Assoc. Prof. Dr. Mehmet Ali Deveci, Orthopedics and Traumatology Specialist, Koç University Hospital answered the questions about Robotic Arthroplasty.
What is hip and knee osteoarthritis/degeneration?
Joint osteoarthritis/degeneration or calcification is a painful joint disease characterized by friction of bone surfaces against each other after the articular surfaces facing each other in knee and hip joints have become worn out. Although this joint calcification occurs with cartilages wearing out due to aging, younger patients may also experience hip fracture and dislocation, avascular necrosis, knee cartilage injury, severe connective tissue injury and inflammatory articular rheumatism.
How is advanced hip and knee degeneration treated?
Advanced degeneration or calcification of hip and knee joint appear in the form of frequently intensifying and movement-restricting pain, limited motion, nocturnal pain, difficulty climbing upstairs/downstairs, knee and hip joint deformity and pain that will not subside despite painkillers and physiotherapy modalities. X-rays performed in such cases are bound to reveal severe narrowing and collapse. The most effective treatment for hip and knee osteoarthritis at this stage is total joint prosthesis.
PAINLESS MOVEMENT FOR PATIENT IS ENABLED
What is total joint prosthesis?
Total hip joint prosthesis procedure involves removal of the femoral head with osteoarthritis in the hip joint, replacement of the joint housing (acetabulum) and the femoral head with a prosthesis, and creation of a new frictionless articular surface. Total knee prosthesis procedure involves cutting the articular surfaces forming the knee joint (i.e. femur, tibia and patella) at appropriate angles and covering these surfaces with a frictionless prosthesis. The prostheses ultimately correct existing deformities, re-establish the muscle-connective tissue balance, eliminate friction and allow the patient to move without pain.
How is total hip prosthesis procedure performed?
Total hip and knee prosthesis operations can be performed based on two techniques.
- In the traditional technique, x-rays are performed. A housing for the hip and a stem of fitting size for the femur are then selected. Bones are cut, and the acetabulum as well as femoral prosthesis are placed in the carved locations at suitable angles. The joint is effectively reseated.
- The other method is robot-assisted total hip prosthesis. In this method, a computerized tomography (CT) scan is performed. Surgical planning and prosthetic dimension/angle calculations are carried out with the help of a robot. Bones are cut at appropriate angles and prostheses are placed as planned also with the help of the robot.
ACCELERATES THE HEALING PROCESS
What is robot-assisted total hip arthroplasty?
Robotic hip arthroplasty is a method utilizing robotic technology for replacement of the hip joint. A robotic surgery system is used in order to allow the surgeon to place the implant properly. By enabling the surgeon to place the implant at the correct position and dimensions, robotic hip arthroplasty can reduce the patient’s healing period and risk of complication.
Who should undergo robot-assisted hip arthroplasty?
Robotic hip arthroplasty can be advisable in the following cases:
- Hip pain and restriction that will not heal with other treatment methods.
- Wearing or damage in the hip joint.
- Calcified hips on a background of hip dislocation.
How is robot-assisted hip arthroplasty performed?
Robotic hip arthroplasty is similar to the conventional hip replacement procedure. However, it involves use of a robotic surgery system in order to allow the surgeon to place the implant properly. The surgeon makes use of a computerized mapping system and obtains 3D images of the hip joint and peripheral tissues. Using these images, the robotic surgery system provide guidance for implant placement in the correct position and dimensions.
What are the advantages of robot-assisted hip arthroplasty?
Robotic hip arthroplasty has the following advantages:
- It can improve the healing process.
- It reduces risks of complication such as fracture, placement errors and blood loss.
- It can ensure a precise implant placement procedure.
- It can improve the patient’s hip range of motion.
- It can mitigate pain.
WALKING AND HIP EXERCISES CAN BE STARTED THE NEXT DAY
How is the healing process after robot-assisted hip arthroplasty?
It is normal for patients to observe pain and swelling in the operation site after undergoing robotic hip arthroplasty. Following the physiotherapy and exercise program recommended by the surgeon can help improve the healing process. After a total hip arthroplasty procedure, the patient is prompted to sit on the bedside in the evening. Gait and hip exercises are initiated immediately on the next day. With the help of our experienced physiotherapy and rehabilitation team, the patient is expected to comfortably walk with crutches, sit down and perform hip and lower back exercises within 3 days; and start performing exercises involving climbing stairs up and down after 3 days. Swelling in the hip and calf is normal during this process. Such swelling will often heal in 1.5 months. After wound care, patients are discharged on day 4. Sutures are removed after 15 days. The patient is asked to use crutches for 3-4 weeks and perform prescribed exercises during this period of time.
How is total knee prosthesis performed?
Total knee prosthesis procedure is performed with an open approach after performing the relevant x-rays. As per the classic technique, calcification are cleared; femoral and tibial canals are accessed; fitting prosthetic dimensions and angles are determined; and the calcified articular surfaces in the knee joint are cut in accordance with templates. The necessary connective tissues are released while performing these cuts to ensure soft tissue balance.
IT IS DEFINED ACCORDING TO PATIENT ANATOMY
How is robot-assisted total knee prosthesis performed?
The most notable difference of robot-assisted total knee prosthesis with regard to conventional methods is that all dimensions and angles of the prosthesis are defined in line with the patient’s own anatomy by means of 3D recreation of preoperative computerized tomography images and complete visualization of the patient’s knee anatomy and joint alignments. The modeling is uploaded to the robot’s software, which lays out the correct dimensions and prosthetic localization prior to performance of the operation. The robot enables proper cutting of the bones without any error during the operation. In turn, this eliminates the need to access bone canals to perform the cuts. As the prosthesis is properly placed after the cuts, excessive connective tissue releases are not necessary.
Who is eligible for robot-assisted knee prosthesis?
Robot-assisted knee prosthesis procedure can be performed on all patients suffering from advanced-stage calcification that requires total knee prosthesis. In fact, robot-assisted knee prosthesis particularly facilitates the procedure for patients with severe inward or outward curvature, severe movement restriction and hindered canal access or deformity.
What are the advantages of robot-assisted knee prosthesis?
The most notable advantage offered by robot-assisted knee prosthesis procedures is that it enables error-free planning of prosthetic angles and bone cuts, as it involves a true-to-life modeling of the patient’s knee. The aim is to clearly demonstrate the patient’s own mechanical properties, ensure the most precise placement of the prosthesis possible and prolong prosthetic survival duration. In the short term, the most significant advantages include less blood loss due to absence of bone canal access, less postoperative pain due to less soft tissue releases and facilitated and early rehabilitation.
How is rehabilitation conducted after robot-assisted knee prosthesis?
After a total knee arthroplasty procedure, the patient is prompted to sit on the bedside in the evening. Gait and knee exercises are initiated immediately on the next day. With the help of our experienced physiotherapy and rehabilitation team, the patient is expected to comfortably walk with crutches, sit down and perform knee flexion and extension exercises within 3 days; and start performing exercises involving climbing stairs up and down after 3 days. Swelling in the knee and calf is normal during this process. Such swelling will often heal in 1.5 months. After wound care, patients are discharged on day 4. Sutures are removed after 15 days. The patient is asked to use crutches for 3-4 weeks and perform prescribed exercises during this period of time.
Early-term rehabilitation is easier due to the mitigated postoperative pain after robot-assisted surgery.
