Robotic Knee Replacement

Robotic Knee Replacement

Robotic Surgery is a new technology that is now being used at specialized centers by experienced reconstructive surgeons for hip and knee joint replacement.

Gregory Montalbano MD, Reconstructive Orthopedic Surgeon and Faculty at the NYU School of Medicine gives a description of the technology and the benefits that it provides for patient recovery.

“For robotic knee replacement the procedure begins with a CT scan of the surgical extremity. The information from the scan is uploaded into proprietary software that generates a skeletal model of the extremity and joint. The surgeon then goes into the virtual environment and does a preliminary plan regarding implant sizing and alignment. The software allows the surgeon to plan the bone resections for the purpose of restoring natural joint mechanics and alignment. The virtual planning is often completed prior to the day of surgery.”

“Next comes the surgery itself. Since the robot can reference the anatomy without visual exposure the exposure can be less invasive compared to using traditional techniques. The skin incision can be downsized, and the muscle can be left without detachment from the bone.”

Dr. Montalbano continues, “once the joint is exposed it is referenced to a computer using specialized surgical instruments and cameras. Following exposure of the joint as many as 100 points are used to accurately reference the patient’s anatomy to the robotic system. The process of referencing is complete when the margin of error is determined by the system to be within 1mm.” 

“Once referencing is complete the knee is moved through a range of motion with the ligaments individually stressed. The ‘gaps’ are measured in the natural state for both extension and flexion for both medial and lateral compartment   Following ‘natural state’ measurements the implant alignment is modified in the virtual plan with the goal of achieving 18-19 mm gaps for both compartments in both flexion and extension. If the limits of tolerance for adjusting implant alignment is reached the soft tissues can be selectively released to make further adjustments and equalize gap measurements. Using this technology all ligaments excluding the ACL can be maintained. The benefit of maintaining the natural ligaments is for the goal of creating a reconstructed joint that will feel and function like the natural joint did in its healthy state. The technology also allows for deformity correction eliminating varus or valgus malalignment (bowlegs/knock knees). The value of precision soft tissue balancing and deformity correction is  to improve range of motion and the overall outcome of surgery. Once the adjustments are completed and the gap measurements are equalized the resection of bone begins.”

“The robot is brought into the surgical field and another reference is performed to ensure that the referencing remains accurate. The surgeon drives the arm of the robot actively with the robot controlling the ‘cut zone’. Robotics will not allow the surgeon to move the blade outside of the planned resection. This feature delivers an extremely high level of precision and execution of the surgical plan. The soft tissues are also protected from the surgical blade minimizing surgical trauma and reducing the potential for postoperative pain improving the overall experience and accelerating recovery.”

“Once the bone resections are complete the planned implants are applied by the surgeon. In situations where the bone quality is good the implants can be applied directly to the resected bone surface with no need for bonding material (press fit) and the bone will grow into the implant and stabilize. If bone quality is compromised, then a binding material is used to secure the implant to the bone surface.”

“Following implant placement, a final assessment is done using the software to determine if the plan was properly executed, the soft tissues are repaired and the skin incision is closed.” 

“In my experience,” says Dr. Montalbano, “having used traditional reconstructive methods for close to two decades and robotics since 2013 the benefit of robotic technology for knee replacement is”

  • Soft Tissue Balancing 
  • Implant Sizing 
  • Implant Alignment 
  • Deformity Correction 
  • Ligament Retention 
  • Muscle Retention 
  • Precision Bone Resections 
  • Soft Tissue Protection 
  • Reduced Incision Size 
  • Less Pain After Surgery 
  • Quicker Recovery 
  • Natural Feel and Function 

“Many patients ask me about the difference between robotics and traditional methods, the analogy I use is that’s it’s sort of the difference between the iPad and a paper notebook.  The paper notebook was fine until the iPad came out, after you use the iPad there is no comparison to a paper notebook although some people still use a paper notebook. Despite robotic technology being available there are many surgeons that still use the traditional method for whatever reason whether their facility hasn’t invested in the equipment, or they are unwilling to go through the required training or probably other reasons specific for them.”

“My opinion is that the combination of surgeon experience and robotic technology has brought joint reconstruction to a new level of sophistication. The technology and the benefits currently exist for those patients that choose the appropriate surgeon and facility.”
iOrtho is a multi-specialty musculoskeletal healthcare practice that provides patients with new technologies and innovative procedures designed to make state-of-the-art treatments readily available while maximizing outcomes. For people with active lifestyles and/or physical job requirements, iOrtho is the comprehensive single-source solution for all orthopedic needs; trauma, arthritis, sports, spine- minimally invasive procedures, computer navigated robotic procedures, custom implants, restorative treatments including hyaluronate acid, plasma, stem cell and vitamin infusion therapy. iOrtho surgeons are affiliated with NYU Langone Health and the practice takes most major insurances.

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