History was in the making in Tamil Nadu on January 8, 2022 when an expert orthopaedic team successfully performed a knee replacement surgery using the most sophisticated robotics technology at Apollo Hospitals, Chennai. Robotic assisted surgery is not a futuristic goal but is happening right now at Apollo across various disciplines.
Dr. Madan Mohan Reddy, Senior Consultant, Joint Replacement and Arthroscopy Surgeon, Apollo Hospitals, Chennai enumerates the robotic technique, “Robotic surgery does not mean that an actual robot performs the surgery. Doctors use a robotic surgical arm to help them execute the procedure, assisting in areas that demand steadied hands and navigate through areas with difficult access in the human anatomy. Robotics is an additional tool in the hands of an expert orthopaedic surgeon to achieve great precision.”
Dr. K P Kosygan, Senior Consultant Orthopaedic Surgeon, Clinical Lead, Dept. of Orthopaedics, Apollo Hospitals, Chennai says, “Since January 8, 2022, using Mako Robotic- Arm Assisted Technology, more than 25 joint and knee replacement surgeries have been performed so far with greater accuracy and precision. Robotic technology available at Apollo Hospital, Chennai can also be used to perform partial, total knee replacement surgeries and total hip replacement surgeries.”
The Mako Robotic-Arm Assisted Technology has revolutionised knee replacement surgeries. The orthopaedic surgeon uses the sophisticated Mako System software to generate a 3D model of the patient’s knee and creates a preoperative plan. The software also enables the surgeon to make further planning intra-operatively to achieve an ideal balance and alignment for the knee that is being operated. Robotic- Arm Assisted Technology enables the surgeon to execute this 3D plan to near perfection using the robotic arm to remove the diseased bone and cartilage and place the implant, while protecting the surrounding soft tissues.
According to him the orthopaedic doctor will not recommend a surgery unless he exhausts all options of nonsurgical treatment, depending upon the severity of the patient’s symptoms of the afflicted joint. This includes pain relief medications, lifestyle modification, physical therapy, knee braces, weight loss in obese patients through diet and exercise, and injections into the joint of which the most commonly used is cortisone. Presently there are other options for injections including Platelet Rich Plasma and a lubricating gel. In situations where patients do not get adequate relief from these non-surgical treatments, the doctor recommends knee replacement surgery and further evaluation is initiated. The patient undergoes a thorough and comprehensive assessment by the orthopaedic surgeon, anaesthetist, relevant medical specialist and physiotherapist before being scheduled for the surgery.
Who is suitable for robotic knee replacement surgery?
Any patient good for a conventional knee replacement is a good candidate for robotic knee replacement surgery. Orthopaedic surgeons recommend robotic knee replacement surgery for more accurate positioning of the implant to restore the natural kinematic of the knee and achieve more natural function so that the patients can return back to an active lifestyle .
The Perfect Alignment
Dr. Reddy says that the diminutive margin of human error in positioning the implant that may occur during a conventional knee replacement surgery is dispensed with in the robotic knee replacement surgery. The patient who has undergone robotic assisted knee replacement surgery feels the function of the knee to be more natural, which sometimes may not be the case with patients who have had a conventional knee replacement surgery.
According to Dr. Kosygan, the success of knee replacement is in achieving near perfect alignment and good balance in the knee after the procedure. The 3 D assisted robotic technique enables the surgeon to create a personalised surgical plan for a patient and placement of the implant as per the plan. It provides real-time data throughout the surgery minimising the amount of bone to be removed and the soft tissue release required to achieve this perfect balance and alignment. The margin of error using the robotic arm is negligent as the robot executes the CT based plan to perfection. This translates into achieving good pain relief and a more natural function of the knee, as good as the native knee, depending upon the age, occupation and functional needs. Post robotic knee replacement surgery, the patient is able to lead an active life and can even resume non noncontact sports or leisure activities that do not involve risk of a fall or accident.
Says Dr. Reddy, “There is minimal blood loss and post-operative pain, shorter hospital stay and quicker recovery. Most patients who do not have other conditions are able to walk the same day and can be discharged the next day. ”
According to Dr. Kosygan, Apollo Hospitals has been implementing Accelerated Fast Track Rehabilitation programme for several years now that enables patients who have had a knee replacement surgery to be discharged within 24 or 36 hours, if they do not have other health issues. Combined with exemplary pain management techniques followed by anaesthesiologists and early rehabilitation programme, the outcomes are very good.
Revision surgeries may be required in patients who have outlasted their earlier implants due to natural wear and tear. Literature evidence says that most implants last up to 20 years or longer . Other indications for revision surgery are implant failure due to infection, improper balance and alignment, persistent painful knee after prolonged rehabilitation or damage to existing knee replacement following injury or fracture around the implant. Revision surgeries can be challenging to even the most experienced surgeon. The advent of 3D assisted robotic joint replacement technology is a very effective tool in achieving good implant alignment and balance even in complex revision surgeries. It is also a very valuable tool in training younger surgeons to achieve this well-balanced and well aligned knee replacement with a lesser learning curve.
Post-operative complications have become almost negligible due to well established treatment protocol at Apollo Hospital. Prophylaxis for deep vein thrombosis is done with the use of blood thinners, stockings and mechanical pumps till the patient becomes mobile. Dr. Kosygan says that all knee replacement surgeries at Apollo are performed in exclusive Orthopaedic Theatres with Laminar and Clean Air Flow systems that minimise risk of peri-operative infection. Along with meticulous aseptic techniques, careful handling of tissues and diligent wound care, postoperative risk of infection is negligible.
With many years of international experience, in terms of infrastructure, technology and clinical expertise, Apollo Hospital is on par , if not better than any other global centre in advanced countries. The robotic knee replacement surgeries in India are cost effective too, coming to only 1/5th of the costs of such surgeries in western countries and hence patients from different parts of the world come to Apollo Chennai for their elective orthopaedic surgeries.
Dr. Kosygan says hi-flex designs, advanced manufacturing and sterilization technology and avant-garde materials of the implants have improved their durability remarkably and have contributed to longer survival of the joint replacement.
The benefits of robotic joint replacement surgery far outweigh the marginal additional costs, whereby patients would be able to lead an active life without complications.
Fear of seeing an orthopaedic doctor for knee pain or injury because it would lead to the suggestion of a knee surgery must be dispelled. Only after exhausting all possible nonsurgical treatment options do orthopaedic surgeons decide on a knee replacement surgery. And presently, robotic knee surgery is the way to go considering that during these fast-paced times, one can hop back to an active life at the earliest, without complications. Delaying visits to doctors would lead to worsening conditions. Among elective surgeries, joint replacement is the most successful procedure in orthopaedic literature.