Robotic Surgery
The more traditional methods of manual instrumentation, computer navigated and patient-specific implant design have all been stepping stones towards the development of robotic-assisted surgery. This is brief summary of what's involved.
What is robotic assisted surgery?
The goals of a joint replacement are to replace worn cartilage with smooth metal end caps separated by a highly crosslinked polyethylene or ceramic bearing surface in order to allow joint movement without pain. In order to do this, the bone ends must be accurately cut in order to position the implants while accounting for each patient’s specific anatomy and soft tissues.
Robot-assisted joint replacement surgery is a surgical procedure in which a surgeon uses a robotic system to help perform a joint replacement, such as a hip or knee replacement. The robot does not operate independently, rather, it assists the surgeon in planning and executing the surgery with greater precision.
How is it done?
1
Pre-op CT scan
A 3D model of the patient’s joint is created using CT
This allows precise surgical planning customized to the patient’s anatomy.
3
Final positioning of the implants are determined
The surgeon adjusts the final position of the implants to account for the patient's soft tissue tension.
2
The bone is matched to the CT
In the operation, your bones are then registered and matched to the CT scan by the computer, so their position in space can be determined by the robot.
4
The robot helps with precision cutting
The robot helps guide surgical tools within a predefined safety zone.
It can adjust in real time to the patient’s movements or anatomy.
Some systems provide haptic feedback (resistance) to help the surgeon stay within safe boundaries.
What is the evidence?
The national joint registry already has evidence suggesting that robot-assisted surgery outperforms non-robotic assisted surgery in the setting of unicompartmental (partial) knee replacements. There is yet to be robust long term evidence on the use of robotic assistance in total joint replacement.
* Hip, Knee and Shoulder Arthroplasty: 2024 Annual Report, Australian Orthopaedic Association National Joint Replacement Registry, p391 AOA: Adelaide, South Australia. 2024 Link here
Summary
While Dr Keighley can perform a joint replacement with any of the traditional methods, the planning, feedback, precision and information provided by the MAKO robot makes this his preferred method for undertaking a joint replacement.
