Robotic Knee Replacement: Advantages and Disadvantages

Knee replacement surgeries help thousands of patients regain mobility and reduce pain yearly. As medical technology advances, robotic knee replacement has emerged as a modern alternative to traditional surgical methods, prompting patients to weigh their options carefully.

The decision between robotic and traditional knee replacement surgery requires careful consideration of multiple factors. While robotic surgery offers potential benefits like increased precision and faster recovery, it also comes with certain limitations that patients need to understand.

Understanding Robotic Knee Replacement

Modern surgical technology has brought significant changes to knee replacement procedures. Robotic knee surgery combines surgical expertise with advanced robotics to enhance precision and outcomes.

Johnson & Johnson Vely's Robot for Knee Replacement

The VELYS™ Robotic-Assisted Solution by Johnson & Johnson is an advanced robot used for knee replacement surgery. It helps doctors perform the surgery with greater accuracy and control. Unlike some other robots, VELYS™ does not need a CT scan before the operation, which makes the process quicker and reduces exposure to radiation.

This robot gives real-time information during surgery about the patient’s joints and soft tissues, allowing the surgeon to make better decisions. It works with the ATTUNE® Knee System to improve the fit and function of the new knee joint.

VELYS™ is compact and fits easily into operating rooms. It helps reduce recovery time, improves movement after surgery, and increases patient satisfaction.

What Exactly is Robotic Knee Surgery

Robotic knee surgery involves a surgeon using a specialised robotic arm to assist during the knee replacement. The system creates a detailed 3D virtual model of the patient's knee joint, allowing for precise surgical planning. During the operation, the surgeon remains in complete control while the robotic arm serves as a sophisticated surgical tool, helping to execute the pre-planned procedure with remarkable accuracy.

How is a Semi-Automated Robot Better than a Fully Automated Robot? 

A semi-automated robot is better than a fully automated robot in surgery because it gives more control to the doctor.

In a semi-automated system, the robot helps the doctor, but the doctor is still the one making decisions and guiding the surgery. This is important because every patient is different, and the doctor may need to make changes during the operation.

A fully automated robot does most things on its own, based on pre-set plans. If something unexpected happens, it might not be able to adjust quickly.

Here’s why semi-automated is better:

• The doctor stays in control
• It allows for real-time changes during surgery.
• It’s usually safer, as the doctor can stop or adjust anytime.
• It keeps the doctor’s skills active, rather than relying only on machines.

How It Differs from Traditional Surgery

The key distinction lies in the surgical approach and tools used. The robotic system offers these unique capabilities:

• Creates detailed 3D mapping of the knee joint
• Provides real-time feedback during surgery
• Allows for adjustments as small as one millimetre
• Helps achieve precise implant positioning

Unlike traditional surgery, robotic assistance enables surgeons to work with enhanced precision while making smaller incisions. The robotic arm can alert the surgeon to movement and guide them to place the prosthetics at the planned location.

Who is an Ideal Candidate

The ideal candidates for robotic knee replacement typically include patients with:

• Advanced osteoarthritis
• Deformities in the femur after injury
• Complex joint degeneration
• Hardware from previous surgeries

Patients under 65 years old with good overall health often make suitable candidates. However, certain factors, such as severe bone deformities or specific health conditions, might affect eligibility. The surgeon carefully evaluates each patient's situation to determine if robotic surgery is the most beneficial approach.

Key Benefits for Patients

Patients choosing robotic knee replacement surgery often experience significant advantages that can improve their surgical journey and recovery. Recent studies have shown remarkable improvements in various aspects of the procedure and its outcomes.

• Enhanced Surgical Precision: The robotic system provides surgeons with unprecedented accuracy in implant placement. Using advanced 3D mapping technology, surgeons can achieve precise alignment & positioning of the knee implant. This enhanced precision offers several benefits:
  • Better implant fit and alignment
  • Less damage to surrounding healthy tissue
  • More natural-feeling joint replacement
  • Reduced risk of implant wear
• Faster Recovery Timeline: Recovery after robotic knee replacement typically progresses more quickly than traditional methods. Most patients begin walking within 24 hours after surgery. Studies show that patients undergoing robotic surgery experience shorter hospital stays. Additionally, many robotic surgery patients are discharged on the first day after surgery.
• Reduced Pain and Complications: Pain management outcomes show significant improvements with robotic surgery. Research indicates that patients experience lower pain scores both at rest and during activity in the first six weeks after surgery. The precise nature of the procedure leads to several advantages:
  • 70.7% of patients are free from opioid use by six weeks post-surgery
  • Lower risk of deep vein thrombosis and other complications
  • Reduced tissue trauma and smaller incisions
  • Less post-operative swelling and discomfort

The minimally invasive robotic surgery approach results in fewer systemic complications during hospital stays and within 90 days after discharge. This improved safety profile and better pain management help patients focus on rehabilitation and return to daily activities more confidently.

