By Dr. Sachin Bhonsle Chief Joint Replacement Surgeon, Robotic & Orthopedic Surgery
My journey over 35 years, I have been a witness and a keen participant in the evolution of Knee replacements till this Robotic stage.
Are robots and AI going to take over the world of knee replacements? Let's see.
It's close to only sixty years since the first model knee replacement was designed. Knees wear out because of wear and tear or arthritis till a stage comes in some people where the pain is such that surgery is required. A completely worn-out joint can only be replaced by a prosthetic joint.
In a conventional knee replacement, the knee is approached from the front via a skin incision and a muscle-sparing cut right down to the bones. Thereafter, the tools used are standard tools like plumb bob, which is a simple weight tied to a string that shows me a straight line down to the floor. The first cut taken in the tibia using these basic tools is parallel to the ground. The second cut taken is in the femur, parallel to the first cut. These two cuts guide the rest of the procedure to fix the knee replacement onto the freshly prepared bones. These basic geometry tools are still used.
The first advancement came with the use of laser beams and computerised navigation, which sophisticated the process of telling us where the straight line and right angles were. Mechanical tools with additional computer navigation took the success of knee replacements to new heights. 95% knee replacements were functional at 15 years, just a couple of decades after its invention.
A newer concept of customization came up soon after navigation was developed. CT scan of a worn-out knee joint was processed and a true size 3-d and reverse 3-d print technology was used to plan the knee replacement surgery well before the patient was even admitted to hospital. This allowed meticulous surgical planning and precise bony cuts. In complex cases like badly deformed bones, this was a boon. Extremely difficult and impossible procedures could now be easily performed with precise planning and reproducible results in average surgical hands.
Robotic knees are a marriage of the above three techniques. Clean surgical technique, basic mechanical tools, computerised navigation, and sometimes a CT scan-based customisation were integrated to input a precise 3d image of patients worn out knee to the robot computer.
This image was then analysed by the surgeon who would then calibrate and set up the robotic arm to implement the bony cuts.
What we are using today is image-less robotics, which doesn't even need a CT scan.
Now the CT scan is not required anymore. Registration of bony points is in real time at the time of surgery, much like scanning software. All I have to do is do surface mapping of patients knee at the time of surgery, and I get a 3d image on the robot computer screen. The knee replacement can then be planned before a single cut is made.
This is ultimate "bespoke" in joint replacement, the robotic joint replacement. latest technology has made it reliable to the point of being foolproof.
Not only that, robotics have been extended to hip and other joint replacements as well as trauma.
Related: Understanding the Recovery Process After Joint Replacement Surgery
Book an Appointment with Dr. Sachin Bhonsle: For Appointments with Dr. Sachin Bhonsle, Call Dr L H Hiranandani Hospital, Powai, on 8424007007
