With the installation of the first robotic-arm assisted joint replacement system for total knee, partial knee and total hip replacement surgery at Cleveland Clinic, Consult QD explores the new technology in a Q&A with Robert Molloy, MD, Director, Section of Adult Reconstruction.
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What are the main advantages of robotic technology in joint replacement?
The technology adds an unparalleled level of accuracy and precision to total knee, total hip and partial knee replacement surgery. First, it allows us to use CT-based 3-D modeling to analyze and visualize each individual’s bone and soft tissue anatomy prior to surgery. That helps us select correct implant size, and customize the surgical plan, everything from orientation and alignment, insertion angle, to bone resection.
The system also allows us to conduct a virtual run-through prior the actual surgery and adjust the surgical plan as necessary. During surgery, it permits a more predictable surgical experience by enhancing accuracy. We can also adjust the surgical plan intraoperatively, when necessary.
The robotic arm positions the saw blade for total knee replacement or the reamer for a total hip. It positions the tools with great precision, preventing the surgeon from going outside predetermined dimensions.
Surgeons adjust the intraoperative plan to balance the knee joint prior to making bony cuts.
How widely is this technology being used at Cleveland Clinic?
We began conducting research with a research robot in about April 2017. Since acquiring the system in December 2017, 18 of our orthopaedic surgeons who perform lower extremity joint replacement have been trained and are beginning to use it.
The system is transforming the way we perform these three joint replacements procedures. We pride ourselves on innovation, but we’re ultimately most concerned about providing the best possible outcome for our patients. We believe this robotic technology has the potential to do that.
Are there contraindications to robot-assisted joint replacement?
No, there really aren’t. Anyone who has been cleared for joint replacement surgery could have the procedure done with robotic-arm assisted technology.
Any other differences between robotic-arm assisted and standard procedures?
It adds about 10 minutes to any procedure. Patients need to undergo CT scans as part of the surgical planning process. Incisions are identical to manual surgery, except one additional one-inch incision is required to accommodate a tracking device that helps the surgeon guide the robotic arm. Blood loss, length of stay (usually one night; sometimes none) and rehabilitation are all similar. Insurance companies must also be consulted regarding coverage for robotic-arm assisted surgery.
What about outcomes?
Registry data show that for partial knee replacement surgery ― which has the longest experience with the technology ― robotic-assisted surgery is more accurate than manual or traditional surgery. There is data to suggest that there are fewer failures of robotic-assisted partial knee replacements than with standard replacements. This may result in less failure of the joint and therefore less need for revisions.
The system we use was launched commercially in March 2017. It has only recently been adapted for use in total knee and total hip replacements, so data is not yet available to demonstrate improvements in these procedures. The system we use was launched commercially in March 2017. It has only recently been FDA approved for total knee procedures, so data is not yet available for total knee replacements. Since 2007, however, about 83,000 joint replacement procedures have been performed worldwide with the system we are using.
Surgeons make bony cuts to prepare the knee for a total knee replacement.