Robotic Hip and Knee Surgery

This is a complete guide to robotic joint replacement.

In this guide you’ll learn all about:

• History of Robotics in Orthopedics
• Benefits and Advantages of Robotics
• Different Orthopedic Robots
• Evidence Behind Robotic Surgery
• Training Required
• How to Prepare for you surgery

So if you want to make sure that you get the most out of your hip or knee surgery, you will get a ton of value from today’s guide.

Hip and Knee replacement surgeries are incredibly successful operations. In fact, the Lancet named total hip replacements “the operation of the century.”

However, hip replacements are known to have problems with dislocations and limb length discrepancies. In patients with hip dysplasia or other deformities in their hips often have distorted anatomy. While anterior hip replacements have improved some of these problems, there is still room for improvement.

Knee replacements are considered an incredibly successful surgery. However, 20% of patients are still dissatisfied with their surgery. In studies of total knees performed on patients in Hawaii by excellent orthopedic surgeons using mechanical jigs, only 86% of these implants are placed in the appropriate position.

Keep reading to learn how robotics improves our surgical techniques.

Knowing the past helps to understand the future.
It’s important to see where we have come from to improve our surgical outcomes.

Traditionally, orthopedic surgeons replace joints manually using special tools. These tools are rigid in their placement of knees and do not allow for easy personalization of placement of the implant.

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.

For a short period of time, many orthopedic companies were showing computer-navigation knee replacements. Computer-guided knee and hip replacements use markers that are pinned to the patient to determine the alignment of the implant. Navigation proved more accurate with implant positioning compared to mechanical jigs. Unfortunately, this technology is harder to use and has not been able to demonstrate improved outcomes for patients.

More recently, robotic-assisted surgery has become more popular as technology improves. Robotic surgery is a drastic improvement compared to joint replacements performed with computer navigation or mechanical jigs. Surgical robots are more precise, which offers multiple benefits throughout the surgery.

There are three main types of robots: active, haptic, and passive. Active systems attempt to perform the entire operation with minimal input from the surgeon. Studies have not demonstrated that these systems are much better than navigation. Passive and semi-active systems, where the surgeon does the majority of the work and the robot functions as a supportive role, are popular. The robot provides feedback on re-shaping the bone and positioning of the implant. This leads to more precision than the human eye.

Dr. Morton is fellowship-trained in robotic-assisted joint replacements and one of the few surgeons in Hawaii to perform this procedure.

Prior to surgery, some robotic systems require the use of advanced imaging such as a long-leg standing film or a CT scan. This imaging allows for:

• Accurate sizing of implants prior to surgery
  • Less guess-work on sizes before
  • Shorter operating period
• Preoperative measurement of patient’s deformity prior to surgery

Rosa Knee Replacement uses x-rays with special calibration markers that allow for accurate determination of preoperative alignment and sizing.   After these x-rays are obtained, a preoperative plan is personalized to each patient before surgery is even performed.

There are some big differences when utilizing the robot to perform your surgery. Below is the step-by-step process of how a robotic knee is performed.
Stay tuned for a video demonstration.

Navigation pins allow for the proper utilization of the robot.

This is performed much in the same way that is done during a normal knee or hip replacement. Soft-tissue releases that are normally performed – do not have to be done.

Dr. Morton will trace out the bone landmarks on your knee replacement, obtaining real-time information to map out your knee anatomy.

The soft-tissue gap balancing information obtained during a robotic joint provides information not normally evaluated during a knee replacement.  This evaluation alerts the surgeon to your specific soft tissue anatomy and helps guide customized, patient-specific implantation of your hip or knee.

Your surgery is then planned on a computer screen prior to the actual implantation.

The robot then guides the cuts through the cutting guides. The robot provides an increased accuracy that cannot be matched by the human eye. These cuts are confirmed to be accurate after they are made.

Once the bone cuts are made, Dr. Morton will place your new hip or knee in the correct position.