Robotic Knee Replacement Surgery Provides More Precise Surgical Outcomes

18 April 2022

Joint replacement surgery has brought new hope to countless people who have suffered from chronic joint pain, allowing them to wave goodbye to their pain and move without restriction.

Now, the more accurate and safer robotic arm joint replacement surgery have brought another good news to patients. This new technology not only assists doctors in achieving precision and safety, but also allows patients to have personalised treatment and achieve a more natural and comfortable level of joint mobility, reclaiming their freedom of movement and mobility.

Dr Chua Hwa Sen, Consultant Orthopaedic and Trauma Surgeon at Sunway Medical Centre, Sunway City pointed out that artificial joint replacement, which originated in the 1960s, has been used in the medical world for over 50 to 60 years. It involves replacing a damaged or non-functional joint with an artificial joint to treat conditions such as joint pain, deformity and restricted mobility, and is commonly used for hip and knee joints.

Hip replacements can be divided into total or partial hip replacements, while knee replacements are divided into total and partial knee replacements.

“A common reason for those who need a hip replacement is damage to the joint or the development of degenerative arthritis, which causes pain and discomfort. In addition, people who were born with poorly grown hips, those who have suffered bone and joint damage due to long-term steroid use and alcohol abuse, as well as injuries and fractures may also lead to hip fractures and necessitate replacement.

 “Those who need knee replacement are usually patients with degenerative arthritis and rheumatoid arthritis. Surgery is aimed at reducing the patient's pain, correcting the deformity and providing a stable joint for them to use,” he said.

He added that in a conventional joint replacement, the surgeon will rely on their own vision and experience to determine where to remove the joint and place the artificial joint. The accuracy of the surgery is closely related to the surgeon's experience and skill.

“In any case, the success rate of conventional joint replacement surgery is quite high, with up to 96% of patients being able to reclaim their mobility after completing artificial hip and knee replacements. However, of this 96%, only 80% are very successful and in about 16% of patients, although they can reclaim their mobility, they might not be able to walk very naturally and comfortably,” he said.

He further pointed out that a very successful outcome means that the implanted joint is comfortable and natural to use, with no pain at all. This is why the medical profession, in its quest for excellence, has in recent years created a new milestone in artificial joint replacement surgery with the introduction of robotic arm knee replacement. This technology helps to avoid subjective interference and makes the procedure more precise.

“Over the years, joint replacement surgery has gone from strength to strength. In addition to improving the quality of the artificial joints used, the surgical approach has also progressed from large wounds to minimally invasive. Today the medical community hopes that robotic arm joint replacement surgery will further improve from 80% to a higher level,” he said.

The robot and surgeon complement each other

Robotic arm joint replacement surgery is the introduction of computers, robotic arms and navigation technology into artificial joint replacement surgery to assist the surgeon in performing the surgery to achieve more precise surgical outcomes.

It revolutionises conventional joint replacement surgery by allowing surgeons to remove damaged joints and insert artificial joints with better precision, minimise damage to surrounding ligaments, blood vessels and muscles, and reduce the number of days spent in hospital, resulting in a faster recovery.

“This innovative procedure is about five to 10 years old in the global medical community and is one of the very common surgical treatments in many overseas countries, and the clinical results are encouraging,” Dr Chua said.

However, he cautioned that robotic arm knee replacement surgery does not replace the surgeon with a robotic arm. The robotic arm essentially only assists the surgeon in performing the surgery and cannot completely replace the surgeon, instead it must complement the surgeon to achieve better results together. Its sophisticated pre-operative planning and immediate intra-operative data provision and support enables individualised and precise surgery.

Its 3 main features are personalisation, safety and precision. “As each patient has different bones, joints and conditions, this new technology allows for individual design and tailoring of the pre-operative plan,” he said.

Prior to surgery, the patient will undergo a special CT scan that clearly presents a 3D model of the knee or hip joint. This information will be integrated within the computerised robot. The surgeon can use the static images taken before surgery and combine them with the dynamic joint movement data collected during surgery, and after evaluation, customise the surgery for each patient, planning the correct angle and extent of resection, as well as the most suitable size and placement of the artificial joint.

Dr Chua pointed out that this new technology is safer and allows doctors to put their worries aside, as opposed to relying entirely on the surgeon's own visual observation.

“With its assistance, the surgeon can more precisely remove the damaged area during the surgery and no longer worry about the removal process affecting the surrounding ligaments, nerve lines and blood vessels. It can also place the new artificial joint in the most precise position.”

As a result of the greater precision, there are also far fewer complications that can arise from it. “The biggest concern, especially after conventional hip surgery, is dislocation. If the precision is improved, the chance of dislocation is also minimised,” he said. The angular error of this robotic arm surgery is only 0.5 degrees or 1.0mm, achieving the most ideal artificial joint placement.

Dr Chua added that the ultra-high precision of the robotic arm also allows patients to recover faster after surgery. “Compared to conventional joint replacement surgery, which requires a hospital stay of three days to a week, those treated with this new technology can be discharged the same day or up to three to four days.”

It also greatly improves the durability of the artificial joint, with natural post-operative movement and no foreign body sensation, resulting in a ‘natural joint’ effect that is not too tight or too loose in flexion, nor does it feel tight or snug. It even makes you forget that you are using an artificial joint.

