Robotic Knee Surgery: Human Expertise with Robotic Precision
27th August 2020
Knee replacement is the third most common surgical procedure in the UK and involves replacing a worn, damaged or diseased knee with an artificial joint – and surgeons are carrying out this procedure with the aid of robots.
Mr Ian Sinha is a consultant trauma and orthopaedic surgeon at St John & St Elizabeth Hospital, and became an early adopter of robotic surgery after being exposed to computer navigated knee replacement while gaining further experience in sports surgery and joint arthroplasty in Australia in 2013.
Mr Sinha spoke to us about the accuracy and performative edge achieved by carrying out knee replacements with the aid of a robot, and how St John & St Elizabeth Hospital’s new high-tech operating theatres will be geared towards robotic surgery.
Robotic knee surgery enables next-level accuracy.
Using a robot gives me the ability to refine the position of the knee replacement by up to half a millimetre – or half a degree – which would simply not be possible with the naked eye or the manual instruments we use for a traditional knee replacement.
This means I can really customise the position of the knee according to that patient’s anatomy; during operation I actually take a map of their knees using a surgical pen with a tracker, and I literally draw the part of their knee that I’m replacing. The robot takes all of those hundreds of points and projects a picture onto a screen which can be manipulated. I input the implant that I’m going to use and I can then move that implant with just a touch of a button by half a millimetre or half a degree. This provides me with a graph that tells me the range of motion of the knee, or whether the knee looks a little bit tight or loose.
The whole idea is that I get live feedback from the robot and the software, so it’s not just me looking at and feeling the knee. The two things combined – the graph, alongside my own hands and my own brain assessing the knee – is what gives me the optimal chance of giving that patient the best-positioned knee replacement.
The surgeon still has autonomy over the operation.
We’ve still got to use our surgical intuition. Sometimes you look at everything and think, “hang on, that doesn’t look quite right – let’s just take a step back and check everything is registered correctly.” So we’ve still got autonomy; it’s the surgeon that makes the incision and it’s the surgeon in control of the robot during the operation. The surgeon is deciding everything in terms of the implant position and the size of the implant, but when it comes to making cuts in the bone and fashioning the bone for the knee replacement, that’s where the robot provides an increased level of accuracy.
The patient will feel the benefits of the increased accuracy.
In the long-term, we believe that putting the knee replacement in the best possible position means that it will ultimately last longer, and in the short-term the benefits appear to be an enhanced recovery, a reduced hospital stay and a decreased chance of needing a blood transfusion.
Studies show a faster recovery time for patients who have had robotic knee replacements. At Imperial College, we have also found a reduced need for blood transfusions post-surgery – none of my knee replacements have needed a blood transfusion for the past two years. We’re generally finding patients mobilise quicker post-surgery and they’re discharged faster – one of my partial knee patients a month ago went home the same day as their operation.
People know people who have had robotic knee replacements, and word of mouth – alongside media reports and internet search results – now means we’re seeing an increase in the number of people requesting robotic surgery.
The robot I use is the NAVIO Surgical System.
The robots are transportable because they are a small system and can actually be moved around quite easily. The company sends the robot in when they know I’ve got two or three cases to do.
With St John & St Elizabeth Hospital’s new operating theatres opening in 2021, they are planning on making the robotics a permanent fixture. The next generation of the robot will be called the CORI surgical system, which will be much smaller – so not only is it more efficient for the surgeon, the idea is that it’s a lot more economical in terms of space and moving the robot between theatres.
How can a patient go about getting a robotic knee replacement at St John & St Elizabeth Hospital?
The patient could go and see their GP and say they’ve got private health insurance, or that they don’t want to wait on the NHS and are willing to pay for a knee replacement. The GP would send a letter to the London Knee Specialists Unit at St John & St Elizabeth Hospital, or it might be specifically addressed to me because they’re interested in a robotic knee replacement.
If you are interested in a knee consultation you can do so by calling the Hospital on 0207 806 4000, book a consultation here. Alternatively, you can request a referral to St John and St Elizabeth Hospital through your GP informing them you either have medical insurance or would like self-pay.