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Role of robotics in total knee replacement surgery

Total knee replacement surgery is most commonly needed where osteoarthritis has developed in the knee joint, which in turn can cause significant pain and prevent full movement of the joint.

In the late 1960s surgeons began to offer knee replacement surgery as an effective treatment for this condition, where the knee joint is replaced by artificial components. Today total knee replacement surgery (also referred to as 'TKA' or 'Total Knee Arthroplasty') is very common indeed, with around 25,000 procedures carried out every year in Australia.

Over the years there have been many improvements to this procedure, focusing both on the materials used in the artificial joint components and on the design and placement of the artificial joint itself.

In very general terms the closer the artificial joint components are to the natural components in terms of size, shape and placement, the better, and recent advances - specifically an approach known as 'robotic arm assisted' knee replacement - is focused on making sure that the geometry of the new knee is as closely matched as possible to the original joint. This in turn ensures that limb alignment is correct.

Although total knee replacement surgery has a high degree of success, the precise placement and alignment of the new joint is critical to the success of the procedure and any misalignment can lead to continued joint pain and possible loosening of the implants, which will require corrective surgery.

Robotic assisted total knee replacement has only recently become available in Australia, with the first procedures carried out in 2017.  The procedure involves accurate 3D 'mapping' of the knee joint either using CT scans before the procedure itself or intraoperative mapping using a computer and infrared camera.

This mapping then allows the robotic arm - guided by the surgeon - to prepare the bone surfaces to ensure as accurate a fit as possible of the new implant, in most cases to within tolerances of less than 1mm.

As the robotic-assisted approach is such a recent development, it is too early to know if it will provide any significant longer term benefits to patients undergoing the new procedure, however assessments of those procedures carried out so far are indicating accuracy equivalent to computer navigated TKR and higher than conventional TKR. Some studies showed shorter recovery times.

If this ultimately results in fewer knee replacements requiring revision surgery further down the track, then this new approach will be a significant improvement.

There is more information on this topic contained in a Patient Information Sheet compiled by Dr Reddy on Robotic-Assisted Total Knee Replacement.