Orthopedic surgery centers that purchase robotic platforms for knee replacement surgery are investing in the promise of positive outcomes and the potential to tap into a patient population that’s guaranteed to grow over the next decade. Surgeons love the precise cuts and more accurate implant placement afforded by robotic assistance, and savvy patients who research their treatment options are aware of the technology that can improve their recoveries and leave their new knee functioning better than it has in years — and perhaps even better than they expected.
Active robotic platforms feature a rotating burr that cuts the bone according to a preprogrammed surgical plan created by surgeons. During procedures, surgeons don’t move the robotic arm to make the cuts; they have the ability to start and stop the procedure, but the robot makes the cuts according to the pre-op plan. Haptic robotic platforms feature a cutting tool attached to a robotic arm, but the surgeon guides the cutting tool to control where the cuts are made.
Yair D. Kissin, MD, vice chair of the department of orthopedic surgery at Hackensack (N.J.) University Medical Center, says robotic systems provide several advantages over conventional knee replacement surgery, including less medial soft tissue release needed to balance the knee. Additionally, in some challenging cases involving bone deformity or severe bone loss, traditional cutting guides may not rest on the bone well or provide proper alignment and will therefore introduce error. With the robot arm cutting the bone, this error is essentially eliminated. Ultimately, robotic assistance lets surgeons make more precise cuts in the femur and tibia that lead to more accurate placement of the implant, a factor that improves the joint’s post-op function and extends the implant’s lifespan.
Dr. Kissin notes that many experts believe patients with significant joint deformity or bone loss might not be ideal candidates for robotic surgery, but he thinks otherwise: “I feel very strongly that these more challenging cases would benefit the most from robotic assistance, which provides more accurate cuts than traditional cutting guides to restore the patient’s anatomy.”
The functioning of the technology itself makes a difference in the robotic system’s accuracy, says Dr. Kissin. Because the steady arm of a robot employs a cutting burr, the joint is more stable than when a surgeon operates with a conventional saw, a factor Dr. Kissin says helps to boost the accuracy of cuts — and therefore post-op outcomes.
“Patient satisfaction rates for traditional total knee replacements are between 82% and 88%, but one of the drawbacks of traditional surgery is the potential for error introduced at each step,” says Dr. Kissin. “Although the error introduced in a single step may be negligible, it’s possible for errors to accumulate and lead to a less-than-optimal outcome.”
Eliminating or reducing the impact of human error means the technology has the potential to level the playing field among knee replacement surgeons and increase access to the procedure for the growing number of patients who will need to have their knees replaced in the coming years.