Robotic Systems: Latest Innovation in Orthopaedic Surgery

Robots have been used in surgery since the late 1980s, and in orthopaedic surgery since 1992. Overtime, the technology has evolved and showed promising outcomes when compared with traditional orthopaedic procedures. Currently these are performed in two modes: haptic and autonomous.

• Haptic or tactile systems: These allow the surgeon to use or ‘drive’ the robot to perform the operation. It demands constant input by the surgeon to perform the procedure.
• Autonomous robotic systems: These require the surgeon to set up the machine, but once engaged, the robot completes the surgery without the surgeon’s help. The use of robotic technology has enabled a wider adoption of the minimally invasive surgery approach, which has gained immense popularity with patients.

Robotic or Robot-assisted surgery, is taking minimal access surgery to the next level with a plethora of advantages for the surgeon as well as the patient. Currently used in a majority of surgical procedures, it has enabled surgeons to perform common and complex procedures with greater safety and precision. Results of the above have proven to be beneficial from the patient’s as well as the surgeon’s perspective.

How is robotic surgery performed?

A robot assisted surgery is primarily a robotic system that is controlled by a surgeon. The surgeon operates from a console near the operating table, which controls the arms of the robotic system. The surgeon’s hand and wrist movements are exactly replicated by the tip of the wrist on the robotic arm. This arm has a wide array of movement and flexibility to overcome the limitations of a human wrist.

Due to this robot enabled dexterity, the surgeon can navigate into areas in the surgical space which were previously not accessible in conventional surgical approach. Moreover, the robotic system lends the surgeon a higher depth in perception due to a 3D surgical imaging technique. This vastly increases the accuracy and safety of the surgical procedure.

Advantages of Robotic Surgery

Some of the key advantages of robotic surgery are:

• Greater accuracy due to precision based approach.
• Higher safety with reduced chances of manual error.
• Minimal pain and blood loss.
• Shorter hospital stay with patients being discharged in a day, and
• Excellent cosmetic results due to tiny incisions.

Robotic systems come with an in-built safety mechanism that is factored in with algorithms of artificial intelligence and machine learning. Most laparoscopic surgeons find the transition to robotic surgery seamless, and adapt easily with a short learning curve. The excellent patient outcomes, increased surgical control over the safety measures and the enhanced accuracy of the procedure are gradually making robotic surgeries the preferred option for healthcare providers far and wide.

The most successful implementation of this technology has been observed in the case of Total Knee Arthroplasty. Let us understand how conventional, navigated and robotic TKA’s compare when choosing the best outcomes in a TKA surgery.

Robotic Total Knee Replacement (Arthroplasty) is the most effective approach

Compared to conventional total knee replacement or arthroplasty, robotic or robot assisted surgical approaches give far better outcomes. Let us understand with a simple comparison.

Conventional TKA

• Low patient satisfaction: Up to 20% of patients remain dissatisfied following TKA. The primary reason for this is linked to human controlled variables. When compromised, these greatly affect positive outcomes in TKA due to:
  • In-accurate implant positioning.
  • Imbalanced flexion-extension gaps.
  • Improper ligament tensioning.
  • Impacted periarticular soft-tissue envelope.
• Conventional jig-based TKA uses manually positioned alignment jigs to guide bone resection and implant positioning. This also means poor reproducibility of alignment-guide positioning and an alarming tendency towards inadvertent saw blade injury to the periarticular soft-tissue envelope. Its limited intra-operative data on gap measurements or ligamentous tensioning restrict the fine tuning of implant positioning.
• Sub-optimal implant positioning may further lead to developing
  • Poor functional recovery
  • Reduced positive clinical outcomes
  • Increased instability
  • Reduced implant survivorship

Clearly there are more problems to this approach which has been reported by patients and observed by specialists over time. To overcome this they moved to a navigated TKA surgical approach.

Navigated TKA

Navigated TKR fares much better than the conventional approach as it follows a planned prototype approach to eliminate errors.

• Computer software converts anatomical information from intra-operative osseous mapping into a patient-specific virtual 3D model.
• This virtual model helps plan optimal bone resection, implant positioning, bone coverage and alignment based on the patient’s anatomy.
• Further it also provides recommendations for bone resection and optimal component positioning based on the patient’s anatomical profile.

However, in comparison to both these approaches, the only concern which was still unaddressed was accuracy. This is where Robotic TKA takes the edge above rest.

Robotic TKA

Here a robotic device helps execute the pre-operative patient-specific plan with a high level of accuracy.

• Optical motion capture technology helps assess intra-operative alignment, component positioning, range of movement, flexion-extension gaps, and soft tissue balancing.
• Active control over the surgeon’s motor function helps improve the accuracy of achieving the planned bone resection and implant positioning.
• Real-time intraoperative data is then used to fine-tune bone resection and guide implant positioning, in order to achieve the desired knee kinematics and limit the need for additional soft tissue releases.
• Improved accuracy of achieving the planned femoral and tibial implant positioning, joint line restoration, limb alignment, and posterior tibial slope compared to conventional jig-based TKA.
• Accuracy in implant positioning in all three planes with reduced outliers.

To ensure that the robotic TKA surgery finds maximum success potential for the patients, we at the CK Birla Hospital, also use CUVIS Joint system to ensure that every surgical outcome leads to a more natural recovery and better quality of life.

Why CUVIS Joint?

The advantages of the CUVIS Joint system are mainly attributed to its comprehensive preoperative plan, intraoperative monitoring, patient specific and appropriate intervention by surgeons. These joints contribute majorly to the success of a TKR due to:

• More accurate implant placement, giving patients a sense of familiarity in natural movement post surgery
• Reduced risk of injury to adjacent tissues
• Improved safety and reduced risk of infection
• Early rehabilitation with early discharge from Hospital.
• Lower blood loss and smaller incisions
• Quicker recovery and rehabilitation with less pain
• Improved quality of life
• The potential for better long-term function.
• Better implant survivorship and longevity.

Outlook

Surgeries must not prevent us from leading a healthy regular life, they must ensure that we all get a chance to overcome pain and experience the unlimited joys that life has to offer. At the CK Birla Hospital we ensure our patients get the best surgical outcomes to lead a better life.

By implementing the latest innovations in surgical techniques we not only improve the chances for our patients, but also enable our award winning team of orthopaedic surgeons to keep delivering on the promise of world class healthcare services.

If you are thinking of getting a total knee replacement, now is the time to ensure that you get the best surgical results. For a consultation and more information about this approach, Book an appointment with Dr Ashwani Maichand today.