While the increasing influence of robots on our everyday lives leaves some feeling uneasy, the infiltration of robot assisted surgery in orthopaedics is enabling surgeons to better plan. Patients undergoing hip and knee replacements can benefit from a greater level of accuracy in the positioning of new joints that robotic technology affords, ultimately impacting results for the better.
Robotic assisted surgery has been in use in the US 10 years for partial knee replacement and a little less for total hip replacement. Both of these have been available in Australia for around 3 years. Robotic assisted total knee replacement is newer having been around for about 2 years and available in Australia for just under 12 months.
Dr Stuart MacKenzie, an Orthopaedic surgeon in Newcastle uses the technology.
“We have been really lucky in Newcastle to have a robot available at Lingard Private Hospital not long after it became available in Australia.
“In fact, Lingard was the second hospital in NSW to have the capability to offer robotic assisted total knee replacement,” he explains.
The technique involves having the robot assist the surgeon with preparation of the bone and positioning of parts for hip and knee replacement.
The patient has a CAT scan before surgery which is uploaded into the robot’s computer providing an accurate shape of the patient’s bone. During the surgery the surgeon then maps the surface of the bone so the robot knows where it is and can fit this to the data from the CAT scan, pinpointing exactly where the patient is positioned.
The surgeon makes a plan on the computer of where they want the parts to go. Accuracy is impressive, with the surgeon able to change the position of the hip or knee replacement parts by 0.2mm.
Once the surgeon is happy with the plan the robot then helps the surgeon to prepare the bone and position the parts for the hip or knee replacement. During this process the robot and the surgeon are both holding the instruments and working together.
“It’s more accurate than the surgeon positioning the parts with traditional techniques,” continues Dr MacKenzie.
“Because the robotic software produces a 3 dimensional computer model of the bone we can plan the surgery on this rather than on a 2 dimensional x-ray. The robotic system allows me to plan the position of the joint replacement parts to within 0.2mm.” He adds.
Robotic assisted surgery can be used for most patients needing a total hip or total knee replacement or a partial knee replacement. For some patients it may not be suitable dependent on the patient’s size or the amount of damage to the bone. At this stage it is not available for other orthopaedic operations.
The robotic technology provides a number of other benefits to surgeons, such as being able to accurately measure the length and angle of the leg during the surgery, which can help to get the tension of the ligaments right during knee replacement surgery.
All doctors are required to undertake continuing education to keep their knowledge current ensuring they remain up to date with current research and techniques.
Dr MacKenzie also visits and operates with surgeons who are already using these techniques to learn directly from them.
“The use of robotic for surgery is really exciting. It is fantastic to have the capacity to be so accurate in performing hip and knee replacement surgery.
“Moving forward there will be more study into the results of patients who have had robotic assisted surgery to see how this increased accuracy may translate into better functioning and longer lasting hip and knee replacements,”
“While it’s still very new it is progressing rapidly. It’s becoming more widespread in Orthopaedic surgery as well as other surgical specialties. No doubt in the near future more and more operations will be able to be performed with robotic assistance.
“At the moment, all robotic surgery is performed by a surgeon controlling the robot directly. I think in the future this may be able to be done remotely so the surgeon may not need to be in the same city, or even country as the patient. We are a way off that yet but the prospect of that is fantastic.”
