Robotic Joint Replacement Surgery – The Future of Hip and Knee Arthroplasty
Dr. Paul Morton was born and raised on the Big Island and is a Kea'au High School graduate. He earned his Bachelor of Science, double-majoring in Chemistry and Biomedical Sciences from Antioch College in Yellow Springs, Ohio. He found his passion for medicine while providing emergency medical services at Miami Township... more
Robotic Joint Surgery
Robot-assisted surgery is a useful tool in orthopedics. Robots have made advancements in urology, spinal surgery, general surgery, gynecology, gastrointestinal surgery, and many other fields. Robots can also be used in hip and knee replacements. Orthopedic surgeons have a variety of systems to choose from based on their preferences. While conventional surgery methods are successful, this new technology offers many advantages.
Robotic Surgery
Traditionally, orthopedic surgeons replace joints manually using special tools. The surgeon has to choose and position the implant using his or her own judgment and visualization. Many surgeons successfully improve their patients’ pain and overall function using this manual method, but there are still some concerns that there is room for error.
More recently, robotic-assisted surgery has become more popular as technology improves. Surgical robots are more precise, which offers multiple benefits throughout the surgery. There are three main types of robots: autonomic, haptic, and passive. Passive systems, systems in which the surgeon does the majority of the work and the robot functions in a supportive role, are popular. The robot can position the implant with more precision than the human eye and can assist the surgeon with other tasks during the surgery to improve outcomes.
Advantages of Robotic Surgery in Hip and Knee Joint Replacement Surgery
Robotic-arm assisted surgery is used partial knee replacements, total knee replacements, and total hip replacements. There are several differences between manual joint replacement and robotic joint replacement.
Partial Knee Replacement
There are two main ways to approach knee replacements: partial knee replacements and total knee replacements. Patients who undergo a robotic-assisted partial knee replacement had improved outcomes compared to conventional methods. These implants were implanted with better positioning, limb alignment, and sizing. Patients who underwent robotic-assisted joint replacement had less pain and stiffness than their conventional counterparts. Additionally, these patients are less likely to need a revision, their implants last longer and patients are more satisfied with their knee function.
Read more about partial knee replacements here...
Total Knee Replacement
Patients who undergo a total knee replacement with robotic assistance also have better outcomes. Implants positioned with a robot similarly have improved positioning with better balance with less invasive soft-tissue surgical intervention. Less soft tissue releases lead to a decrease in swelling and pain. This means that they needed less pain medication after the surgery. Patients undergoing a robotic total knee replacement also report better function and movement compared to those who undergo conventional surgery. These patients are overall more satisfied than their conventional counterparts. Australian registry data evaluating younger patients undergoing total knee replacements may have a lower requirement for revision if their knee is placed more accurately using robotic assistance.
Read more about total knee replacements here...
Total Hip Replacement
Robot-assisted total hip replacements also have several benefits. Hip implants are placed with more precision with robotic assistance. Better implant position leads to a lower likelihood of hip dislocation and limb length discrepancy postoperatively In the short term, both robot-assisted and conventional hip replacements had similar functional scores. Based on these short-term benefits, surgeons believe that these joints may last longer with fewer revisions.
Read more about total hip replacements here...
Robot Systems
There are multiple types of robotic systems. They each have their own advantages and disadvantages. A surgeon or hospital system can choose which system is most appropriate for them and their patients. The three major systems have comparable navigation, limb alignment calculations, and calibration technology allowing for individualized placement of your hip or knee replacement.
The Stryker Mako robotic system is the first robot that was produced on a large scale in the United States. Before surgery, the Mako robot uses Computed Tomography, otherwise known as a CT scan. CT scans allow for accurate implant positioning preoperatively. Intra-operative ligament balance checking allows for personalized positioning of each hip or knee implant. This allows for precise implant positioning and alignment. The Mako is a haptic system, meaning that the instruments are guided by the surgeon while being used, providing manual feedback during the operation, and will cease functioning if the robot is placed in an unsafe zone.
Another major robotic system produced by Smith and Nephew is called Navio. The Navio is a passive system, meaning it does not actively perform the surgery, but instead will stop functioning when the instrument is out of a defined safe area. A major advantage of this system is that it does not require the patient to receive a CT scan. CT scans can be expensive and time-consuming, so eliminating this cost is a huge benefit. The Navio does this by mapping your knee out intra-operatively into a computer and allow for implant positioning during surgery.
A newer robotic system from Zimmer Biomet is the Rosa. The Rosa is more active than Navio in that it places guides for the surgeon, but the surgeon still has an active role and deploys the various tools. Unlike the Mako, the Rosa only requires an X-ray as opposed to a CT scan. An X-ray is much less expensive and takes less time than a CT scan. X-rays are routinely performed in the office and low cost. These x-rays are performed with special arrays in the office, allowing for more accurate preoperative planning in determining implant position. This may provide additional information pre-operatively that is not available to the Navio that may allow for more accurate implant positioning without the added expense of the Mako.
Click on the robots below to learn more about the technology:
Stryker Mako
Learn more about Stryker's Mako Robotic system
Smith and Nephew Navio
Learn more about Smith and Nephew's Navio system
Zimmer Biomet Rosa
Learn more about Zimmer Biomet's Rosa
Summary
Early results of several scientific studies have demonstrated that robotic-assisted surgery has increased precision and better outcomes than manual orthopedic surgery for certain joint replacement procedures. Patients who undergo robot-assisted surgeries have less pain, less swelling, and stiffness, and improved function compared to the patients who had conventional surgery. There are benefits to each robotic system available. Ask Dr. Morton about your options in regards to having a robotic-assisted joint replacement surgery.
Works Cited
Dunbar NJ, Roche MW, Park BH, Branch SH, Conditt MA, Banks SA. Accuracy of dynamic tactile-guided unicompartmental knee arthroplasty. J Arthroplasty 2012;27:803e808.e1.
Pearle AD, van der List JP, Lee L, Coon TM, Borus TA, Roche MW. Survivorship and patient satisfaction of robotic-assisted medial unicompartmental knee arthroplasty at a minimum two-year follow-up. Knee 2017;24:419e28.
Roche M. Robotic-assisted unicompartmental knee arthroplasty. The MAKO experience. Clin Sports Med 2014;33:123e32.
