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The knee and Osteoarthritis

The knee is a hinge-like joint made up of the femur (thighbone), tibia (shinbone), and patella (kneecap) held together by muscles, ligaments and ther important soft tissue.

In between the knee is a natural cushioning called meniscus that is made up of cartilage. This material provides shock absorption during weight bearing activities such as walking or climbing stairs. Through wear and tear, the cartilage in your knee can break down causing a disease known as osteoarthritis.

Age, obesity, heredity, gender and other factors can lead to the progression of osteoarthritis. Common symptoms include pain, swelling and stiffness.

Treatment for knee osteoarthritis

While there is no cure for osteoarthritis, there are multiple treatment options to manage the pain and potentially delay progression of the disease.

Non surgical treatment options

  • Lifestyle changes: lose weight and avoid aggravating activities to
    reduce the stress on your knee.
  • Exercises: lose weight and avoid aggravating activities to
    reduce the stress on your knee.
  • Anti-inflammatory medications: lose weight and avoid aggravating activities to
    reduce the stress on your knee.
  • Cortisone/steroid injection: lose weight and avoid aggravating activities to
    reduce the stress on your knee.
  • Joint fluid therapy: lose weight and avoid aggravating activities to
    reduce the stress on your knee.
  • Glucosamine/chondroitin: dietary supplements intended to support
    joint health.
  • Bracing: used to provide external stability to the knee.

Surgical treatment options

  • Arthroscopic surgery: lose weight and avoid aggravating activities to
    reduce the stress on your knee.
  • Partial knee replacement surgery: lose weight and avoid aggravating activities to
    reduce the stress on your knee.
  • Total knee replacement surgery: lose weight and avoid aggravating activities to
    reduce the stress on your knee.

Reasons for surgery

Knee replacement surgery should be considered when all conservative measures fail to provide relief. Surgery may be performed for the following reasons:

  • Relieve pain
  • Improve joint stability
  • Improve alignment and correct bone deformity
  • Maximise quality of life
  • Optimise activities of daily living

Total knee replacement

Total knee replacement is one of the most common surgical procedures performed in all of medicine; there are over 50,000 performed every year in Australia and New Zealand.

More than 90% of people who undergo total knee replacement experience dramatic relief in knee pain and are better able to perform common activities.

Total knee replacement removes and replaces the damaged knee surface with an implant. A total knee implant is made up of three parts: a metal femoral component (thighbone), a metal tibial component (shinbone), and a plastic spacer that is placed in between. A fourth component made of plastic is sometimes used to cover the back of the patella (knee cap).

Total knee replacement with Robotic Surgical System

Increased Accuracy through Advanced Imaging Techniques

The cornerstone of the Robotic Knee Replacement lies in its ability to utilize advanced imaging techniques to create a 3D model of the patient’s knee. This cutting-edge technology enables surgeons to make the most precise measurements and cuts, resulting in superior placement of the artificial knee joint. As a consequence, patients experience a more natural feel post-surgery, reducing discomfort and improving overall functionality.

Enhanced Safety and Minimized Risk of Complications

The precision and accuracy of the Robotic Knee Replacement significantly reduce the risk of errors and complications during surgery. Surgeons can make smaller incisions due to the high level of accuracy, which minimizes trauma to the surrounding tissues. As a result, patients experience less pain and a faster recovery process compared to traditional knee replacement surgeries.

Faster Recovery and Improved Postoperative Rehabilitation

The minimally invasive nature of the Robotic Knee Replacement translates to a swifter recovery period. Patients often report reduced postoperative pain and an enhanced ability to resume normal activities sooner compared to traditional knee replacement surgery. The faster recovery enables patients to regain their independence and enjoy an improved quality of life in a shorter timeframe.

Long-Term Results and Enhanced Mobility

Numerous studies have demonstrated the long-term success of the Robotic Knee Replacement. Patients who undergo this innovative procedure often experience greater mobility and improved quality of life for many years following surgery. This longevity of positive outcomes highlights the durability and efficacy of the Robotic Knee Replacement as a reliable solution for patients seeking knee replacement surgery.

