In the rapidly evolving landscape of orthopaedic surgery, the integration of robotic assistance in hip and knee arthroplasty, in my opinion, has become a game-changer.
While traditional arthroplasty techniques can yield excellent results and will continue a mainstay of orthopaedics, I believe that in most circumstances, the use of robotics introduces a new level of predictability and precision, contributing to enhanced patient satisfaction and long-term success.
Precision in joint reconstruction
One of the key advantages of robotic-assisted hip and knee arthroplasty lies in the unparalleled precision it offers during joint reconstruction. Traditional methods, while very successful, rely on the surgeon’s skill and experience, which can vary. In contrast, robotics provide a level of accuracy that can exceed human capabilities.
Utilising preoperative planning and intraoperative feedback, robotic systems allow for meticulous bone resection, optimal implant positioning, and fine-tuned soft tissue balancing.
This heightened precision can translate into more reliable joint kinematics, ultimately contributing to improved postoperative function and reduced complications. Robotic-assisted arthroplasty can empower surgeons with advanced tools to create highly individualised treatment plans for each patient.
Through detailed preoperative imaging and virtual modelling, the surgeon can tailor the procedure to the patient’s unique anatomy, addressing specific deformities and optimising implant placement. This personalised approach may enhance the desired biomechanics of the joint but may also contribute to improved post-operative function.
The ability to account for variations in anatomy ensures a customised and predictable outcome, which can lead to increased patient satisfaction and improved long-term results.
Challenging case example
While the debate around the necessity of robotics in hip and knee arthroplasty persists, real-world cases can demonstrate the transformative impact of these technologies, especially in complex scenarios.
Consider the case of a young female patient with abnormal acetabular and femoral anatomy, severe osteoarthritis, and significantly contracted soft tissues due to childhood SUFE (slipped upper femoral epiphysis).
This challenging case necessitated a level of precision and customisation beyond what traditional methods could offer. By utilising CT-guided robotic planning and robotic-assisted surgery, it was possible to navigate the intricacies of the patient’s unique anatomy with unparalleled accuracy. The robotic system allowed for meticulous planning and execution, ensuring optimal placement of components to achieve the best possible range of motion without impingement.
The precision achieved during surgery went beyond routine cases, addressing the complexities presented by abnormal anatomy and soft tissue constraints. Through robotic assistance, accurate implant placement, alignment, and restoration of leg length were achieved with a level of confidence that traditional methods might struggle to replicate.
This not only resulted in a successful total hip replacement but also exemplified the adaptability and reliability of robotic-assisted techniques in overcoming challenging scenarios.
This case demonstrates the value of robotics in achieving consistently accurate outcomes, particularly in cases with abnormal anatomical variations. The ability to tailor the surgery to the patient’s unique needs increases the likely success of the procedure but also the restoration of functionality and quality of life in challenging cases.
In turn, this reinforces the argument for the predictability and precision offered by robotic-assisted hip and knee arthroplasty.
In acknowledging the transformative potential of robotic-assisted hip and knee arthroplasty, it is crucial to address potential pitfalls that come with these advancements.
Firstly, in the event of a need to abort the robotic procedure mid-surgery, the surgeon’s expertise becomes paramount. The ability to seamlessly transition to conventional methods underscores the importance of a surgeon’s experience, ensuring the continuity of the procedure.
Additionally, the use of two separate, small stab incisions for the placement of pin arrays raises concerns about potential complications. These incisions, while necessary for robotic guidance, pose a risk of bone or soft-tissue injury and may become susceptible to post-operative wound infections.
Lastly, the learning curve for surgeons adopting robotic techniques can result in longer operative times. The initial phases of adaptation and proficiency development may extend the duration of procedures.
Despite these challenges, the potential benefits of robotic-assisted surgery, as exemplified in precise and challenging cases, may outweigh these pitfalls when approached with careful consideration and ongoing professional development.
Key messages
- Robotic surgery can be a game changer
- Surgery can be tailored to individual anatomy
- Precision and predictability are key benefits.
Author competing interests – nil