Advancing precision: Exploring robotic knee replacement surgery

In his latest online article, Mr Ben Spiegelberg gives us his insight into robotic knee replacement surgery. He talks about the indications, how it differs from the traditional surgery, the advantages and disadvantages, how can preoperative planning help with precision and accuracy, how its evolved over time, the latest advancements and the risks and complications.

What are the indications for robotic knee replacement, and how does robotic surgery differ from traditional knee replacement surgery?

In terms of the indications for robotic knee replacement surgery, the requirements are exactly the same as regular knee surgery. This applies to patients who have arthritis and are dealing with things like ongoing pain, difficulty moving their knee, and trouble doing everyday tasks because of it. If treatments like physical therapy, losing weight, and injections haven't worked, and the pain and limitations persist, then surgery becomes an option.

With robotic knee surgery, it's like an upgraded version of the regular surgery. It's for the same type of people, but it brings some extra benefits. The main difference is that it's more tailored to each individual. Regular surgery follows a one-size-fits-all approach, but with the robot, doctors can adjust things based on the person's exact needs. This helps especially for those cases where the standard surgery didn't work.

The robot gathers a lot of data during the surgery and uses it to plan out how the new knee should fit in the person's unique knee structure. This allows for very precise adjustments in things like cutting the bone and placing the new knee part. Through this personalised approach, people tend to have better results after the surgery in terms of how well their knee works.

What are the advantages and disadvantages of using robotic-assisted techniques for knee replacement surgery?

Robotic knee replacement surgery offers advantages like personalised implantation and precise surgery. This often leads to better results in terms of function for patients after surgery. Over time, we expect the implants to last longer due to the improved precision in placement. It's important to mention that there are no real downsides to robotic knee surgery. While the surgery might take a bit longer, usually around 10 to 15 minutes, it doesn't really affect the patient's recovery.

During the procedure, we use a few drill poles to support the computer array in the bone. Although there's a small risk of a fracture from this, it's quite rare. Only two pins are placed in the femur and two in the tibia, which significantly reduces the chance of any issues. I want to note that, even though it's been documented, I haven't personally encountered any cases of this happening in my practice.

How can preoperative planning with 3D imaging and virtual modelling improve the accuracy and precision of robotic knee replacement procedures?

When using extra imaging methods, the advantage of the robot-assisted surgery system I use (the Corey system) is that it doesn't need any special images before the surgery, just regular X-rays which I use for my own reference. Unlike other systems that require a CT scan before the surgery, which exposes the patient to more radiation and costs, or an MRI, the Corey system gets all the information it needs during the actual surgery. This makes it simpler because everything is gathered in real-time during the operation.

How has the use of robotic surgery for knee replacement evolved over time, and what are the latest advancements in this technology?

Robotic surgery is a fairly new concept, being around for about six or seven years. Before that, there was computer navigation, but it wasn't as versatile during the actual surgery. With computer navigation, surgeons planned the surgery in advance and then followed that plan during the operation. Robotic surgery takes things a step further. It lets us gather real-time information during surgery, like the tension in the knee from different angles and movements. This helps us create a customised knee replacement that fits the patient perfectly.

From the older Aveo system to the newer Corey system, robotic surgery has improved. The Corey system is faster at processing data, which is crucial because a computer's performance depends on the information it can handle. The Corey system is currently the most up-to-date and effective option for robotic surgery. It's where the field of robotic surgery is headed in the future.

What are some of the potential complications and risks associated with robotic knee replacement, and how can these be managed?

When we talk about risks with robotic surgery, they're pretty similar to what you'd find with regular surgery. But with robotic surgery, we have an extra factor. We use drill holes to keep our equipment steady in the bone. This gives the computer a point to work from. These holes are held in place by drill pins – two in the thigh bone and two in the shin bone. There's a small chance these pins might cause a fracture, although I personally haven't seen that happen. It's rare, but it's something to consider.

In knee replacement surgery, there are general risks, too. Infections can happen, so we use antibiotics to prevent them. Stiffness after surgery is also possible. Robotic surgery often leads to less stiffness, but it's not a guarantee.

There's also the risk of blood clots, which we try to lower by giving blood-thinning medication. Since the knee joint is a man-made thing, it can wear out over time. But because robotic surgery is so precise and customised, we expect less wear and tear. This is a theory though; we'll need more time to get real data.

Robotic knee replacements have only been around for about five to seven years, so we don't have long-term info yet. We'll need to wait around 20 to 25 years for that. Considering the focus on precision, we're hopeful for better long-term results and less wear and tear over time.

Mr Ben Spiegelberg is a distinguished orthopaedic surgeon with over 15 years of experience. You can schedule an appointment with Mr Spiegelberg on his Top Doctors profile.