Personalized Approach for Optimal Fittings

Every patient’s knee is unique, with distinct variations in size and shape. The Robotic Knee Replacement offers a highly personalized approach, ensuring that the fitting and placement of the artificial knee joint are tailored to each patient’s specific needs. This level of customization leads to a better fit, greater comfort, and improved mobility for the patient, ultimately contributing to a better quality of life after the procedure.

Preparation for surgery

There are several activities that you should plan for once you decide to have surgery:

Initial surgical consultation: Preoperative x-rays, complete past medical history, complete past surgical history, complete list of all medications and allergies (prescription, over-the-counter, vitamin supplements).

Complete physical examination: Your doctor may determine if you are in the best possible condition to undergo surgery.

Blood donation: A transfusion may be necessary after surgery, therefore you may wish to donate blood prior to surgery.

Physiotherapy: Instruction in an exercise program to begin prior to surgery and an overview of the rehabilitation process after surgery will better prepare you for post-operative care.

Preparation for the hospital: You may want to bring the following items:

  • Clothing: underwear, socks, t-shirts, exercise shorts for rehabilitation.
  • Footwear: walking or tennis shoes for rehab; slippers for hospital room.
  • Walking Aids: walker, cane, wheelchair or crutches if used prior to surgery.
  • Insurance Information

Preparation before surgery:

  • Follow your surgeon’s instructions for preparation the evening before surgery.
  • You may be advised not eat or drink after midnight.
  • Shower (with five minute scrub to surgical area with special soap provided).
  • Prepare your belongings and review total knee booklet.

Preparation for after surgery:

  • Move items and furniture in your home so they are easier to access while your mobility is limited.
  • Remove clutter and obstacles that could be tripping hazards.
  • Have a plan; preparing meals ahead of time and arranging visitors to help with everyday chores will make your recovery smoother.

What to expect in surgery

You will first be placed under anaesthetic to relax your body for surgery and block pain. The correct form of anaesthetic will be discussed and determined prior to surgery with your surgeon and anaethetist.

Your surgeon will then make an incision that extends several centimetres above the knee cap to several centimetres below the knee cap. Using the robotic system, special trackers are secured to both the thigh bone (femur) and shin bone (tibia) with four small surgical pins placed through tiny incisions in the skin.

These trackers are crucial to the precision of the system as they provide a constant reference point to the surgeon throughout the procedure.

Using computer assistance, the unique shape and motion of your knee are collected by the surgeon. This allows for a three-dimensional model of your knee to be generated and used by the surgeon to plan the procedure. Proper implant size and position will be determined at this time.

Once your surgeon virtually determines the correct implant size and positioning, a handheld robotics- assisted tool is used to accurately position bone removal cut guides.

These cut guides enable the surgeon to use a surgical saw to remove your damaged knee bone, making room for the implant. The extra layer of precision provided by the robotic system is designed to enable accurate cut guide placement.

Download Discharge Instructions

Postoperative

Immediately after surgery you will be monitored as you awake from anaesthetic. Once awake,
you will be taken to your hospital room. Plan to stay in the hospital for several days.

In addition to the incision along your knee there will be two small incisions on both your
thigh and lower leg where the tracker pins were placed. Expect to feel some pain. This is a natural part of the
healing process. Your doctor and nurses will work to reduce your pain.

Most patients begin exercising their knee the day after surgery, although each patient’s
postoperative care will vary. A physiotherapist will prescribe exercises to help restore knee strength and function,
and increase range of motion in your knee. It is common to experience swelling, stiffness and tightness at this
time.

Rehabilitation following surgery

The success of your surgery will largely depend on how well you follow your surgeon’s instructions the first few weeks following surgery. How quickly you recover depends on factors such as knee pain, flexibility, strength and balance. Follow up visits will likely be scheduled to check up on your condition and progress as you recover.

In order for you to meet the goals of knee replacement surgery, you must take ownership of the rehab process and work diligently on your own as well as with your physiotherapist. The rehabilitation process can be quite painful at times. However, if you commit to following your program and overcome the challenges in rehab, you will succeed in meeting the goals you set when deciding on surgery.

