
  • Foot and ankle surgery
  • Orthopaedic trauma
  • Pediatric orthopaedics
  • Sports medicine

Our partnership with the surgeons at NOMS Access Orthopaedics offers each patient:

  • Five-star patient satisfaction
  • Total joint replacement expertise
  • Complete care close to home

For more information, please visit

NOMS Access Orthopaedic Surgeons

Jason Brown

Jason A. Brown, DO

Callahan Web (1)

Nicholas Callahan, DO


David A. Pocos, DO


Michael T. Powers, DO