Robotics in Surgery
Revision Knee Replacement Using Robotics
Chad Mitchell, MD, FAAOS
August 3, 2023
The emerging robotic technology in orthopedic surgery is quickly advancing, especially for partial and total knee replacements. The computer mapping technology combined with the robotic-assistance makes a great combination for precision cuts and joint alignment. Patients are seeing immediate ambulation and improved early knee range of motion following these surgeries.
The computer navigation and robotic-assistance surgeries are great for an arthritic knee, but can it help someone who may be having a problem with their previous knee replacement and need to have it revised? The need for total knee replacement revision includes those components that are loose, unstable, or infected.
Orthopedic knee replacement surgeons are using the computer navigation technology to maximize range of motion and stability outcomes following the revision surgery. Traditionally, revision total knee arthroplasties have significantly less patient satisfaction which is thought to be due to increased scarring, bone loss, joint line elevation, difficulty visualizing the proper knee alignment, and decreased range of motion. Revision knee replacements can have good results, but these revisions tend to have significantly lower range of motion and patient satisfaction scores.
To optimize knee function following a revision surgery, orthopedic surgeons are using computer navigation for mapping out the problem knee including the components. Also, the anatomic joint line can be recreated virtually, so that the revision knee surgery restores the proper joint line. A problem like an elevated joint line can lead to poor patient outcomes.* After mapping out the knee, the problem components are removed and the underlying bone defects are mapped into the computer system. The surgeon can then use the mapping data to tell the robotic drill where to make the precise cuts that will allow the new revision knee components to function with good range of motion, stability, and proper joint line height. All of this is an attempt to get a similar outcome to an original or primary knee replacement.
A robotic drill is used to mill the computer generated cuts that give the best implant position with respect to range of motion and stability of the knee. Notice the reflectors that give the computer robotic system points of reference to make the precision cuts. This robotic-assisted revision knee arthroplasty usually preserves more bone with a better surface fit of the components and less use of additional metal components.
Orthopedic surgeons who use robotic-assistance for revision knee replacements are anecdotally reporting that they are using less revision knee component parts and removing much less bone during the procedure. For patients, this translates into more stable components, better alignment and better range of motion of their revision total knee replacement. Some of these patients are also able to go home on the same day of surgery.
In my opinion, a robotic-assisted knee replacement revision with computer navigation is an excellent option for obtaining a precision-aligned knee after complications with a primary knee replacement. In my experience, these patient’s recover faster and some can go home from the surgery same day. As an orthopedic surgeon, it is encouraging to see the improved results of the robotic-assisted revision knee replacements over the previous methods used. Robotics certainly has a place in improving the healthcare of patients.
[*] Buller LT, Metzger CM, Deckard ER, Meneghini RM. The Effect of Joint Line Elevation of Patient-Reported Outcomes After Contemporary Revision Total Knee Arthroplasty. The Journal of Arthroplasty. 2022;37;1146-1152.