Overview of Robotic-Assisted Total Knee Arthroplasty
A total knee replacement (TKR), also known as total knee arthroplasty, is a common and safe surgical procedure often used to treat severe arthritis. It’s a great way to ease pain and improve the function of the knee after other non-surgical treatments have failed. With satisfaction rates between 75% and 92%, it’s considered a successful treatment option. As medical technology advances, doctors are finding ways to increase these success rates and patient satisfaction.
One of these advancements is the use of robots in surgery. The term ‘robot’ comes from the Czech word ‘robota’, meaning ‘forced labor’. The term was coined by Czech playwright Karel Capek in his 1920 science fiction play, “Rossum’s Universal Robots.” The play, which debuted in January 1921, presented robots as artificial beings created in factories to perform ordinary tasks for humans. This was the first time the word ‘robot’ was used in English and, more broadly, science fiction. Since then, the use of robots in surgery has come a long way, with the first robotic surgery taking place in 1988.
Robotic surgeries, including robot-assisted total knee replacements, are becoming more common due to their many benefits. For instance, they can help reduce the risk of mistakes during surgery, particularly when it comes to making cuts in the bone and placing the artificial knee in the right position. Overall, patient outcomes tend to be better after robotic knee replacements compared with traditional, non-robotic procedures.
Robotic surgeries first started in the field of neurosurgery in 1988, when a robot was used to perform a biopsy, a type of procedure that involves removing a small piece of tissue for examination. Shortly after, in 1991, surgeons started using robots for urological procedures. Robotic surgeries have several advantages over traditional methods, such as smaller incisions, more precise management of soft tissues, quicker recovery times post-surgery, and shorter hospital stays. These benefits have led to a widespread adoption of robotics in several specialties, including orthopedics.
The first robot-assisted total knee replacement was carried out in the United Kingdom in 1988. Since then, the use of robotics in orthopedics has been on the rise. In fact, as the population ages and the occurrence of osteoarthritis increases – which often necessitates a knee replacement – the demand for robotic total knee replacements is expected to grow even more.
Anatomy and Physiology of Robotic-Assisted Total Knee Arthroplasty
Robotic Total Knee Replacement (TKR) is a medical procedure that uses a special technology that relies on a CT scan of your knee. This scan allows the surgeon to create a 3D model of your original knee. This model is crucial in helping the surgeon know the exact dimensions of the knee and helps them in choosing the precise size of the replacement knee.
The chief goal of robotic TKR is to repair the original structure of your knee. This includes the overall balance of the knee, the alignment of the joint, and ensuring the kneecap moves well. In accomplishing these goals, it is very important to take good care of the surrounding tissues.
If these tissues or ligaments are harmed it may slow down your recovery, or cause the knee joint to be unstable and decrease the lifespan of the replacement knee.
Robotic TKR is careful to limit harmful movements that could accidentally injure your bone or surrounding tissues. Getting the best outcome from a total knee replacement depends on many factors. These include the precise positioning of the replacement knee, balancing the knee correctly, tensioning the ligament perfectly, and preserving the surrounding tissues. Most of these factors depend heavily on the skills and experience of the surgeon. Before robotic TKR, it was difficult to have a consistent method to manage these details.
Inaccurate placement of the prosthetic knee or imbalance in the knee can lead to less successful outcomes, a longer recovery process, increased instability, and a shorter life of the implant.
The specialized software used in robotic TKR can convert images from a CT scan into a 3D model of your knee. This helps your doctor plan how to cut the bone, where to place the replacement, how to align your leg, and how much of the bone to cover. The robot used during the operation helps to limit any accidental harm to the surrounding tissues and bone.
Why do People Need Robotic-Assisted Total Knee Arthroplasty
Robotic technology for knee replacements has been developed to make the surgery more accurate and precise. The main goal of this technology is to extend the life of the artificial knee joint by making sure it fits absolutely perfectly in the body. A perfectly fitted joint can help reduce the wear and tear on the plastic (polyethylene) part of the joint and can lower the chances of needing another replacement surgery in the future.
According to some research, robotic knee replacement surgery had better results in ensuring the correct balance between the bending and straightening gaps in the knee. This was achieved in 94% of patients, compared to 80% of patients who had traditional knee replacement surgery. The robotic system provides the surgeon with detailed measurements by using its advanced software. This feature allows the surgeon to balance the soft tissues in the knee accurately, which can be done either before or after making the cuts in the bone for the artificial joint.
When a Person Should Avoid Robotic-Assisted Total Knee Arthroplasty
The length of a surgery can affect the likelihood of developing an infection at the place of surgery. Thus, for patients who are already more likely to get an infection for any reason, it’s usually better to go for the traditional joint replacement surgery which typically takes less time. This way, the risk of getting an infection after the surgery can be minimized.
