Robotic knee replacement surgery and everything related to it

Robotic knee joint replacement is one of the most advanced surgeries that require special preparation and quality equipment, and it's not correct that the robot replaces the joint on its own but requires a skilled surgeon to guide it.

What is the robotic knee joint replacement procedure?

Robotic knee joint replacement is similar to traditional knee operations where the consultant orthopedic surgeon removes the damaged tissue in the knee to replace the natural joint and place the artificial joint, and the only difference is that a robotic arm or a portable robotic device is performing the surgery.

Robot-assisted knee surgery allows operations to be performed with higher accuracy in less time, and the use of robotic technology means that the recovery period for the patient of the orthopedic clinic after the operation will be shorter because it preserves the soft tissues better and provides more stability to the knee after the operation.

Robots used in knee surgery

There are several models of surgical robots used in body joint surgery with many trade names, one of which consists of a robotic hand that was specially designed to give the orthopedist an alert at the first wrong movement of the bone saw outside the prescribed surgical plan, and this helps to reduce surgical risks by a large percentage.

Most robotic systems create a three-dimensional image of the patient's knee by referring to a set of tomographic images, through which the size and position of the artificial joint can be accurately determined.

There is a particular type of automated robot with a special drill that is controlled by the surgeon and is used in partial knee replacement. Instead of alerting the doctor before an error occurs, the engineers who designed it used the capabilities of artificial intelligence to move the endoscope semi-independently without the surgeon's intervention, and there is no need for a CT scan when using this technology.

Best types of artificial knee joints

These joints were used for the first time about two centuries ago, and it was a great medical achievement, as many cases that suffered from severe knee stiffness did not have a cure in the past, as most health centers applied palliative treatment of painkillers and others, and their effectiveness was limited.

In most orthopedic hospitals, certain materials are used to manufacture joints. The types of joints have been divided according to the materials in which they are used:

•  Metal and plastic: It is the most common type in the medical center that specializes in joint replacement usually, as it is the least expensive and the longest-lasting, but it can sometimes cause erosion of the cartilage and bone under it, and these accidents have decreased with the development of manufacturing methods.
• Ceramic and plastic: Sometimes, a metal joint is not replaced due to the patient's sensitivity to some metals, so ceramic joints have been created with better properties and less impact on the patient's immunity.
• Ceramic only: In some cases of osteoarthritis, the joint completely damaged is replaced by an artificial ceramic joint.
• Metal only: Its use in medical treatments has decreased significantly during the past ten years, but in the past, it was popular with those who suffer from knee problems and do not wish to replace the joint repeatedly.

People who need robotic knee replacement surgery

Patients who are candidates for traditional knee replacement are often the same patients who can perform operations using a robot, as this technique is exemplary even when performing the most complex procedures, which include:

• Deformities of the femur after injuries
• Complex joint degeneration
• Injury as a result of previous operations

Robotic knee joint replacement is one treatment options that preserve knee ligaments. There is a unique technique in which all ligaments are preserved, which gives the patient the ability to move smoothly, especially for patients who:

1. Their daily activities require significant physical activity, such as sports.
2. Their bones are intact before surgery.
3. Their ligaments are also functional and intact before surgery.

   

Reasons for replacing the knee joint

The most common indication for robotic knee replacement surgery is severe osteoarthritis pain, but your doctor may suggest knee surgery when:

• The knee joint suffers from severe pain that awakens the patient from sleep.
• The patient cannot walk or the seek care of himself.
• The pain has not improved with the use of analgesics or with conservative treatment methods.
• The patient understands the importance of the surgery and the time it will take to recover.

Knee replacement surgery for the elderly

Although the robotic knee replacement is a major surgery that requires several weeks to heal, no age limit prevents the patient from undergoing robotic knee operations.

Many studies have shown that patients in their eighties and even nineties benefit from knee joint replacement operations as much as younger patients. Therefore, conditions in which this type of surgery isn't recommended aren't familiar.

Preparation for robotic knee replacement surgery

There are several recommendations for patients who will undergo robotic knee surgery, the most important of which are:

1. Stopping anticoagulants such as aspirin, ibuprofen, and blood thinners such as warfarin and clopidogrel at least two weeks in advance.
2. Refer to the specialized medical center when there are diseases such as heart and diabetes for evaluation before operating.
3. The doctor should be informed in case of excessive consumption of alcoholic beverages.
4. Please refrain from smoking because it directly affects the results of robotic joint surgery and other surgeries.
5. It is necessary to tell the medical staff if you have a cold, fever, or rash before the operation.
6. Visit the physical therapist to do some special exercises before knee joint surgery.

The patient must refrain from eating for at least six hours before the operation and adhere to the medications that must be taken before knee joint surgery, as they will contribute significantly to speeding up recovery.

Robotic knee replacement surgery techniques

There are well-known robotic surgical systems used in orthopedic surgery and in knee replacement surgery in particular, which are:

1. Navio Surgical System
2. Mako Robotic-Assisted Knee Surgery

Navio robot

In operation, surgeons launch the Navio robot, the robot measures the dimensions of the knee or the joint, and the patient moves his knee within its natural range so that the robot recognizes the range of movement and forms a unique 3D model that enables the surgeon to plan the operation with extreme accuracy before it even begins.

All of these steps occur right in the operating room, where robotic technology complements the work of the surgical staff by objectively evaluating procedures and helping to guide implants.

Mako robot

This robot differs from its predecessor in that it is dedicated to knee joint surgery qualitatively way and works slightly different, as tomographic images are taken before entering the operating room, and unique tracking points are placed on the surface of the knee, which the robot detects and adheres to.

Post-operative care in robotic knee replacement

Patients after robotic knee replacement surgery need to stay in the hospital For a day or two for the anesthesia to go away, and the knee is usually moved to ensure the integrity of the ligaments and the success of the surgery. Still, it usually takes four months for a full recovery.

Downsides of robotic knee replacement surgery and its complications

Recently a British study conducted in 2022 discussed the possible complications and damages associated with a robotic knee replacement surgery and compared them with the side effects that occur with a traditional joint replacement. Although their percentage is significantly lower, it is still possible to happen.

Bone and joint complications after knee replacement surgery include:

• Fractures of the endoscopic hole site
• Infections at the site of the endoscopic hole
• Iatrogenic injury
• More blood loss
• Articular stiffness

The adverse health aspects include:

• Increased length of surgery.
• More expensive than traditional knee surgeries.
• The need for orthopedists to work longer with robotic technology to gain experience, as the learning curve is different from traditional surgery.

Pain after robotic knee replacement surgery

After knee pain, patients need careful evaluation by specialists because installing an artificial joint may cause pain through several mechanisms and methods that have been classified in a British study Published in 2019.

After knowing the results of the clinical tests and determining the cause, appropriate action is taken, including:

• Giving NSAIDs
• Patellar tendon reconstruction
• Re-operation of the patient's painful knee
• Knee ligament placement
• Repositioning of the hip or knee under anesthesia

Do not hesitate to Contact us to learn more about robotic surgery and its applications in orthopedics.

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Sources:

1. PennMedicine
2. National Library of Medicine
3. Medline Plus
4. Harvard Health Publishing
5. Cleveland Clinic
6. BioMed Central

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