Conventional Vs Navigation

Using Technology and Achieving Accuracy!!
Conventional Vs Navigation Vs Mako Robotic Platform …

The First very pertinent Question is – Why we are still using traditional conventional techniques in Joint replacement surgeries ……………despite all the evidence? With the Navigation and even better The MAKO Robotic Technology! If you are a patient what would you choose your surgeon to do? 60-70 % accuracy or more than 99% accuracy…Lets Discuss some common conditions and the impact of a huge burden.

Osteoarthritis is the most common joint disorder in the United States and the aging US population is expected to grow substantially. According to an article by Iorio et al. [3], the authors reported that during the period of 2000 to 2030, the elderly population is expected to increase 104%, accompanied by a projected 565% increase of primary TKA procedures. In India more than 15 crores of population is suffering from some forms of osteoarthritis and needs surgical intervention.

Technological advancements have revolutionized the field of orthopaedics. Robot-assisted Total Hip replacement, partial and total knee arthroplasty (TKA) now enables surgeons to execute these procedures with unprecedented accuracy and precision [1–2]. A study by Choong et al. demonstrated that there is a correlation between optimal alignment and improved quality of life and knee and hip functionality [5]. Studies have also demonstrated that proper alignment of the prosthesis during total knee replacement is critical in maximizing implant survival [6].If we discuss per se the evolution of Technology in Joint replacement surgery , 1960’s there were static plans  and loads of instrumentation to perform Joint replacement surgery. The outcomes were good but long-term results did show early failures and there are many minute details which needs to be perfect to have a joint which should last forever.

The basic fact is that our eyeballing techniques are good to judge parallel lines but in case we have a variation of one or two degrees its practically impossible to be sure. In Joint replacement procedures we should be 100% perfect to give the best results in terms of patient satisfaction.

The introduction of Navigation Technology in the 1990’s revolutionized these complex surgeries. The question is Why and How? Basically as mentioned that the replacement procedures are highly precise surgeries and if we have any error  this may impact on the logetivity and survivor ship of the implant and may be a cause  of pain and eventually a failure.The human eyes cannot judge variations in one or two degrees and it is this point which is a big difference when we are on conventional techniques and jigs which have been used since 1970’s.

When we talk of navigation technology We should understand – How does it Work ?

Navigation systems take the special positions of patients’ anatomical reference points and surgical instruments are transferred to a computer and processed using software that is capable of providing surgeons with information relating to various steps of the operation in a visual or graphical and numerical form, thereby giving surgeons a greater degree of control and precision in carrying out the procedure. it definitely helps us in eliminating these but still we are using the power tools which are controlled by hand and the results are verified only but whilst in execution or cutting with hand held saws there might be iatrogenic injuries which means if anything goes wrong will impact implast logetivity and eventully a failure. The planning is done on radiographs and a 3 D model is created and the bony cuts are verified in a much precise way as compared to conventional instruments. Studies have shown that computer navigation eliminates alignment “outliers”.  Experienced surgeons using conventional alignment systems can accurately align the knee replacement in over 90 – 95% of cases.  However, studies show that in as much as 5 to 10% of surgeries, postoperative knee alignment will be less than ideal.  These patients in this 5 to 10% group are considered “outliers”.  It is felt that computer navigation’s accuracy can help the surgeon shrink this percentage of postoperative alignment outliers.

When we talk of MAKO Robotic Platform – The smart Robotics – The moto is Know more and Cut less !!The question is How ?It is a different ball game and the accuracy is upto 100 percent as published in latest Journals…

Steps of How the Mako System Improves Total Knee Replacement /TOTAL Hip replacement for Someone with Arthritis Pain: with 100% precision.

 STEP 1 :INVESTIGATIONS AND SEGMENTATION: The X rays and  CT scan of the patient’s knee is segmented and fed into the robot to obtain a three-dimensional model of the knee joint -the femur, the tibia, and the surfaces that have been damaged by arthritis.

Figure 1 -Pre-Planning and Segmentation of the CT SCAN image

The surgeon with his or her own preferences can then preoperatively plan the best location for the femoral component and tibia component over the model bone, based on factors including patient size, angle of legs, location of articulating surface, and how the femur moves on top of the tibia.

