Robotic knee replacement: an examination of benefits and risks

Robotic technology is increasingly used for knee replacement surgery and is favoured over traditional surgery among some surgeons. Leading consultant trauma and orthopaedic surgeon Mr Ben Spiegelberg explains more about the benefits, as well as the risks of the surgery.

The use of robotic technology in knee replacement has several benefits, which include the following:

Improved accuracy and precision: As with any operative procedure, there is a small chance that human error will occur. However, fortunately, robotic assistance adds an additional level of accuracy and precision to the surgery.

Increased consistency – As well as being more precise, robotic technology is more consistent than conventional methods.

Less destructive and intrusive – The surgery can be performed through smaller incisions reducing the likelihood that patients will experience pain from ligament and soft tissue releases around the knee.

Greater chance of restoring movement and mobility – As a result of a smaller incision, less soft tissue releases and greater accuracy of implantation, many patients experience reduced recovery periods as well as an increased chance of restoring freedom of movement and complete mobility.

These benefits result in improved outcome metrics.

Improved patient results – Studies indicate that individuals undergoing robotic surgery exhibit enhanced functional outcomes and reduced hospital readmissions compared to those opting for conventional knee replacement. Additionally, they necessitate less rehabilitation.

Higher patient satisfaction  – Patients undergoing robotic knee surgery can resume their daily activities and return to work sooner, contributing to higher satisfaction ratings.

Lower long-term costs  – Patients undergoing robotic knee surgery generally experience fewer complications, resulting in fewer hospital visits. The CORI robotic system, being an image-free preoperative mapping system, eliminates the costs and implications associated with a CT scan. Moreover, patients recover more swiftly, allowing for earlier return to work.

Is Robotic knee replacement surgery better?

Robotic surgery has exhibited superior results when compared to traditional knee replacement procedures. The enhanced precision, consistency, and minimised trauma to bone and soft tissues associated with CORI robotic knee replacements contribute to more favourable results for patients.

What risks are associated with robotic assisted knee replacement?

As with any surgery, there are some risks linked to robotic surgery. Common risks include:

Bleeding – Bruising following the surgery is common, and in rare circumstances, a blood transfusion or iron tablets may be essential. Additionally, although unlikely, in some cases the bleeding may form a collection within the knee joint, which may require a further operation to remove it.

Blood Clots – Deep vein thrombosis (DVT) is a blood clot in a vein. The likelihood of developing a deep vein thrombosis (DVT) is higher post-surgery, particularly after lower limb procedures. DVTs can travel through the bloodstream and potentially become lodged in the lungs, resulting in a pulmonary embolism.

In order to minimise the risk of DVT formation, you will be provided with stockings to wear on your legs during your hospital stay, along with a daily tablet or injection to thin the blood. Early mobility after surgery is a key preventive measure against the formation of blood clots.

Pain – The knee will be in pain after the operation. However, this pain will decrease over time and typically, there is significant improvement by the two-week post-operative milestone. However, on rare occasions, pain may persist as a chronic issue.

Knee stiffness – Knee stiffness may occur after the operation, especially if the knee feels stiff before surgery. If this pain persists, despite physio input, manipulation under anaesthesia may be recommended.

Implant wear and loosening – Thanks to modern operating techniques and advanced implants, knee replacements can last beyond 20 years. However, in some cases they can fail, which often contributes to the wear and tear of the plastic liner.

There are also some less commonly occurring problems which can develop as a result of robotic technology, such as infection. 

You will receive antibiotics just before the operation starts and the procedure is performed in a sterile theatre. The wound site may become red, hot and painful, and there may be a discharge of pus or fluid. This is usually treated with antibiotics and an operation to wash out the joint may be necessary. In rare cases, the implant may be removed and replaced at a later date (revision surgery). The infection can sometimes lead to sepsis (blood infection) and strong antibiotics are required.

Finally, there are some potential risks which are highly rare, but there is a slight chance that they will take place, such as the following:

Pulmonary Embolism – This happens when a blood clot (DVT) breaks off and lodges within the lungs. It can affect breathing and is a serious condition that can be fatal.

Poor scars – After surgery, the wound may become red, thickened and painful (keloid scar). These types of scars occur more commonly Afro-Caribbeans.

Nerve Injuries – The surgeon will try to prevent any nerve damage, but despite these efforts, damage to the small nerves of the knee is a risk, and could lead to temporary or permanent altered sensation or movement around the knee and lower leg. It is important to note that it is normal to have a patch of numbness to the outer aspect of the knee, however, this will generally resolve over time.

Fracture – When the implant is inserted, there is the potential for bone to be broken, which may need to be fixed immediately or at a later date.

Instability – Although unlikely, the reconstructed joint can be unstable and therefore require further surgery.

Blood vessel injury – Blood vessels at the back of the knee may become damaged in the operation, which can require further surgery by a vascular surgeon.

If you would like to book a consultation with Mr Spiegelberg, do not hesitate to do so by visiting his Top Doctors profile today.