Robotic Total Knee Arthroplasty

The common causes of persistent knee pain and the treatment options available, including robotic-assisted total knee replacement. Discover the benefits of this advanced surgical technique and the high success rates achieved at Suncoast Orthopaedic Institute.

• degenerative osteoarthritis
• knee pain treatment
• intra-articular injections
• weight loss
• physical therapy
• surgery

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Uploaded on Dec 21, 2023 | 3 Views

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1. SUNCOAST ORTHOPAEDIC INSTITUTE ROBOTIC TOTAL KNEE ARTHROPLASTY JOSEPH NOAH MD

2. DEGENERATIVE OSTEOARTHRITIS COMMON CAUSES OF PERSISENT KNEE PAIN RHEUMATOID ARTHRITIS POST TRAUMATIC ARTHRITIS PREVIOUS SEPTIC ARTHRITIS

3. NSAIDS ACTIVITY MODIFICATION TREATMENT FOR KNEE PAIN INTRA ARTICULAR INJECTIONS WEIGHT LOSS PHYSICAL THERAPY SURGERY

4. OVER 800,000 SURGERIES PERFORMED ANNUALLY ABOUT 90% OF PATIENTS EXPERIENCE IMPROVEMENT IN PAIN ABOUT 82% EXPERIENCE IMPROVEMENT IN OVERALL FUNCTION TOTAL KNEE OUTCOMES ABOUT 80% OF KNEES ARE STILL FUCTIONING AT 25 YRS POSTOP UP TO 20% OF PATIENTS EXPERIENCE CONTINUED PAIN OR TIGHTNESS DESPITE RADIOGRAPHS THAT SHOW A WELL POSITIONED IMPLANT

5. STANDARD WEIGHT BEARING IMAGES ARE USED FOR PLANNING USUALLY PERFORMED USING A COMBINATION OF MEASURED RESECTION AND GAP BALANCING TECHNIQUE SYSTEMS RELY ON BONEY LANDMARKS TO SET COMPONENT PLACEMENT STANDARD TOTAL KNEE REPLACEMENT JIG SYSTEM IS USED TO MAKE BONE CUTS SOFT TISSUES ARE RELEASED AS NEEDED TO EQUALIZE FLEXION AND EXTENSION GAPS RESTORE NORMAL ANATOMICAL ALIGNMENT

6. 26% OF IMPLANTS ARE MALALIGNED > 3 DEGREES THERE IS A 8X LOOSENING RATE FOR MISALIGNED IMPLANTS TOTAL KNEE OUTCOMES ALL SURGEONS ARE SUSCEPTIBLE TO MALPOSITIONING (INCLUDING HIGH VOLUME SURGEONS) THE MAJORITY (EXCLUDING INFECTION) OF EARLY FAILURES ARE RELATED TO INSTABILITY, LOOSENING OR MALALIGNMENT/MALPOSITIONING

7. ROBOTIC ASSISTED TKA USES COMPUTER SOFTWARE TO GENERATE A VIRTUAL 3D MODEL OF PATIENT SPECIFIC ANATOMY FOR IMAGE DEPENDENT SYSTEMS THIS VIRTUAL MODEL DERIVED FROM PREOP CT OR MRI ROBOTIC TOTAL KNEE REPLACEMENT THIS IS USED BY SURGEON TO PREPLAN BONE CUTS, COMPONENT SIZE AND POSITIONING SURGICAL PLAN IS MAPPED INTRAOPERATIVELY TO THE PATIENT'S BONY ANATOMY USING THE NAVIGATIONAL SOFTWARE SOFT TISSUE BALANCING IS ACCOMPLISHED BY MODIFYING CUTS AND IMPLANT POSITION. LESS RELIANT ON SOFT TISSUE RELEASES

