Robotic Total Knee Replacement

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Introduction

Robotic knee surgery is an emerging surgical technique that allows for significant improvements in the field of artificial joint replacement. It is an advanced technology that utilises robotic feedback to substantially increase a surgeon’s precision. During a robot-assisted knee arthroplasty a robotic arm is used to read the parameters of bony anatomy and soft tissue constraints, it provides an immediate analysis and navigates the surgeon, in executing precise cuts and placements of the artificial knee components. Robotic technology allows not only for unparalleled precision but also for accelerated completion of the procedure, decreasing general surgical and anaesthesia-associated risks.

Indications and Contraindications

Indications

Indications for Robotic Total Knee Replacement are similar to those for standard total knee replacement. Robotic surgery significantly improves the outcomes of all patients, but is especially advantageous in those with the most severe bone deformities, contractures and joint destruction:

Severe disability and pain due to osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis.
Failure of non-surgical treatments, such as medications, physical therapy, and injections.
Substantial deformity around the knee joint.
Revision knee surgery.

Contraindications

The contraindications for Robotic Total Knee Replacement are similar to those for standard total knee replacement:

Poor general health.
Generalised or localised active infection.
Poor soft tissue envelope about the knee.
Poor bone quality about the knee.
Unrealistic patient expectations.

Benefits and Risks

Benefits

General Benefits of Robotic Total Knee Replacement are similar to those for standard total knee replacement. Some benefits are characteristic of the robotic procedure:

Minimal soft tissue injury trauma: Robotic surgery allows for a smaller incision, precise cuts, and less scarring, leading to a faster recovery with less pain and shorter hospitalisation
Reduced Blood Loss: reduced tissue injury allows for less blood loss, reducing the risk of complications associated with excessive bleeding.
Precision and Accuracy: The primary benefit of robotic surgery is the high precision, resulting in improved alignment and fit of the prosthetic joint. This enhances the long-term outcomes.
Customisation: Robotic surgery allows for a higher degree of customisation based on the patient’s unique anatomy. It is very important, especially in patients with severe deformities, instabilities or contractures.

Risks

General Risks of Robotic Total Knee Replacement are similar to those for standard total knee replacement. Some drawbacks are characteristic of the robotic procedure:

Technical Challenges: While robotic systems offer precision, they also introduce a level of technical complexity. Our team is adequately trained and has experience in treating hundreds of patients using this technology.
Limited Availability: Not all hospitals and surgical centres have access to robotic systems for knee surgery. Our facility is specialised in robotic total knee surgery and there are two robots available in our surgical suite.

Surgical Approach

The surgical approach for robotic total knee replacement is similar to conventional total knee replacement. The robotic technology, however, will assist the surgeon with performing the bone cuts and soft tissue releases with much more precision, within a fraction of a degree, what would otherwise not be attainable by simple clinical assessment, even given a surgeon with very extensive experience.

Robotic Total Knee Replacement Pre-Surgery Information

Prior to knee replacement surgery, the following procedures and preparations will take place:

Patient Evaluation: A thorough assessment of the patient’s overall health, medical history, and orthopaedic condition. When necessary, your health might need optimisation and we may refer you to another specialist.
Medications: Inform your healthcare provider about any medications you’re taking, as some may need to be adjusted before surgery. You should stop taking aspirin or anti-inflammatory medications 10 days prior to the surgery. Also, you should discontinue any naturopathic or herbal medications during this period.
Imaging: X-rays, CT scans, and MRIs are used to evaluate the extent of damage and plan the surgery. CT scans are especially helpful in planning the surgical steps.
Skin preparation: The night before and on the morning of the operation, you will be asked to wash the leg with a sponge provided at the pre-admission clinic. If there is any suspicion of an iodine allergy, a Betadine Skin test might be used.
Bowel Prep: Glycerin suppositories will be provided at the pre-admission clinic, and you will need to administer them the evening prior to the surgery. An instruction leaflet will be given to guide them.
Patient education: During a physiotherapy assessment, a qualified physical therapist will provide you with personalised instructions on gait training, the use of crutches, and pre- and postoperative exercises. You will be fitted with crutches to take home and practise before the surgery.

On the day of the Surgery

Surgical paperwork will be administered by the nurses, and the anaesthetist will meet with the patient to ask a few questions.
A hospital gown will be given, and the operation site will be shaved and cleaned.
Betadine skin prep will be applied to the area above the operation site and wrapped.
All x-rays are to be sent with the patient to the theatre.

Robotic Total Knee Replacement Surgical Procedure

During the surgery, you will be given anaesthesia to ensure your safety, comfort and pain-free procedure. The surgeon will make an incision over the knee joint and place markers to allow the robot to measure the patient’s anatomical parameters. Then the robotic arm will guide the surgeon through the removal of damaged cartilage and bone, with extreme precision. Using the robotic feedback the surgeon will be able to balance the knee joint, obtaining both the stability and maximum range of motion. Finally, the definitive artificial knee components will be implanted, the surgical wound closed and the dressing applied.

Robotic Total Knee Replacement Post-Surgery Information

Immediate Post-Surgery:

Following the surgery, patients will be taken to the recovery room for monitoring. Once their condition stabilises, they will be transferred to the ward.

The patient will be set up with a button for self-administered pain relief through a machine called a PCA machine (Patient-Controlled Analgesia). It is crucial for patients to use the PCA machine as prescribed by their healthcare provider to avoid overmedication.

Patients will be encouraged to start moving their knee and walking within a day or two of the surgery. The surgical wound dressing will usually be reduced on the second day post-op to make movement easier. A physiotherapist will be available to guide them through exercises and assist with rehabilitation and mobility.

The expected hospital stay after the surgery is approximately three to five days.

Discharge: Depending on individual needs and situations, patients may be discharged home or transferred to a rehabilitation hospital. It is essential to continue with the prescribed physiotherapy exercises for a successful recovery.

The Recovery Process:

Following discharge, patients may require the use of a walker or crutches for about six weeks. As their leg gains strength and control, they can transition to using a walking stick under the guidance of a healthcare provider. Patients may resume driving around the six-week mark, but only when they feel confident that they’ve regained control of their leg. More demanding physical activities, such as sports, may be resumed comfortably after three months.

The degree of knee flexion will vary from patient to patient, but ideally, by six weeks, the knee should be able to bend to about 90 degrees. The goal is to achieve a range of movement between 110 and 115 degrees after surgery. This goal should be discussed with and determined by your healthcare provider.

Upon returning home, an occupational therapist will assess the patient’s living space and provide necessary precautions. This may include installing rails in the bathroom or making adjustments to sleeping arrangements if there are stairs in their home.

Follow-Up:

Regular follow-up appointments with the team will help monitor your progress and address any concerns:

1 week postop: for wound check,
2 weeks postop: for suture removal
6 weeks postop: for x-ray assessment of healing and your progress,
Later at 3, 6, 9, 12 months postop and further annually an x-ray will be mandatory.

Concerns

If patients are worried about their level of pain, experience significant bleeding, or notice fever or redness around the surgical site, they should contact the office immediately. If assistance is needed after hours, patients can contact the hospital where the surgery was performed, and they will contact Professor Al Muderis on their behalf.

Norwest Private Hospital: (02) 8882 8882

Macquarie University Hospital: (02) 9812 3000

This treatment could be eligible for our No 'Out-of-Pocket' Expenses Program

For further information, click here or to check your eligibility, please contact our team.