Robotic Knee Replacement In Jaipur : ‘Debunking Myths and Misconceptions

The popularity of robotic assisted surgeries (RAS), commonly called robotic surgeries, has increased immensely over the past few years. India is also seeing an increasing acceptance of robotic surgery among surgeons and patients, given its various benefits and advantages, as compared to conventional open surgery. Among other benefits, robotic surgery offers faster recovery, less pain and discomfort, minimal blood loss, reduced risk of infection, greater precision, smaller scars. But there are still many misconceptions and myths about robotic knee replacement surgery,that are stopping people from choosing this advanced procedure. Robotic knee replacement surgery in jaipur has become the talk of the town lately, and it’s not hard to see why.

In a tete-a-tete with Dr S.S Khatri, Senior Consultant Orthopaedics, Joint Replacement & Robotic surgery,Vaishali Nagar, jaipur debunks some of the common myths about robotic knee replacement surgery as well as addresses common concerns patients have after the surgery.

Robotic knee replacement surgery is a procedure where the damaged cartilage of the knee joint is removed and replaced with an artificial joint with robotic assistance. Robotic assisted surgery offers better planning prior to surgery and greater precision with better alignment and joint balancing during the surgery. These lead to shorter recovery times and better patient outcomes.

If you also believe this, you couldn’t be more wrong! It’s called robot-assisted surgery for a reason. Robots do not perform the entire surgery. There is a surgeon present in the operation room, and they will use the robotic arm to ensure precise placement of the implant. The robotic arms make accurate cuts and ensure a correct alignment of the implant. The robotic arm won’t move until the surgeon directs. So, there’s no way it can perform surgery without a surgeon’s assistance.

Fact: Contrary to popular belief, the surgery is not solely conducted by AI. The robotic arm is guided by the surgeon to ensure precise placement of implants that are optimal for each individual patient.

In conventional surgery, the surgeon has to make all decisions right when the patient is on the operation table. They need to get the implants and fit them immediately. With a robotic knee replacement surgeon in jaipur, a patient can have peace of mind knowing that the surgery is pre-planned and the implants are customized to the patient’s unique anatomy much before the start of bone cuts. The focus is solely on the eroded portion of the knee, while the healthy portion is left untouched

Fact: The surgeon operates along with the robot and hence it is known as robotic-assisted knee replacement. The robotic arm is always held by the surgeon. The robot also provides a virtual boundary called a haptic boundary which prevents the surgeon from inadvertently damaging the nerve, vessels, or vital soft tissue structures.

People assume that knee replacement is a complicated procedure, as it’s just like kidney or liver transplant surgery, where the entire organ is removed and replaced. Contrary to these beliefs, knee replacement removes the eroded parts of the knee cartilage and retains the healthy portions. The damaged cartilage are replaced by artificial implants. The procedure can be done either in a conventional way or using advantage robot-assisted technology. The latter is a better and safer choice, as the cuts are made precisely, and implants are positioned in appropriate places. In fact, robot-assisted surgery is comparatively safer than surgery performed without a robotic arm. There’s always the risk of the implants not fitting the patient’s anatomy, or they might get placed incorrectly.

Any patient who’s fit for traditional surgery is also a good candidate for a robot-assisted knee replacement procedure. Since robot-assisted surgeries involve fewer complications and faster recovery, these are ideal treatment options for elderly patients who need a total knee replacement. The surgery offers a greater level of precision and reduced risk of problems, making it a highly effective choice for all patients

Some patients think that they will have to give up most of their activities after robotic knee replacement surgery. Patients can continue with their routine activities after robotic knee replacement surgery. Many patients return to sporting activities as well. Some are concerned that they cannot kneel or squat after robotic knee replacement surgery. With good rehabilitation and physiotherapy, patients regain most of their range of movements of the knee joint and can kneel or squat.

Prior to the bone cut, the patients undergo 3 d bone mapping of their knee joint which gives detailed information regarding the bony anatomy and aids in planning . This helps in preparing a customised plan for each patient and deciding the size and type of implant required. During the surgery, the soft tissue tension is assessed, and minimal soft tissue release and bone resection is carried out. Because of this prior planning, the alignment of the implants and joints is assured in every case. This results in lesser pain and early mobilisation of the patient after the surgery and improves the long-term outcomes.

