Premier Orthopaedics and Chester County Hospital have teamed together to bring robotic assisted knee replacement to Chester County and surrounding communities. Knee replacement is a very common procedure that is performed for end stage osteoarthritis that has not responded to conservative measures. The operation involves removing the surfaces of the knee and replacing them with metal and plastic.
Patient satisfaction following total knee replacement ranges from 80-90%, leaving a fairly significant window for improvement. This is where robotic assistance and computer navigation can start to make a difference.
The ROSA robot (Zimmer Biomet, Warsaw, IN) allows the surgeon to assess the patient’s knee and plan the implant position prior to making any bony cuts. In essence, this allows the surgeon to customize the implant position and soft tissue tension around the implant, specifically to each individual patient. Each knee is customized right there on the spot!
In conventional knee replacement, the surgeon evaluates the soft tissue tensions around the knee and then uses jigs to place the cutting guide using experience and known landmarks along with established averages, to perform the operation. The ROSA provides the surgeon with objective data, to what used to be a subjective “feel.” The ROSA can measure angles to a single degree and distances within a millimeter. The human eye is not able to appreciate this degree of accuracy, therefore the robot can allow for greater overall accuracy.
The robot is allowing surgeons to plan, ahead of making bony cuts or soft tissue releases, therefore leading to more calculated interventions. With less soft tissue dissection, and less need for repeat bony cuts, there is an opportunity for less patient pain and swelling, and possibly a faster recovery.
During the operation, the surgeon sets up arrays attached to the bone that communicate with the robot. The surgeon then systematically registers the patient specific anatomy to the robot to create each individual’s unique plan. Stresses are placed on the knee in different positions, and the data is recorded. The robot then shows a patient specific representation of the knee. The surgeon can manipulate the position and size of the implant to maximize the soft tissue balance around the knee. Then, the robotic arm places the cutting jig into the exact location on the patient’s anatomy, and the surgeon performs the cuts.
All the decisions are still made by the surgeon, as are all of the bony cuts and soft tissue releases. Accuracy can be measured each step of the way to avoid compounding minor variations that add up to big differences for the patient. There is no need for more advanced imaging modalities such as MRI or CT scan, therefore the patient (and their insurance company) is not responsible for increased cost in order to undergo a robotic knee. This can all be achieved right there in the OR. The future of knee replacement is changing. That future involves individualizing care to optimize outcome.
Dr. Andrew Old is an orthopaedic surgeon with Premier Orthopaedics. He is one of the few surgeons in the area performing robot-assisted knee replacement surgery. Dr Old welcomes new patients to his West Chester, Kennett Square and West Grove offices.
To schedule a consultation with Dr. Old, call 610-692-6280.
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