Precision and Longevity: Robotic-aided knee ops rock

Living with the pain of arthritis in the knee joint can needlessly rob people of years of good life quality. Fortunately, technology used in knee replacement surgery has taken a great leap forward.

Orthopaedic surgeons can now turn to robotics to achieve ideal placement for more natural feeling joints.

“Wear and tear of our articular cartilage is a natural process and when this leads to pain and poor quality of life it is called osteoarthritis,” said Dr Graham Bayes, an orthopaedic surgeon practising at Netcare Mulbarton Hospital.

In the general population, the overall lifetime risk of requiring a knee replacement is about 30%, although as average life expectancy improves the percentage becomes higher for an ageing population.

“Many people are unaware of how far joint replacements have come in recent years and, sadly, learn to live with pain and compromised mobility for years unnecessarily.”

Total knee replacement is often recommended for people with advanced osteoarthritis of the knee, as it is well documented that most patients will have reduced pain and improved quality of life, even with traditional surgical techniques.

“Orthopaedic surgeons aim to recreate the normal anatomy and function of the knee.

“One of the major factors in patient satisfaction after a knee replacement is the balance of the knee, which is determined in surgery.

“If the knee ligaments are not balanced correctly, it can feel as though the knee is ‘giving way’, which holds the person back in their daily activities,” Bayes explained.

“It has been said that knee replacements are second only to hip replacements when it comes to operations that improve quality of life.

“For half a century, knee replacements were performed with the traditional technique, but we want to do better for our patients.

“One of the earlier advances was navigation systems, however, technology has moved on considerably from there.

“Robotic assisted surgery is incomparable in the control it provides the surgeon to attain their alignment goals in knee replacements,” Bayes said.

“The previous paradigm aimed for the globally accepted norm of patients being 80% pain free and satisfied with their knee replacement but with robotics this is all changing.

“We prefer for patients to be able to forget they ever had a problem with their knee and get their lives back for many years to come, and now technology is bringing us closer than ever to this goal.

“Many of our colleagues internationally share the opinion that a new standard in patient satisfaction will be made possible with robotic-assisted surgery.

“It is here to stay as a tool for orthopaedic surgeons to more precisely implant knee joints that are correctly fitted and balanced, and therefore longer lasting.”

Robotic-assisted surgery allows the surgeon to place the implants in with precise accuracy and make sure that the ligament balance of the knee is ideal before any bone cutting.

This means that once the robotic system has all the information, the surgeon can review the surgical plan and make adjustments in advance until the knee is aligned, balanced and well placed.

Only then does the operation proceed.

Once the surgeon has made the required cuts, trial implants are placed to check the fit and the robotic system analyses and rechecks it to make sure the plan has gone as anticipated.

This allows for the surgeon to fine-tune before the final knee implant is set in place, explained Bayes who has performed more than 50 robotic-assisted total and partial knee replacements at Netcare Mulbarton Hospital.

The dimensions and final result of the surgery are then captured and the robotic system stores the data for future study of the patient’s results and ongoing progress.

Bayes is contributing to building local data with a clinical audit of his patients’ outcomes, adding to the body of international research in robotic-assisted orthopaedic surgery.