8. SYSTEMS ARE EITHER ACTIVE OR HAPTIC ACTIVE (AUTONOMOUS) SYSTEMS CARRIES OUT A DETERMINED PREOPERATIVE WITHOUT SURGEON ASSISTANCE HISTORY OF ROBOTIC TOTAL KNEE REPLACEMENT HAPTIC SYSTEMS ARE SURGEON GUIDED WITH BOUNDARIES SET BY PREOPERATIVE PLAN ROBODOC (1992) AND CASPAR WERE EARLY ROBOTIC SYSTEMS. BOTH WERE ACTIVE SYSTEMS BOTH WERE ABANDONED SECONDARY TO TECHNICAL DIFFICULTIES REQUIRING ABORTING THE PROCEDURE AND EXCESSIVE OPERATIVE TIMES

9. MORE ACCURATE BONE CUTS AND SOFT TISSUE BALACING MORE ACCURATE IMPLANT POSITIONING ROBOTIC TOTAL KNEE REPLACEMENT POTENTIAL ADVANTAGES MAY IMPROVE OBJECTIVE FUNCTIONAL OUTCOMES MAY IMPROVE SUBJECTIVE OUTCOMES MAY IMPROVE LONG TERM SURVIVORSHIP

10. HIGHER UPFRONT COSTS FOR HOSPITAL OR ASC NO REAL OPEN PLATFORM SYSTEM. IMPLANT IS DICTATED BY THE ROBOTIC SYSTEM USED ROBOTIC TOTAL KNEE REPLACEMENT POTENTIAL DISADVANTAGES HIGHER OPERATIVE TIMES CAN AFFECT OPERATIVE EFFICIENCY LEARNING CURVE WITH ANY NEW PROCEDURE OR TECHNIQUE ADDITIONAL INCISIONS FOR TEMPORARY NAVIGATIONAL PINS SOME SYSTEMS REQUIRE ADDITIONAL ADVANCED IMAGING (CT SCAN)

11. ROBOTIC KNEE REPLACEMENT IN A STUDY PERFORMED BY 6 EXPERIENCED JOINT SURGEONS ALL HAD STATISICALLY SIGNIFICANT IMPROVEMENT IN SURGICAL TIMES LEARNING CURVE WITH ANY NEW PROCEDURE EVEN EARLY IN THE LEARNING CURVE IMPLANT POSITIONING AND ALIGNMENT DID NOT SUFFER IMPLANT POSITIONING ACCURACY AND ALIGNMENT WAS UNCHANGED

12. ROBOTIC KNEE REPLACEMENT MULTIPLE COMPANIES HAVE A ROBOTIC KNEE SYSTEM MOST COMMONLY USED LOCALLY ARE THE MAKO, ROSA AND VELYS THE MAKO AND VELYS USE A CUTTING SYSTEM WHILE THE ROSA USES AN AUTONOMOUS CUTTING BLOCK SYSTEM ONLY THE MAKO SYSTEM REQUIRES ADVANCED PREOP IMAGING (CT)

13. ROBOTIC KNEE REPLACEMENT THE ROSA (ZIMMER) IS A SEMI OPEN PLATFORM IN THAT IT ALLOWS THE USE OF SEVERAL IMPLANTS FROM ZIMMER THE ROBOTIC ARM AIDS IN THE POSITIONING OF CONVENTIONAL CUTTING JIGS BONE CUTS ARE MADE BY THE SURGEON USING CONVENTIONAL INSTRUMENTS THERE IS NO HAPTIC FEEDBACK TO THE SURGEON

14. MAKO ROBOTIC TOTAL KNEE MAKO IS A CLOSED PLATFORM HAPTIC SYSTEM. NO JIGS OR CUTTING BLOCKS ARE USED. IT ALSO HAS APPLICATIONS FOR TOTAL HIP AND PARTIAL KNEE A PREOP CT OF THE KNEE IS LOADED INTO THE ROBOTIC SOFTWARE TO CREATE A 3D MODEL PLAN IS CREATED TO DETERMINE HOW MUCH BONE TO RESECT AND WHERE TO POSITION THE IMPLANTS IMPLANT POSITIONING AND TEMPLATING PERFORMED VIRTUALLY AND VERIFIED INTRAOP CUTS ARE PERFORMED BY THE ROBOTIC ARM UNDER SURGEONS CONTROL WITH HAPTIC FEEDBACK