STEP 2: PATIENT SPECIFIC PERSONALIZED PRE-OPERATIVE PLANNIG PRIOR TO SURGERY

Figure 2   Patient Specific Personalized Pre-Operative Planning prior to Surgery

The health provider team then loads the plan onto the robot. The surgeon in the operating room compares the plan to the individual patient’s motion — bending the knee, flexing, straightening it out, all while looking at how the motion is replicated on the robot’s screen. Based on whether ligaments are lax or tense, the surgeon might tweak component positioning by fractions of millimetres before locking in the final plan. The robot arm will lock the plane of its saw blade into a place relative to the position of the final three-dimensional plan — and assists the surgeon with performing the cuts. The surgeon pushes the saw, but the robot limits where the saw can go in space. It is important to understand that the surgery is performed by an orthopaedic surgeon, who guides Leo II Mako’s robotic arm during the surgery to position the implant in the knee joint. Leo II Mako Smart Robotic arm does not perform surgery, make decisions on its own or move without the surgeon guiding it. It also allows the surgeon to adjust your plan during surgery as needed.

STEP 3: EXECUTION OF PLAN WITHIN PRE-DEFINED LIMITS OF HAPTIC BOUNDARY ENABLING MORE THAN 99% ACCURACY

 

Figure 3: Execution of Plan within Predefined Limits of Haptic Boundary so Soft tissue and Neurovascular damage cannot be done, and accurate Position is visualized on a screen whist operating

“The surgeon still performs the surgery, but now with the accuracy and precision specific to a plan, specific to a patient, which was not possible before with conventional, manual instruments,”

The robot’s haptic boundary prevents soft-tissue trauma. There are several peer-reviewed publications on the benefits, including reduction in post-operative pain, increased patient satisfaction, increased flexion, less opioid drug use; reduction in length of stay, and fewer readmissions due to complications from the procedure has been published

Benefits of Robotic-Assisted Total Knee Replacement Positive outcomes

Robotic surgery is being adopted to have the best surgical plan, the best execution and to have a positive clinical outcome for the patient. Robotic surgery has been increasingly chosen as an option to address human errors that could potentially result in misalignment and decreased longevity of the prosthesis. The precision of robotic-assisted surgery allows for: More accurate implant positioning, which can result in a more natural feeling after surgery ,Improved safety and reduced risk of injury to adjacent tissues as there is lesser retraction,  Value & Safety Provided by the  Pre-Op CT, Small incisions, which can mean a quicker recovery, a shorter hospitalization, and less pain and a potential for better long-term function.

In a nutshell The Robotic Technology helps in –

  • More accurate implant positioning, which can result in a more natural feeling after surgery,
  • Improved safety and reduced risk of injury to adjacent tissues as there is lesser retraction,
  • Value & Safety Provided by the Pre-Op CT,
  • Small incisions, which can mean a quicker recovery, a shorter hospitalization, and less pain and a potential for better
  • Minimal blood Loss
  • Precision in Mapping of the Joins
  • Early mobilization and Early Discharge from the Hospitals(less Hospital Stay)
  • A Happy Patient

Change is the law of Nature progress is inevitable, Technology is here to stay….Only the form will change and become smaller with time….Nature`s Law

Those who embrace the change will survive, those who do not will perish  retire 🙂

 

 

[1] J. E. Lang, S. Mannava, A. J. Floyd et al., “Robotic systems in orthopaedic surgery,” Journal of Bone and Joint Surgery B, vol. 93, no. 10, pp. 1296–1299, 2011.

[2] J. H. Lonner, T. K. John, and M. A. Conditt, “Robotic arm assisted UKA improves tibial component alignment: a pilot

[3] R. Iorio, W. J. Robb, W. L. Healy et al., “Orthopaedic surgeon workforce and volume assessment for total hip and knee

replacement in the United States: preparing for an epidemic,” Journal of Bone and Joint Surgery A, vol. 90, no. 7, pp. 1598–1605,2008.

[4] G. Zhang, J. Chen,W.Chai, M. Liu, andY.Wang, “Comparison between computer-assisted-navigation and conventional total knee arthroplasties in patients undergoing simultaneous bilateral procedures: a randomized clinical trial,” Journal of Bone andJoint Surgery A, vol. 93, no. 13, pp. 1190–1196, 2011.

[5] P. F. Choong, M. M. Dowsey, and J. D. Stoney, “Does accurate anatomical alignment result in better function and quality of life? Comparing conventional and computer-assisted total knee arthroplasty,” Journal of Arthroplasty, vol. 24, no. 4, pp. 560–569,2009.

[6] B. M. Hetaimish, M. M. Khan, N. Simunovic, H. H. Al-Harbi, M. Bhandari, and P. K. Zalzal, “Meta-analysis of navigation

versus conventional total knee arthroplasty,” Journal of Arthroplasty, vol. 27, no. 6, pp. 1177–1182, 2012.

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