Robotics Transforms Knee Replacement Surgery: Technology Allows for Ultraprecise, Customized Procedure

Over the past two decades, I have seen many advances in joint replacement surgery that have benefited patients. I believe robotic-assisted knee replacement, which allows for an ultra-precise procedure, is one of the most exciting. 

I recently reached a milestone when I performed my 500th robotic-assisted knee replacement. I use the MAKO robotic system, which is FDA-approved for both total and partial knee replacements.

Joint replacement is highly successful in relieving arthritis pain and improving quality of life, and robotic system allows us to really customize the procedure for each patient. The MAKO system allows for optimal alignment and positioning of the knee implant, as well as optimal ligament balancing, all critically important for the best outcome and long-term success of the surgery. Such precision could potentially lead to a longer-lasting knee replacement.

Over the past few years, I've seen more patients in their 40s and 50s with arthritis. The main concern for patients in this age group is that the implant may wear out over time. Although a knee replacement could last 20 years, or even longer, it doesn’t last indefinitely. For younger individuals in particular, robotic-assisted surgery has made joint replacement an attractive option, as it could prolong the life of the implant.

More recently, studies have focused on the pinpoint accuracy of the robotic-assisted knee replacement system. A study we conducted at Hospital for Special Surgery published in the Journal of Knee Surgery last year found that the technology was advantageous in the training of orthopedic surgeons, as it allowed for increased accuracy and precision.

A separate study in the Bone & Joint Journal in 2018 by researchers in the United Kingdom found robotic-assisted total knee replacement was associated with decreased pain after surgery, improved early functional recovery and a shorter hospital stay.

Before surgery, a CT scan is taken of the patient’s knee. The scan is then uploaded into the Mako system software, where a 3D model of the joint is be created. The 3D model is used to plan and assist in performing the joint replacement.

In the operating room, the orthopedic surgeon controls a robotic arm that uses computer‐guided mapping software, similar to GPS, integrated into the surgical instruments to position the implant in the knee joint.

The digital tracking system constantly monitors and updates the patient’s anatomy and enables the surgeon to make real‐time adjustments to optimize implant placement, alignment, ligament balance and joint motion. This provides each patient with a personalized surgery tailored to his or her individual anatomy.

With more accurate alignment and positioning, the implant should experience less wear and friction, and it could ultimately last longer. Studies will be needed to confirm this over the long term.

The precision of the robotic‐assisted procedure also offers more protection to the surrounding soft tissues and enables more healthy bone to be preserved, an advantage in the event another knee replacement is needed down the road.

For more information, visit my website.

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