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BRAIN ATTACK:

Robotic Knee and Hip Replacement

By Dr. Ramneek Mahajan in Robotic Surgery

Dec 26 , 2022 | 2 min read

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Robotic Knee and Hip replacement are performed in more than 600000 patients annually in the United States (US), and the number is projected to grow by 673% in 2030.

Alignment of limb and implant placement accuracy is increasingly considered among the important prognostic factors for long-term implant survivorship, satisfaction and clinical outcome of patients.

As in Conventional joint replacement, the technicalities of implant positioning vary according to the individual patient, and the use of standard equipment to do the same does not have the same precision; a robotic arm assists the surgeon by providing tactile and visual feedback in achieving the desired orientation, which helps in achieving desired mobility.

Three types of robotic systems exist depending upon the degree of control over the robot: autonomous (active), hands-on (semi-active) and passive. The passive systems do not operate independently. They are called computer-assisted or navigation systems, depending on the patient- and instrument-centred reference points to provide the surgeon with perioperative recommendations and guide the positioning of the surgical tool.

Active robots hold the cutting tool and autonomously make bone resections. Semi-active robots combine both principles with the surgeon maintaining overall control over bony resections under robot surveillance that gives live intraoperative feedback to confine diversion from the preoperative surgical plan, which has been widely used, also at our centre.

The benefits of robot-assisted orthopaedic surgery

Robotic surgery can support surgeons with advanced targeting, visualization, and task execution with precision beyond human skills. It provides a high level of repeatability with reproducible results eliminating variations in surgical outcomes.

Robotic surgery can help cut bone, position implants, and guide surgeons in positioning instruments more precisely. It is ideal for total joint replacement, such as hip and knee, as the bone can be treated as a fixed object.

Mako is a semi-autonomous robotic system which has been adopted throughout the world and has been a proven system.

The benefits are:

It helps surgeons to create a personalized plan which is tailor-made for that particular patient with the help of a pre-surgery CT scan, hence helping in optimum implant placement. This thoroughness of replacement surgery helps in avoiding missed matches and outliers.

The joint balancing is real-time visualized during surgery, helping the surgeon minimize excessive stress on soft tissues and ligaments around the knee, providing greater freedom from pain. Also, this ensures that the patient will have more natural movement post-surgery.

The use of robotics in joint replacement has led to lesser and more precise bone resection, hence reducing blood loss. It has been shown to have a faster recovery time than conventional joint replacements. Overall safety has improved, and chances of implant failure and revision surgery requirements have decreased. Mako robot has a great safety profile; it has a haptic profile preventing movement of the robotic arm beyond the working field.

Any robotic system, autonomous or semi-autonomous, is as good as a surgeon utilizing the system; in the end, it is the surgeon trained to perform robotics surgery who is in control of the workflow to employ the best of robotics and understanding of convention to get the best outcome for that particular patient.

Robotics in Orthopaedics joint replacement surgery is a new Era, which will stay and be adopted by surgeons around the world. More and more patients are getting their surgery done using the system, as long-term outcomes have shown enhanced implant functioning as the used implant is time tested. Hence, the patient should consult with an orthopaedic surgeon to provide up-to-date guidance and optimized treatment.


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