Robotics and Navigation assisted Arthroplasty

TERMS

Robotics: Through Computer assisted surgery, your surgeon obtains 3-D visualization allowing greater visibility, corrective alignment and balance of the implant joint. Joint replacement surgery with the aid of a Navigation System helps improve the results of your procedure. The system empowers surgeons to accurately fit new implant components specifically to the anatomy of the body.

 

 

 

 

 

 


Computer Assisted Orthopedic Surgery Equipment

 

Navigation: Advanced computer assisted surgical solutions that greatly enhance the precision and accuracy of hip and knee replacement surgeries

The robot assisted total joint arthroplasty was developed in 1986 [1].


Since then, several robotic systems have been developed in the Orthopaedic Medical Field  23 and 4. Food and Drug Administration in the USA permitted the method in 2008 despite the fact the clinical application in Germany began in 1994 [5]. There are several clinical and research studies published according to robotic arthroplasty 67 and 8.

The wide spread of this innovation led to edition of a new scientific paper called:



The robotic system can customize a computed tomography (CT)–based preoperative planning and accurate surgical procedure.




In the robot system algorithm, the markers and pins are registered at their angles. First the femoral part is cut by the robot and then the tibial part. After the cuts, the soft tissue balancing is done in the conventional way.


X-Rays intra and post op defining the cuts accuracy.





There are advantages using this technique noted as:

  • • More exact implant placement
    • Extended life of the implant
    • Optimal joint positioning which restores mobility
    • Decreased possibility of a revision surgery
    • Faster recovery
    • Improvement in your quality of life

Such advantages have been proven in several published data  234 and 9. Despite the fact, there are definite disadvantages, such as increased operating time, more radiation exposure, and several pinholes in bones, its advantages help the surgeon to restore the mechanical status with accuracy, even in severely deformed limbs 39 and 10.

Surgical procedures for successful robot-assisted arthroplasty can be divided into several distinct stages. These include preoperative planning, calibration of the robot, surgical exposure, fixing a bone to the robot, registration, milling, and implantation. To perform successful surgery, all of these stages should be completed effectually. Even when the surgery is well planned, sometimes unexpected obstacles are encountered  during surgery. There are records of: serious avulsion or patellar tendon rupture, repetitive failure in registration, failed sterile calibration, errors in handling, limited motion in hip joint, error in tibial work space, damaged CD-ROM, error in defining SMG,

Now, the robot is considered a good assistant to guide the way in surgery. Undoubtedly, the best scenario is uninterrupted and precise surgery. However, sometimes it is better to choose to abort the robot-assisted procedure than to incur increased risks when serious technique problems are encountered during surgery. This flexible approach and comprehensive understanding of the causes of errors markedly reduce the surgical time, dissection, and interestingly, the rate of aborted surgery itself. In addition, it allows to avoid various sources of error.

Recent trends have focused on improved rehabilitation and pain management to accelerate post surgery recovery. First, at 3 months post op, there seems to be no difference in the comfort and function of patients having conventional surgery and those having a MIS procedure. With limited visibility afforded to the surgeon, Robotics and MIS techniques have a risk of increased complications including sub-optimal device placement. This can negatively impact the long term success of the replacement as well as its short term function.

References

1. H. Paul, W. Bargar, B. Mittlestadt et al.
Development of a surgical robot for cementless total hip arthroplasty
ClinOrthopRelat Res, 285 (1992), p. 57

2 .M.S.H. Jakopec, F. Rodriguez y Baena, P. Gomes et al.
The first clinical application of a “hands-on” robotic knee surgery system
Comput Aided Surg, 6 (2001), p. 329

3.J. Bellemans, H. Vandenneuker, J. Vanlauwe
Robot-assisted total knee arthroplasty
ClinOrthopRelat Res, 464 (2007), p. 111

4.J. Decking, C. Theis, T. Achenbach et al.
Robotic total knee arthroplasty
Acta Orthop, 75 (2004), p. 573

5.M. Börner, A. Bauer, A. Lahmer
Rechnerunterstützter Robotereinsatz in der Hüftendoprothetik
Der Orthopäde, 26 (1997), p. 251

6. T. Hananouchi, N. Sugano, T. Nishii et al.
Effect of robotic milling on periprosthetic bone remodeling
J Orthop Res, 25 (2007), p. 1062

7.T. Hananouchi, N. Sugano, N. Nakamura et al.
Preoperative templating of femoral components on plain x-rays
Arch Orthop Trauma Surg, 127 (2007), p. 381

8. S. Nishihara, N. Sugano, T. Nishii et al.
Clinical accuracy evaluation of femoral canal preparation using the ROBODOC system
J Orthop Sci, 9 (2004), p. 452

9. W. Siebert, S. Mai, R. Kober et al.
Technique and first clinical results of robot-assisted total knee replacement
Knee, 9 (2002), p. 173

10. M. Borner, U. Wiesel, W. Ditzen
Clinical experience with ROBODOC and Duracon total knee
J. Stiel, W. Kornermann, R. Haaker (Eds.), Navigation and Robotics in Total Joint and Spine Surgery, Springer-Verlag, Berlin (2004), p. 362

11. S.Y. Kim, H.E. Rubash
Avascular necrosis of the femoral head: the Korean experience
J.J. Callaghan, A.G. Rosenberg, H.E. Rubash (Eds.), The adult hip (2nd ed), Lippincott Williams and Wilkins, Philadelphia (Pa) (2007), p. 1078

12. S.E. Park, C.T. Lee
Comparison of robotic-assisted and conventional manual implantation of a primary total knee arthroplasty
J Arthroplasty, 22 (2007), p. 1054

13. Y.H. Kim, J.S. Kim, S.H. Yoon
Alignment and orientation of the components in total knee replacement with and without navigation support: a prospective, randomised study
J Bone Joint Surg Br, 89 (2007), p. 471

14.Sang Eun Park, MD,Chun Taek Lee, MD
Comparison of Robotic-Assisted and Conventional Manual Implantation of a Primary Total Knee Arthroplasty 
Journal Arthroplasty, Vol 22, Iss 7, Oct 2007, pp 1054-1059

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