What you should know about robotic knee replacement surgery

For decades, robotic technologies have been changing medical procedures and health care for the better. Now, advanced robotic technology has come to knee replacement surgery. But what does this mean for you if you need a knee replacement? What does this mean for orthopedic surgeons?

Knee replacements are already one of the safest and most successful surgeries, with low risks of complications and quality-of-life improvements that can last for many years. Even still, it’s possible that robotic-assisted knee replacements may further improve patient outcomes and satisfaction.

We spoke to Dr. Christine Pui, an orthopedic surgeon at TRIA, to learn what robotic knee surgery is, when it’s used and the possible benefits compared to traditional knee surgery.

What is a robotic knee replacement?

When we talk about “robotic” knee replacements, we’re referring to how the procedure is done – not the type of artificial joint that’s implanted. In other words, you will not have a robotic knee joint after surgery.

Instead, robotic knee replacement is a procedure that uses a robotic technology to improve accuracy and precision during knee replacement. At TRIA, we use the ROSA® Knee System, a robotic surgical assistant.

And, if you’re wondering if the robot performs the surgery on its own, the answer is no.

“The robot assists me in performing the surgery – it doesn’t do the surgery itself,” said Dr. Pui.

In fact, the role of the robotic assistant is to provide surgeons with real-time information to make sure the new joint is precisely placed based on the patient’s unique anatomy. But while the robot provides a guide for greater precision, your doctor still needs to be a skilled surgeon. That’s why it’s so important to work with an orthopedic surgeon who’s experienced in total knee replacements.

Is robotic knee surgery new?

Robotic technology isn’t a new technology. In fact, back in 2006, surgeons performing a partial knee replacement were the first to use robotic-arm-assisted technology. Since then, millions of robotic-assisted procedures have been done on different parts of the body.

“They keep making refinements in terms of the technology,” Dr. Pui said. “We’ve been waiting for robotic technology to get to the point where it makes sense for our patients – and now it has.”

“By investing in this technology, we’re able to provide another option that’s not widely available within other health care systems,” she added.

What happens during robotic-assisted knee replacement?

“Fundamentally, a robotic-assisted knee replacement is the same procedure as traditional knee surgery,” Dr. Pui said. “The only difference is the technology we use.”

During all knee replacement surgeries, the damaged bone and cartilage is removed from the joint and kneecap before an artificial joint – which is made of metal alloys, high-grade plastics and polymers – is implanted.

Using robotic technology allows doctors to be more precise and accurate when making surgical bone cuts, releasing soft tissue and positioning the implant. This is because doctors have more information to work with.

Before a knee replacement using ROSA, X-rays of your knee are taken to get detailed information about your specific anatomy. These X-rays are used to plan out the procedure, including the best locations for the surgical cuts and knee implant.

Then, during the procedure, ROSA uses cameras and optical lens tracking to follow the exact position of your leg.

“If your leg moves – even just slightly – the robot adjusts so that the surgery is as precise and accurate as possible,” said Dr. Pui. “We can change the measure of the cuts by as little as one millimeter to achieve exactly what we want.”

Who is a candidate for robotic knee surgery?

If you’re a candidate for a total knee replacement, it’s likely that a robotic-assisted procedure is an option for you.

“Anybody can have a robotic knee surgery,” said. Dr. Pui. “But it’s especially good for patients with challenging needs, trauma or prior surgeries to their knees. Surgery in those situations can be very difficult, and I anticipate that the robot would be very helpful.”

In particular, a robotic-assisted knee replacement may be a great choice if you have:

• Damage to the femur because of an injury
• Advanced osteoarthritis due to normal age-related changes such as thinning cartilage
• Damage on or surrounding the knee
• Prior surgeries and hardware in the femur or tibia near the knee

Is robotic surgery better for knee replacement?

It’s too early to say if robotic-assisted knee replacement surgery delivers better results than traditional surgical methods. But what we can say is that we expect robotic technology to continue to improve.

“It’s kind of the wave of the future,” Dr. Pui said. “The more data we get from performing robotic-assisted surgeries, the more we’ll be able to refine the procedure. And hopefully, patient satisfaction levels will continue to improve, too.”

