Use of Robotics in Knee Replacements

Beginning stages of robotic surgery began with partial knee replacements in about 2012. And it was estimated that about 14% of partial knee replacements were done using robotics. Well it began in 2006, by 2012 it was about 14% of partial knee replacements were done robotically. My personal opinion of this is that I think that this is a perfect procedure to do a robotic surgery. And I do all of my partial replacements robotically because they’re done through smaller incisions, it’s less invasive, and you can become more accurate by utilizing the robot. So I think for sure that this is and I think we’ve seen over the years that doing this procedure robotically has increased the survivorship of a partial knee replacement. So this is a slide here looking from Goldman Sachs, kind of projecting what are, what, what’s the future of robotics?
So this arrow is showing where we are in 2017. So there’s just a huge increase of over 50% what they’re estimating as far as the, um, growth of robotics and knee replacements over the next three years plus. So how does it work? How are we gonna, how do we do a robotic replacement? Well, I showed you the picture of the robot here before. This is the actual handpiece with a saw blade that’s attached to the robot. Um, each patient will have a personalized surgical plan based off a CT scan, so they all have to have a cat scan before the procedure. And I call that and I described that as being the map of the patient’s knee. The processes that the knee replacement goes in by removing the disease bone. We’re using this saw and we like to say that we’re preserving soft tissues because the saw is kind of restricted where, where you can move it once the parameters are set.
And this assists in positioning of the implant for each patient. It’s very patient specific. So, and you get, you know, with robotics, the precision and accuracy is the big thing. So you have precise removal of the bone according to that patient’s plan in the CT scan. So this is kind of a picture here of a CT scan showing the distal femur in the patella. Each patient gets it. And then the CT scan is then sent to the Mako representative and then we work together to set up a plan. I review all of my cases with this Mako representative to get the exact fit, sizing and positioning of the implant. So the top row here is the femur different views, the purple outlines the bone, and then the green is the actual implant. So you can see that you can turn it, rotate it, move it up and down.
And this is all based off the software program that we utilize in this procedure. So about down here as the tibia. Can do the same thing with the tibia. So then surgery is executed and what we found is, this is a post-operative x-ray, and what we’re finding doing these is that with the ability to know the sizes that we would like to use or that we’re going to use and then executing these precise bone cuts and sizing of the implants. We get X rays that turn out like this. And we’ve found that our x-rays even look better hand, than we thought they would. And they’re perfectly sized in position. So it’s, it’s very encouraging. Now that does not translate always with the patient having a perfect knee. But from this perspective, our x-rays have postoperative x-rays look really good.
All right. Couple pictures here from the surgery from a patient that volunteered here to do this. Here’s the knee. So right knee, the foot is in the leg holder here. There’s an array that communicates with the tower here and around the femur and the tibia. And then here’s our instrumentation. Our plan for this patient is viewable on the monitor in the room. We’re seeing that the position of varus for the femur and the tibia. The rotation here on the middle view of external rotation on the femur and the tibia, and then the, a flection and a slope here on the lateral view. These are our sizes, size three for the femur, three for the tibia, and nine-millimeter plastic insert in between. So that’s kind of what we have. And when we’re happy with the, the, the sizing of that, then we’ll get ready to actually execute the rest of the procedure in the bone resections.
So this would be the picture that we get right before, cause this is kind of the theoretical, um, computer generated model that will happen. So what we’re trying to achieve as a well-balanced knee, one that doesn’t feel too lax when you move it from side to side. And you look at the, did you resect the same amount of bone from the lateral side as the medial side? In this case where at 15 millimeters and 60 millimeters. Now that’s pretty accurate. One millimeter this actual device can change the amount of bone resection by a half a millimeter. So in my opinion, that’s, uh, you know, I do a lot of the knee replacements without a robot. But to get a cut down, to remove a half of a millimeter is very, very challenging.