People often think robot-assisted knee replacement surgery is new and futuristic. But that’s not quite correct.
We performed our first cases here in Hampshire more than five years ago. And the Stryker Mako system we use first emerged nearly 20 years ago. That’s a reasonably long time!
The good news about this longevity is that it has enabled surgeons to both grow their experience with this technology and see the outcomes bearing fruit in research around the world. While not every study has shown the advantage of robotic over conventional surgery – and we await more high-quality, long-term research as it emerges – many studies have suggested there are good reasons to embrace the potential benefits.
So what are those benefits? Here are six to consider.
Precision planning
Robot-assisted surgery starts with a CT scan, which essentially takes dozens of snapshots of your leg from multiple angles. The computer turns these images into a 3D model of your knee. The model is then loaded into the Mako system, where the medical team creates a detailed plan for your operation, from implant positioning to surgical cuts. So the procedure is tailored to the patient.
Precision cuts
In theatre, the robotic arm helps the surgeon stick to the parameters they created during the plan. The surgeon remains in control of the arm throughout, but haptic feedback (tiny pulses of resistance that travel through the arm) helps him or her to stay within a fraction of a millimetre of the pre-planned boundaries.
Natural fit
One result of this precision is that it encourages a good anatomical fit for the implant. The goal is to achieve the best possible positioning of the implant, and optimal alignment of the joint within the leg. This encourages more natural kinematics (ie movement) in your new knee. As one systematic review from Italy concluded, “robotic-assisted [total knee replacement] offers benefits in accuracy, precision and alignment correction, with lower outliers and reduced errors[…]”
Pain reduction
Tissue damage is, of course, one of the side effects of any surgery. So higher precision means less disruption to soft tissue. This, in turn, can reduce pain post-operation. One Scottish study, for instance, found that, two years after their knee replacements, patients with robot-assisted surgery recorded a median Oxford Knee Score of 46, versus 41 for patients without. (A knee score is a questionnaire-based tool for evaluating pain and function; higher scores mean less discomfort.)
Recovery time
Although several factors affect recovery speed after surgery (targeted exercises and physio, for example), reduced tissue damage is a significant one. Several studies seem to bear this out. This recent one from Dallas, Texas, for instance, found that patients’ “hospital stays were nearly a half day shorter” after robot-assisted surgery versus conventional, and “were significantly less likely to have a host of complications” too. Another US study appeared to show that patients having a partial knee replacement returned to work more quickly afterwards (on average, six weeks post-operation).
Patient satisfaction
Ultimately, we want to see evidence that people’s lives are improving after replacement surgery. That’s certainly how Ed – a patient who had one of our early robot-assisted partial knee replacements – felt about his operation. “I handed the crutches back at my two-week review,” he explains in this case study. “Two and a half weeks after the operation, I could walk upstairs. The pain level is five percent of what it was before. It’s just fantastic.” It’s just one person’s experience, of course. But, overall, we’ve been very pleased by the outcomes we’re seeing with the robotic system here in our hospitals.
For further reading!
Interested in reading more about robot-assisted knee replacements – and how the technology actually works? You may find these articles helpful…
Knee replacement surgery with robotic technology: an overview (website article)
5 things you may not know about robotic knee surgery (blog)
Why robotic surgery can be a good option for partial knee replacements (blog)
