Robotic Assisted Knee Surgery

The use of robotics in orthopaedic surgery is becoming more and more popular. This is especially true in total knee arthroplasty. The design of knee implants has changed many times over the years and there are several major design types, each with their own benefits. The materials used and the manufacturing processes have also improved. As a result, there are many designs of implant that have produced excellent results in many hundreds of thousands of knees.

Despite this, even the very best surgeons, performing many thousands of knee replacement surgeries have about 20% of their patients who are not totally happy with their knee surgery. The reasons for the 20% is not clear, however it is believed that as patient’s knees are very individual, that perhaps the techniques we traditionally use for total knee replacement surgery may not be individual enough. To overcome this, techniques have been invented to personalize total knee surgery with the use of pre-operative scanning and individual planning. This allows the surgeon to identify the size of implant to use, and to plan exactly where it should be placed to give the best stability, range of motion and therefore the best functional outcome, for the patient. Using this technique, dissection of soft tissue can be reduced to a minimum and size of the exposure of the knee bones for removal of the damaged cartilage and bone can be kept to a minimum. All of these techniques make recovery following the surgery easier, less painful and faster. By individualizing the surgery, it is hoped to achieve a higher proportion of patients that will achieve an excellent result. The technique is still in its early stages but results so far are promising.

The majority of the operation is in the planning of the implant position, which is decided by the surgeon. The actual use of the robot is simply putting the plan into place, with the robot following the pre-determined plan and guiding the saw to cut very specifically where the cuts need to be made. This ensures precision cuts and protection of soft tissues with the surgeon in control at all times. Once the bony cuts have been made, (usually a matter of a few minutes) the robot is removed and implantation of the knee components is completed by the surgeon.

The idea that the robot ‘Does the surgeon’s job’ is incorrect. The surgeon is in control at all times, and indeed, the robotic part of the procedure is irrelevant without the surgical planning, exposure and implantation of components.

The benefit of the pre-operative planning and robotic assistance also makes Partial Knee Replacement surgery more viable, and this technique is now utilized far more. If only one area of your knee is damaged, sometimes just the one damaged side of your knee can be replaced. This is called Uni-Compartmental knee replacement. This preserves your undamaged knee areas and patients can have a faster recovery with this operation.

Not all patients will be suitable for this and Dr. Thornton-Bott will discuss the options of this technique with you at the consultation.