There is a misconception that robotic joint replacement is prohibitively expensive, making it accessible only to the wealthy elite. While it is true that robotic technology initially came with a higher price tag, its increasing popularity and advancements in the field have made it more accessible to a broader range of patients. As technology improves, costs tend to decrease over time, allowing more individuals to benefit from this revolutionary procedure.

Another myth surrounding robotic joint replacement is that the recovery process is more extended and challenging compared to traditional surgery. On the contrary, robotic joint replacement can lead to quicker rehabilitation, say some of the best knee replacement surgeons in jaipur . The precision of the robotic arm allows for smaller incisions, reducing tissue damage and postoperative pain. As a result, patients often experience a speedier recovery and can return to their normal activities sooner.

Fact- The robotic knee replacement surgery has proven to effectively transform lives of many patient by restoring their health, the success rate of robotic joint replacement is even more than 99% in most of the cases, The success rate of any procedure depends on several points that is condition of the patient and routine of the patient. Robotic knee replacement surgery effectively helps the patient to perform all the daily activities without any pain.

A prevalent misconception is that robotic joint replacement will replace skilled surgeons with automated machines. The truth is that robotic systems are sophisticated tools designed to complement a surgeon’s skills, not replace them. While the robotic arm aids in the procedure’s precision, the surgeon’s expertise, decision-making, and technical knowledge are irreplaceable. The combination of a skilled surgeon and robotic technology results in the best possible outcome for the patient.

Fact: Modern-day pain management is so advanced that the patient does not feel any pain during surgery. Anaesthesia is given before the surgery to provide a painless operation. Post-surgery pain management is done by epidural infusion or a nerve block. Patient-controlled analgesia is the latest technique in pain management in which the patient controls the analgesia dosage per pain tolerance.

Fact: 99% of the patient do not need a physiotherapist. After replacement, doctors train patients on how to exercise, and the patient needs to practice at home. Most of our patients start walking with a walker the same day after the surgery. By 2-4 weeks, they can walk comfortably without any support.

Fact: The only risk in the whole surgery is the chance of infection. The chances of having an infection in our highly advanced joint replacement centre are around 0.2%.

Driving becomes easy because it doesn’t exert pressure on the knee. Most patients start driving anywhere between 4-8 weeks after surgery.

Diabetes and blood pressure are no longer a concern when considering knee replacement surgery. The only thing required is blood sugar and BP under control; modern-day medicines are capable of doing this

Today’s joint replacements last from 20 to 25 years, and for many people, it lasts for a lifetime.

Fact: Age does not matter for this procedure. If you are clinically affected, the patient can undergo knee replacement surgery. Some patients have undergone knee replacement even at the age of 90+ years and are happy with the operation.

Benefits of robotic knee replacement for advanced arthritis

The advantages of robotic knee replacement surgery are significant:

Reduced post-surgery pain

The precise nature of robotic surgery minimizes damage to tissues around the knee, resulting in less post-operative pain.

Increased accuracy

Robotic assistance ensures a higher level of accuracy, allowing patients to regain mobility more quickly. This, in turn, reduces the time spent in the hospital after surgery.

Reduced complications

With the aid of robotic technology, the risk of complications during and after surgery can be minimized like less blood loss, less chances of embolism, less pain, early recovery.

Improved long-term functionality

By achieving optimal implant alignment and stability, robotic knee replacement can enhance the long-term functionality of the knee joint.

Enhanced patient satisfaction

he benefits of robotic knee replacement, such as improved accuracy, faster recovery, and reduced complications, can contribute to higher patient satisfaction.

Conclusion

In conclusion, robotic knee replacement surgery has emerged as a groundbreaking advancement that challenges several misconceptions associated with the procedure. The benefits it offers, including decreased pain, enhanced precision, and accelerated recovery, make it a promising solution for individuals experiencing advanced arthritis. It is imperative for patients to stay informed about these technological advancements and engage in thorough discussions with orthopedic specialists to determine the most appropriate treatment options for their unique circumstances. By embracing robotic knee replacement surgery, patients can potentially regain mobility, alleviate pain, and enhance their overall quality of life.

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