15. MAKO ROBOTIC TOTAL KNEE MAKO REQUIRES TEMPORARY NAVIGATIONAL PINS THAT ARE INSERTED IN THE TIBIA AND FEMUR SOFT TISSUE COMPLIANCE IS TESTED AT FULL EXTENSION AND 90 DEGREES SOFT TISSUE BALANCING IS PRIMARILY ACHIEVED WITH BONE CUTS RATHER THAN SOFT TISSUE RELEASES

16. MAKO ROBOTIC TOTAL KNEE ADVANTAGES INCLUDE ALLOWING THE SURGEON TO MAKE MODIFICATIONS IN IMPLANT POSITIONING TO IMPROVE IMPLANT FIT CUTS ARE LIMITED TO WITHIN 1 MM OF PREOPERATIVE PLAN. THE SURGEON RECEIVES BOTH SENSORY AND AUDITORY SIGNALS IF DEVIATION OF THE PLAN OCCURS ALLOWS THE IMPLANT TO FIT THE KNEE RATHER THAN CUTTING THE KNEE TO FIT THE IMPLANT ALLOWS SURGEON THE ABILITY TO VERIFY SOFT TISSUE TENSION AND BALANCE WITH TRIAL IMPLANTS

18. MAKO ROBOTIC TOTAL KNEE MANUAL KNEE REPLACEMENT ATTEMPTS TO REESTABLISH THE NORMAL ANATOMICAL AXIS BY USING STANDARD GUIDES IN SOME PEOPLE RESTORING THE KNEE BACK TO "NORMAL" MAY CAUSE EXCESSIVE TENSION ON LIGAMENTS MAY BE SOURCE OF PAIN OR SUBJECTIVE TIGHTNESS

19. ROBOTIC TOTAL KNEE IN A RECENT STUDY PATIENTS WHO UNDERWENT ROBOTIC ASSISTED TKA HAD LOWER ASEPTIC REVISION RATES AT 2 YRS IN THE SAME STUDY, PATIENTS REPORTED SIGNIFICANTLY IMPROVED 2 YR WOMAC SCORES IN PAIN, FUNCTION AND TOTAL SCORES, THERE WAS A GREATER PROPORTION OF ROBOTIC ASSISTED PATIENTS

20. MAJORITY OF STUDIES SHOW IMPROVED IMPLANT POSITIONING AND ELIMINATION OF OUTLIERS WHEN COMPARED TO PREOPERATIVE PLANNING STUDIES SHOW MORE ACCURATE SOFT TISSUE GAP BALANCING WITHOUT THE NEED FOR SOFT TISSUE RELEASES MORE ACCURATE IN REESTABLISHING THE JOINT LINE TREND TOWARD BETTER PATIENTS SUBJECTIVE OUCOMES AND IMPLANT SURVIVORSHIP BUT MORE STUDIES NEEDED ROBOTIC TOTAL KNEE OUTCOMES

21. FUTURE STUDIES MAY HELP US DETERMINE WHO COULD MOST BENEFIT FROM THIS TECHNOLOGY ROBOTIC TECHNIQUES MAY NOT BE INDICATED IN ALL PATIENTS ROBOTIC SYSTEMS IMPROVE THE OBJECTIVE IMPLANT POSITION BUT CAN IT IMPROVE PATIENT SATISFACTION TREND TOWARD BETTER PATIENTS SUBJECTIVE OUCOMES AND EARLY IMPLANT SURVIVORSHIP BUT MUCH MORE TIME IS NEEDED TO DETERMINE LONG TERM SURVIVORSHIP ROBOTIC KNEE SURGERY FUTURE

22. THANK YOU THANK YOU