Important Limitations to Consider

While robotic knee replacement offers notable benefits, patients must carefully consider several essential limitations before surgery.

• Cost Implications: The financial aspect of robotic knee replacement surgery presents a significant consideration for many patients. The robotic surgery cost is generally higher than traditional surgery. This higher cost stems from several factors:
  • Advanced robotic equipment and maintenance
  • Specialised surgical instruments
  • Additional diagnostic imaging requirements
  • Higher operation theatre charges
  • Robotic-specific disposable items
• Availability Challenges: Access to robotic knee replacement surgery remains limited in many areas. Not all medical facilities possess the necessary equipment or trained staff to perform these procedures. The specialised nature of the technology means it's primarily available at large specialty hospitals. This limitation often requires patients to travel to major cities for treatment, adding to the cost and inconvenience.
• Technology Dependence Risks: The reliance on sophisticated technology introduces unique challenges to the surgical process. The procedure takes longer than traditional surgery, averaging 123 minutes compared to 107 minutes for conventional methods. This extended duration can lead to:

The longer surgical time increases the risk of infection and may require blood transfusions in some cases. Additionally, surgeons face a significant learning curve when adopting this technology, which varies based on their experience with robotic systems. In technical difficulties, surgical teams must be prepared to switch to conventional methods, highlighting the importance of maintaining expertise in traditional surgical techniques.

Making an Informed Decision

Making the right choice about robotic knee replacement surgery requires careful consideration of multiple factors and thorough preparation. Patients must gather essential information and understand their options before proceeding with the procedure.

Questions to Ask Your Surgeon

Before committing to robotic knee surgery, patients should have a detailed discussion with their surgeon. Key questions to address include:

• "What are the specific outcomes and complication rates for this procedure?"
• "How many robotic knee surgeries do you perform annually?"
• "What is the expected recovery timeline and rehabilitation process?"
• "Will I need assistance with mobility after surgery?"
• "What are the potential risks specific to my case?"

Preparing for the Procedure

Proper preparation can significantly impact surgical outcomes. Medical evaluation should be scheduled within 30 days of surgery. The preparation process includes:

• Taking iron supplements to build blood supply and reduce transfusion needs. Patients should also focus on achieving optimal health through weight management and lifestyle adjustments. 
• Those with existing medical conditions need additional evaluation to ensure they're suitable for the procedure.
• Support from family & friends plays a vital role in recovery. Bringing a key person to appointments helps ensure a better understanding of the process and post-operative care requirements. 
• Additionally, patients should prepare their home environment for post-surgery mobility needs and arrange necessary support for the recovery period.

Conclusion

The decision between robotic and traditional knee replacement requires careful consideration of several factors. Patients must weigh the advantages of improved surgical accuracy and shorter recovery times against higher costs and limited availability. Success depends mainly on choosing an experienced surgeon, understanding insurance coverage, and preparing thoroughly for the procedure.

FAQs

1. What are the main advantages of robotic knee replacement surgery? 

Robotic knee replacement offers enhanced surgical precision, faster recovery times, and reduced post-operative pain. Patients often experience better implant fit, less damage to surrounding tissue, and a more natural-feeling joint replacement.

2. How does the cost of robotic knee replacement compare to traditional surgery? 

Robotic knee replacement is generally more expensive than traditional surgery. It typically costs more than conventional methods. The higher cost is due to advanced equipment, specialised instruments, and additional imaging requirements.

3. Are there any limitations to the availability of robotic knee replacement? 

Yes, robotic knee replacement is not widely available in all medical facilities. It's primarily offered at large speciality hospitals, which may require patients to travel to major cities for treatment, potentially adding to overall costs and inconvenience.

4. What are the potential risks associated with robotic knee replacement? 

While robotic surgery offers benefits, it does have some risks. These include longer surgery times, which can increase infection risk, and the possibility of technical difficulties requiring a switch to conventional methods. There's also a learning curve for surgeons adopting this technology.

5. Who can be an ideal candidate for robotic knee replacement? 

Ideal candidates are typically patients under 65 with good overall health, suffering from conditions like advanced osteoarthritis, complex joint degeneration, or deformities in the femur after injury. However, severe bone deformities or specific health conditions may affect eligibility, and each case is evaluated individually.