Knee: Robotic Total Knee Replacement



Total knee replacement (TKR) is one of the most successful surgeries of our times in relieving knee pain secondary to osteoarthritis of the knee.

Conventional knee replacement uses pre-operative x-ray of the knee and surgeon controlled positioning of instruments to make cuts in the bone so that the artificial knee implants can be put in place. An important component of achieving the correct positioning of the implant is "soft tissue balancing" which is basically making sure the ligaments are in good amount of tension to allow the joint to move freely without being too tight or too loose. The surgeon achieves this by training, and gets better at this by performing a large volume of TKRs.



A step in improving this was Navigated TKR. The navigation used in TKR is a bit like satellite navigation when driving. There are positioning "beads" placed on the patients bones and this is then captured by camera and fed into a computer. The computer software then analyses the positioning of instruments and guides the surgeon in real time to ensure that the bone cuts he is making is accurate.


The next step in the evolution of TKR is a Robotic TKR. A pre-operative CT scan of the knee feeds in the necessary 3 dimensional data into a computer which then analyses the deformities and plans the surgical cuts. There are lots of different robotic arms available. The robotic arm then makes precision cuts in the bones with minimal soft tissue damage and aids with component positioning that matches the accuracy of pre operative planning within 1 degree.




While numerous studies have shown that robotic TKR is more accurate, allows earlier rehab and causes minimal soft tissue damage, the long term scores and outcomes at 6 months and 2 years are the same as conventional TKR.


A detailed analysis of robotic TKR can be found in the editorial here:

https://online.boneandjoint.org.uk/doi/full/10.1302/2046-3758.810.BJR-2019-0175


For more information or advice about TKR, www.askthebonedoc.com/book-online




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