We’ve touched on a few of these things already, but here’s what we know so far about the possible advantages of robotic knee surgery:

Less invasive surgery

ROSA helps surgeons perform knee replacements with greater surgical precision, which means the surgery may disrupt less bone and tissue. This also means that it may take you less time to heal.

A better implant fit

Every person’s knees are unique. Systems like ROSA allow a surgeon to tailor the knee replacement for each person’s anatomy, which may result in a better fit and more natural feeling.

“One thing ROSA does is collect a lot of data which helps us gauge how the knee is going to function,” said Dr. Pui. “ROSA helps make sure the knee is a good fit with good balance. This can hopefully help the artificial knee feel more natural for the patient.”

Shorter recovery process

For both robotic-assisted knee replacement surgery and traditional surgery, you’ll need time to heal. You’ll also need physical therapy to help you regain strength and mobility. You might also take medication for a couple weeks to help manage pain while you recover.

With robotic-assisted surgery, it’s possible that you may have a shorter recovery time. With the traditional approach, it takes about 4-6 weeks for patients to resume normal activities like driving or going to work. But some of our patients who’ve had a robotic-assisted procedure were back to activities in about half the time.

Patient satisfaction

Knee replacement procedures have a very high success rate. In one study, 96% of implants lasted for more than 10 years with 90% lasting for 20 years. But patient satisfaction rates tell a slightly different story.

“The data out there shows that about 85% of people are really happy with their knee replacements versus total hips, which is more like 95%,” she said. “One of the things we’re trying to achieve through ROSA is to increase patient satisfaction with their knee replacements.”

Frances’ knee replacement story

Frances, who’s 74, lived with knee pain for about 10 years. But when she couldn’t walk for more than a few minutes, she made an appointment with Dr. Pui and they decided the best thing was a knee replacement – with the help of the robotic assistant.

Frances was a little worried about the recovery process. She thought it would take a long time to get back to normal activities and that she would be in pain.

But that wasn’t Frances’ experience. Instead, when she woke up after her knee replacement procedure, she was hardly in any pain. After 3-4 days she stopped taking the pain medication except at night.

She was much more mobile more quickly than anyone would have expected.

“When I would walk into places they were like, ‘Really you just had it done a week ago?’” said Frances.

She’s happy that she had a robotic-assisted knee replacement surgery and knows that her doctor is a huge part of her success.

“Every time I hear horror stories about the pain, I just want to find Dr. Pui and give her a hug,” said Frances.

These days, Frances is living life on her terms.

“Do I have pain? Yeah, every once in a while,” she said. “It will last maybe a few minutes, but it goes away. And I just feel like it’s healing.”

What are the risks of robotic knee surgery?

Robotic knee surgery has the same risks of traditional knee surgery, including infection, knee stiffness, ongoing knee pain or an implant that doesn’t work the way the patient and doctor hoped it would.

Complication rates with traditional knee replacement surgery are low – 95% of people don’t have problems. We don’t yet know if robotic surgery will further reduce your chance of complications.

Your friend in knee (and robots)

If you’re considering a knee replacement and wondering if a robotic-assisted surgery is right for you, make an appointment with an orthopedic doctor at TRIA.

During the appointment, your doctor will examine your knee, ask you about what you’re experiencing and how you’re currently managing your symptoms. They may also order tests like an X-ray or MRI to see what’s happening inside your knee.

Another big part of this appointment is discussing what your goals are, and if surgery may be the best way to help you meet them. For example, there may be nonsurgical treatment options for knee pain you haven’t tried yet.

If surgery seems like a good option, your doctor will talk to you about scheduling, risks and recovery. They may ask if you’re interested in robotic-assisted surgery. But, if they don’t, feel free to bring it up if you’re interested.

All health plans are required to cover robotic-assisted knee surgery. Still, it’s a good idea to check with your health plan to see how much of the procedure they’ll cover.

Deciding on a knee replacement is a big decision, and thankfully it’s not one you need to make alone. We’ll be there every step of the way, offering guidance and support – from your first consultation through recovery.