Equipment used for Robotic-Assisted Total Knee Arthroplasty
Robotic knee arthroplasty, a surgery to replace the knee joint, come in different types. Some, known as “fully active,” robotic systems perform all the steps of the surgery, including the cutting of tibial and femoral bones. Meanwhile, other types, called “semi-active,” help the surgeons throughout the surgery by giving them feedback during the operation, particularly when they’re cutting the tibia and femur. The surgeons start the procedure, put in place retractors, which are tools used to hold back tissues, and the rest of the operation is carried out as per the pre-established surgical plan.
The robotic Total Knee Replacement (TKR) system uses the previous operation plan to carry out the bone cuts. The system provides surgeons with visual, audio, and tactile feedback, which helps control the strength and the direction of the saw movements during the bone cuts.
In addition, some robotic TKR systems come with software that turns two-dimensional knee x-rays into a three-dimensional bone model. The purpose of this robotic tool is to assist in putting the cutting guides in place and to perform bone cuts more accurately.
How is Robotic-Assisted Total Knee Arthroplasty performed
Robotic Total Knee Arthroplasty (TKA), also known as knee replacement, is a type of surgery done with the help of robot technology. During surgery, doctors can use this technology to see how stable your knee is, how it is aligned, and its range of motion. This method has several benefits. It allows for better control over cutting bones and positioning the artificial knee. It also decreases tissue damage and muscle injury caused by surgery. This means the body’s natural response to injury, inflammation, is also reduced. As a result, you may be able to get back on your feet, and achieve milestones like standing on your leg faster.
There are several types of robotic knee surgeries, depending on the technology they use:
One type uses a robotic arm to assist with cutting bones. It prevents the saw from cutting outside the planned area. This enhances precision and protects your soft tissues. Before this surgery, a 3D model of your knee is created, using CT images. This model helps to calculate how much bone needs to be cut and where the replacement knee should be positioned.
Another type of robotic knee surgery uses a handheld robotic device controlled by the surgeon. This device is mainly used for partial knee replacements. Instead of using a set area to guide the surgery, the robot adjusts the device’s positioning and speed to avoid unwanted bone cutting. Before the procedure, you don’t need a CT scan for this method. It works with many types of knee replacement parts and brands.
Some robotic knee surgeries are designed to make sure the replacement knee fits just right in your body. For this type, a 3D image of your knee is created from a CT scan. The surgeon uses this image to plan the surgery beforehand. This includes calculating how much bone should be cut, the size of the artificial knee, and where to place it. After the surgeon confirms the alignment of your knee, the robot does the cutting of the bones.
The last type uses a motorized robot to create precise cuts in the bones. It works based on a plan to avoid human errors that may occur using a traditional saw. The main goal is to position the artificial knee precisely. For this method, a CT scan before the surgery is not needed. However, it only works with one specific type of knee replacement part.
Possible Complications of Robotic-Assisted Total Knee Arthroplasty
Robotic knee replacement surgery can be quite costly due to the need for special software. There are additional expenses as well, including a pre-surgery CT scan that can increase the overall cost while also exposing the patient to more radiation. The surgery can also take longer, especially when the surgeons are still learning how to use the robotic system effectively.
Furthermore, the surgical team needs to undergo continuous training to keep updated with the system and its software. The time taken to plan the surgery beforehand could also increase. Typically, a technical engineer is required to be present in the operating room to assist with the robotic procedure. If anything goes wrong during surgery, the team might need to switch to a traditional knee replacement method, adding complexity to the procedure.
What Else Should I Know About Robotic-Assisted Total Knee Arthroplasty?
Robotic surgery to replace a knee (called total knee replacement, or TKR) is becoming more popular. This technique allows doctors to be more precise in placing the artificial knee parts, balancing the knee’s supportive ligaments, and aligning the leg. As a result, the artificial knee is likely to last longer. However, more studies are needed to confirm these findings as this technology continues to evolve.
The current results from robotic TKR are promising, showing improvements in mechanical functionality, x-ray results, and patients’ overall well-being. Therefore, many surgeons specializing in replacing joints (arthroplasty surgeons) support the continued use of robots to enhance surgical accuracy and improve patients’ outcomes in knee arthroplasty.
When a previous knee replacement fails or causes problems, a patient may require a second surgery, also known as revision knee surgery. This is usually to fix issues like the artificial knee becoming loose, which can happen due to infection or without any clear cause. A 10-year research study shows robotic-assisted knee replacements tend to last longer, reducing the need for revision surgery.
