Arthritis of the knee affects millions of Americans. The numbers of patients who will need knee replacement surgery continues to rise. It is estimated that within the next 5 years the number of cases will exceed over 1 million per year. (1) This includes both partial and total knee replacements. Fortunately, the results of surgery have improved over time. Now, with robotic surgical techniques and multi-modal anesthesia these procedures can be safely performed as an outpatient with excellent outcomes.

What is Arthritis?

Knee arthritis is the loss of cartilage from the surfaces of the knee. Patients experience symptoms of stiffness, swelling, pain and loss of motion. Eventually the loss of cartilage may lead to abnormal angulation of the knee causing the knee to function poorly. This may result in extreme pain and instability causing the knee to not function properly, potentially resulting in the knee collapsing as a patient walks precipitating a fall.

How do you treat Arthritis in the Knee?

Knee arthritis is initially treated with non-surgical techniques. All of these modalities do not repair or replace the damaged cartilage but rather just control the inflammation in the knee. Modalities range from anti-inflammatory agents such as Motrin®, Celebrex® or Voltaren® to injections of Hyaluronic acid or Steroids. When the symptoms are mild these are the first line of treatment. Physical therapy also will help a knee early on in the disease process. Newer treatment options such as PRP (platelet rich plasma) or stem cell injections (Lipogems) also may work and are good options to consider initially while recognizing these treatments don’t repair or regenerate the lost cartilage. Therefore, when the non-surgical options have been exhausted or if there are medical reasons that prevent the usage of the non-surgical modalities, partial or total knee replacement may be the best option.

• Partial Knee Replacement
• Total Knee Replacement

The Future of Joint Replacement: Robotics

Robotic surgery for knee replacement is now being offered to patients who qualify for outpatient surgery at Bethesda Chevy Chase Surgery Center, our outpatient surgical center. Patients that qualify for outpatient joint replacement are healthy, have good support and are capable of caring for themselves at home after their surgical procedure. Surgery is performed under regional anesthesia, which avoids common side effects from general anesthesia that often include post-operative nausea, vomiting, confusion, and prolonged fatigue. Additionally a regional pain nerve block is administered before surgery along with non-narcotic pain regime “cocktails” allowing patients to recover quicker and return to their home the same day of surgery.

Robotic outpatient knee replacement offers superior results and enhances patient satisfaction. This technology should lead to better performance and longevity of knee replacement surgery.

Why Robotics?

Robotic surgery allows the surgeon to improve the accuracy of the device whether it is a total knee replacement or partial. The robotic systems give the surgeon real time feedback on the position of the implant in the knee as well as the performance of the knee implant. The robotic systems allow the surgeon to collect information before the implants are placed and guide the surgeon in the precise location of the implant as well as the soft tissue balance of the knee. These attributes are vital to overall function and longevity of the implant.

Multiple studies have shown that the major risk to long and short term success of the knee replacements whether partial or total is the risk of infection and the placement of the implant in space. (2) Therefore the performance and success of the implant can directly be related to its position and soft tissue balance, thus supporting robotic joint replacements.

How Does Robotic Joint Replacement Work?

Robotic systems analyze the position of the implant and the effect of the soft tissue (ligaments) on the knee function on a real-time basis. During the surgical procedure trackers are placed before the implant surgery is initiated. These trackers give the surgeon pre-op analysis of the current status of the knee that includes the bone contours and the soft tissue balance (ligaments). The surgeon then executes a virtual plan that simulates the implantation of the device. Adjustments can be made at this time to the plan to accommodate individual patient characteristics.

With the plan in place the surgeon proceeds with the operation but the robotic system gives real time feedback and adjustments can be undertaken as the procedure evolves. Before final implantation of the implants the surgeon can check in virtual real time the status of the implant position and the soft tissue balance (ligaments). This sequence reduces variability and adds reliability to the operation. The robotic operation adds no additional risk to the patient and only enhances the potential for a satisfactory, durable knee replacement surgery.

Robotic Surgery Videos

• Dr Bertrand Kaper – cadaver lab, good overview of implant planning and positioning/gap balancing
• Dr Jimmy Chow – Navio 7.0/Robotics overview, surgeon experience
• Dr Jeffrey Geller – Surgeon experience presentation
• Dr James Comadoll – Abbreviated live surgery

Robotic Surgery Presentation

CORI-Robotic-Assistance-Patient-Presentation

References

1. Kurz, SM, Ong, KL, Lau, E and Bozic, KJ, Impact of Economic Downturn on Total Joint Replacement in the United States; Updated Projections to 2021, JBJS, 2014 Apr 16;96(8)
2. Sharkey PF, Lichstein PM, Shen C, Tokarski, AT and Parvizi, J; Why are Total Knee Arthroplasties Failing Today-Has Anything Changed in 10 years, J of Arthroplasty, 2014 Sep;29(9)