Robotic Knee Arthroplasty

Overview

Robotic knee replacement surgery is a surgery that is performed to replace an arthritic knee (or some other condition that has led to a degenerative joint disease within the knee). The surgery itself is performed by a surgeon with the assistance of a robot with a built in computer system that allows for more precise calculations of where bony cuts need to be made in order to remove the arthritis fully from the patients knee. It also allows a slightly smaller incision size and slightly more conservative tissue dissection due to the highly precise nature of the robotic assistant.

Symptoms

Knee arthritis can be a very painful condition that interferes will everyday activities, work and recreational sports. The vast majority of patients who suffer from knee arthritis will be candidates to have robotic-assisted knee replacement surgery. The indications for this are essentially the same as normal knee replacement surgery that is not assisted by a robot. Pain in the knee that is frequent, severe and debilitating. Ideally the patient should also have a full assessment by an orthopedic surgeon including an examination and assessment of plain-film radiographs.

Provided that the patient’s examination and plain-film radiographs demonstrate degenerative joint disease and the patient’s symptoms coincide with this, that patient will be considered a candidate for a knee replacement. The only contraindication to a patient receiving a knee replacement from procedure that uses robotic assistant would be severely abnormal anatomy or any other severe deformity that precludes the use of the sophisticated computer-navigating software.

Treatment

The procedure of replacing a patient’s knee using robotic assistance is broadly similar in terms of the surgical approach and equipment that is used. The procedure will involve bringing in a robot to calculate the position and depth of the bony cuts necessary in order to complete the surgery successfully. The robot itself does not complete the surgery and is under the control of the surgeon the entire time. The computer software the robot uses builds a 3-dimensional image of the knee based on reference points given to it by the surgeon using separate “navigational pins”. These can be placed inside the surgical field, or using separate small incisions which you may notice after the surgery.

Once the 3D image is built, the computer then calculates the exact position of the cuts needed to remove the arthritis from the bone, and the robotic arm makes the cuts in the exact position calculated with input from the surgeon using it. The parts of the procedure such as closure of tissue planes and closure of the skin incision are still up to the surgeon to do on his/her own.

Duration

You will experience some postsurgical pain in the area that has been operated on after your knee replacement. This is normal and you will be prescribed medications by your surgeon to attempt to control your pain and bring it within tolerable levels. It is important to remember that, at this stage, it is unrealistic to expect that there will be no pain and so a small amount of soreness in and around the knee is normal. It will take one to two weeks for the postsurgical pain to dissipate; however, this does not indicate that the knee has fully healed.

There will be some discomfort in the knee up to around 6 weeks following the surgery and in some patients, this may even persist up to 3 months following the surgery. The pain is caused by a number of factors including the muscles around the knee recovering from the surgery and regaining strength that they have lost, as well as other tissues around the knee healing and getting used to the new biomechanics of the knee joint.

It is also important to remember that a small subset of patients even experience pain up to and beyond 6 months and even a year following the surgery and that this is not necessarily an indication that the knee replacement has failed. Pain that lasts long after the surgery can be for a number of reasons and it is important to communicate your experience of this pain with your surgeon accurately so that they can best direct any therapeutic intervention in your ongoing care.

Summary

Given that most patients who suffer from knee arthritis and who would like to pursue a knee replacement as a treatment option would likely be candidates for robotic-assisted knee replacement surgery, it is something that you can ask your orthopedic surgeon or healthcare provider about. We will be happy to discuss the possibility of you receiving a knee replacement assisted by a robotic device and answer any questions or concerns you have with regards to this particular treatment option.

Dr. Sebastian Heaven
Orthopedic surgeon at London Health Sciences Centre (LHSC)

I provide Orthopaedic patient care at several different locations, including a Regional Joint Assessment Centre, a Level 1 Trauma Centre and a District General Hospital. My scope of practice is broad and includes Trauma, Arthroplasty and Sports Orthopaedics.

My areas of special interest include Primary and Revision Arthroplasty, Periprosthetic Fracture Management and general orthopaedic trauma management in isolation and in the context of complex polytrauma patients. I also have clinical research interests in these areas, as well the development of interprofessional relationships between trauma team members and fellow healthcare professionals.

I have personally written all or most of what's on this page for Complete Orthopedics, and approve the use of my content.