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Got questions about robotic knee surgery? Here’s what you need to know

Wilma Kotze Photography Dr Hardcastle

Got questions about robotic knee surgery? Here’s what you need to know

Using robots to assist in surgical procedures is not new and is becoming increasingly common across the world, including in knee replacement surgery. A robot assisted knee replacement surgery is similar to traditional or manual surgery. During a traditional surgery, damaged tissue and bone in the knee is removed and replaced with an artificial joint. A robot assisted surgery is the same, except that a robotic arm assists the surgeon in placing the new components more precisely.

In my practice, I use a semi-automated robot during most of the total knee replacement surgeries that I perform.

These are my responses to some of the most common questions my patients ask about robot assisted knee replacement surgery.

Who does the surgery – the doctor or the robot?

The doctor and the robot work together to perform the surgery, however, the doctor is always in control of what happens. Think of the robot as a guide, or an additional surgical tool, which helps the doctor to follow the surgical plan.

The robot has trackers and rays, which the surgeon places in the appropriate places around the patient’s knee at the beginning of the surgery. The tools that we use during the surgery are attached to a robotic arm which tracks our movements. These provide real-time data during the surgery to make sure that the new joint is placed precisely according to the patient’s unique anatomy.

The surgeon still does the cutting, placement of the joint, and suturing – using feedback from the robot to ensure precision and accuracy. For this reason, the doctor doing this surgery still needs to be a skilled and experienced orthopaedic surgeon.

What are the advantages of robot assisted knee surgery?

Preoperative planning: Before surgery, X-rays are used to create a 3D model of your knee which shows your knee joint, bone structure and surrounding tissues. These are used to make an implant, customised for each individual patient’s anatomy. It also helps the surgeon to plan the procedure.

Precision during the surgery: All the data collected before the surgery is entered into the robot to help plan the most precise places to cut and the best placement of the implant. During the surgery, the robot collects data and provides real-time, objective feedback and information about the knee and soft tissues inside it – information that they don’t have access to in a traditional surgery – allowing them to make better decisions in theatre. The robot guides the surgeon on the cuts they make, bone they remove, soft tissues they release and the placement of the implant, greatly reducing the unpredictable elements of the surgery.

Optimal joint alignment: Using the intraoperative data provided by the robot, the surgeon can place the implant in the best possible position for each patient’s unique anatomy. This may help to ensure a more natural feeling joint replacement.

Post-operative certainty: Having all this additional data available makes it easier to follow and track patients during their recovery because we have exact records of how their implant was placed.

In the future, related technology will have sensors on the implants which will help us to monitor a patient’s walking and mobility post-surgery and allow us to better identify patients who may not be doing well post-operatively.

Is robotic knee surgery safe?

Yes. The risks are the same as with traditional knee replacement surgery, which include nerve damage, deep vein thrombosis (blood clots), infection, an allergic reaction to the artificial joint, or continued pain.

The robotic system also has several safety mechanisms built into it. In the unlikely event that there is a problem with the robot during surgery, the surgeon can still convert from using the robot to doing manual surgery.

What happens if there is loadshedding during my surgery?

Luckily, hospitals have backup power and the plugs in theatre are connected to UPSes. Should you be having an operation during loadshedding or a power outage, it will continue seamlessly.

Do you, as the surgeon, trust the robot?

Yes, the robot is there as an additional tool for the surgeon, to improve the precision during surgery. The surgeon is still in control throughout the surgery.

Is there a downside to robot assisted knee surgery?

In my practice, I don’t see a downside to robot assisted knee surgery. I believe that in the next five to 10 years, most joint replacements will be done robotically.

Does the surgeon get trained to use the robot?

Yes, most robotic systems require the surgeon to complete a validation course. Small group discussions with other surgeons are also held as part of the training. The companies supplying the robots ensure that the team in theatre knows how the system works and will provide additional support for the surgeon and their team during the first surgeries performed with the robot.

Will I walk better after a robot assisted knee replacement?

You could potentially walk better after a robot assisted knee replacement because the robot allows us to place the new joint more accurately and in a more natural way.

However, as with traditional surgery, everyone’s recovery journey is unique. The robot has no impact on your recovery once you’re out of surgery. If you do not follow your physiotherapy and rehabilitation schedule, you will not recover as quickly or as well as you should.

Will I be able to walk more quickly after a robotic surgery?

Because of the more accurate placement of the implant and less soft tissue injury, there is a chance that you may walk more quickly. When you are able to walk also depends on whether your pain is well managed and you are comfortable.

However, everyone recovers at a different rate after surgery. You walking well a few days after the surgery is no indication of your long term recovery. You will still need to invest the same amount of time and rehabilitation to regain mobility, strengthen your leg, and return to your normal activities.

How much pain can I expect?

There’s not enough data available to say for sure whether those who have undergone a robot assisted surgery experience less pain. However, because joints are placed more accurately and there is less soft tissue disruption with a robot assisted surgery, there is the potential that the patient may experience less pain.

It is important to remember that you will still have undergone surgery, either way, and that pain management and appropriate rehabilitation will be an important part of your recovery.

Will robot assisted surgery cost me more?

Yes, robot assisted surgery does cost more. However, some hospitals, such as MediClinic often absorb those costs so that it doesn’t get transferred to the patient. At other hospitals, the patient may have to make a co-payment.

Does medical aid cover robot assisted knee replacement surgery?

Many medical aids do cover robot assisted surgeries. However, it is best to discuss this with your particular medical scheme before your operation.

Which robotic system do you use?

I use the Zimmer Biomet ROSA because of its excellent data capturing and the advancements they are making in AI.

An exciting future for robot assisted surgery

While it’s still relatively early days in terms of robot assisted knee replacement surgery, data regarding the longer-term outcomes is starting to come in. These show that the accuracy of cuts made during robot assisted surgery is better and that robotic knee replacements have lower redo rates than traditional knee replacements. As the available data increases, we are hoping that it shows that robot assisted surgery will result in quicker recoveries, better outcomes, and implants that last longer.

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