“Generally, the average life of an artificial joint from a knee replacement surgery is 15 years, and from a hip joint replacement surgery is 15 to 20 years. Robotic arm replacement is able to extend the current average life of the artificial joints through its ultra-precision. Current data shows that the percentage of early replacements required is very low.”

New technology with accreditation and clinical data

Sunway Medical Centre is the first hospital in Malaysia to introduce Mako Robotic-Arm Assisted joint replacement surgery, and Dr Chua successfully performed the first robotic arm hip replacement surgery using this machine on 5 July 2021.

Dr Chua, who used to practise in Australia, has performed numerous related surgeries on patients there since 2015. “Clinical data received from this procedure over the years has been very positive and we hope to introduce it to Malaysia so that local patients can get better results as well.”

Dr Chua disclosed that it is a robotic arms surgical system that is available in the market that can perform both total and partial knee replacement, as well as total hip replacement surgery. Sunway Medical Centre currently has both of these robotic arms surgical system.

He said that most of the patients he's spoken to so far are concerned about the safety of this new technology and whether the robot will fully replace the surgeon to operate the surgery.

“This technology is already very common overseas, and any new treatment used on patients must have all the accreditations and sufficient clinical data to back it up. Furthermore, the robotic arm is only assisting the surgeon in the procedure,” he reiterated.

Another consideration for patients is the cost of the procedure. Although the cost of the technology is high and Sunway Medical Centre has invested heavily in the new technology, the hospital is currently charging the same fee for the procedure as for a conventional joint replacement surgery so that more patients can benefit from the new technology.

“In the future, it is expected that the cost of the procedure will be slightly higher than conventional joint replacement surgery by 10% to 15%, but we will not set the price too high so that everyone can afford it.”

He is confident that, based on the positive data and benefits currently being collected worldwide, robotic arm joint replacement surgery will one day replace the conventional one.

“Medical technology continues to advance, just like knee ligament surgery, which used to be treatable only by open surgery and is now treated using minimally invasive arthroscopy.”

Who is suitable for robotic joint replacement surgery?

Dr Chua pointed out that those who need joint replacement surgery are those with moderate to advanced arthritis.

“Robotic joint replacement surgery is needed when your joints are damaged, painful to the point that it is affecting your daily life, limiting your activities and reducing your quality of life. If your health condition is confirmed by your doctor, then you may undergo the robotic joint replacement surgery.”
The procedure is not suitable for people who cannot afford the risk of anaesthetic drugs and who have had a very serious bacterial infection in the joint. It is also not suitable for people with severe damage to the spine, weakness in the legs and insufficient muscle strength to support the artificial joint.

“Anyone suitable for conventional joint replacement surgery is suitable for robotic joint replacement surgery,” Dr Chua said.

What are the symptoms of knee and hip disorders?

According to Dr Chua, symptoms of knee disorders include pain, swelling, stiffness and deformity. As for hip disorders, the symptoms are pain, pain when standing up, walking pain, and in severe cases, even walking with long and short legs, stiffness and inflexibility.

“Whenever you feel persistent pain and swelling in the joint that affects your daily activities, it is important to seek medical attention as soon as possible. If left unattended, joint problems will get worse, the pain will keep you from going anywhere and your quality of life will be greatly reduced.”

“A disease should be treated when the condition is still minor. Delaying treatment not only exacerbates the condition, the treatment is also not as effective as early treatment and can even be more expensive.”

Dr Chua said that early joint health problems come with various treatment options which may not require replacement surgery.

“We can strengthen the muscles around the joint with moderate exercise, glucosamine supplementation and hyaluronic acid injections, or undergo arthroscopic surgery, radiofrequency ablation (RFA) treatment to reduce the pain, as well as taking pain relief and anti-inflammatory medication.”

Protecting your joints in everyday life
Although medical technology has advanced to the point where high quality artificial joints can be precisely placed, allowing patients to resume their normal lives and move around naturally, However, it is important to take care of your knee and hip joints early to avoid having to have an artificial joint replacement surgery in the future.

To protect the joints, you must start with your daily diet, exercise and weight management. “Joint health problems are not exclusive to the elderly, as joint degeneration is also becoming more and more prevalent at a younger age. The reasons for this include the fact that the nature of modern work is different from that of the old farming society, where life is more comfortable, exercise is lesser and weight increases naturally. Too much or too vigorous exercise can also damage the joints,” Dr Chua said.

He therefore urged the need for people to manage their weight to avoid being overweight, as well as to exercise in moderation. “Exercises that are good for the knee and hip joints include walking, swimming and walking around in the swimming pool.”

“It is best for elders to avoid walking down and uphill, especially downhill. They can ease the burden on their joints with the help of crutches. Wear good sports shoes when exercising, and for women, reduce the use of high heels.”

In terms of diet, people can consume more foods such as ginger, oranges, limes, lemons and beans, or take glucosamine supplements. Dr Chua reminds people that if they develop joint-related health problems, they should face and address them as early as possible in order to maintain a good quality of life.

“If you are scared and afraid to face it, you will only make the problem worse. If your joints hurt and you choose not to treat it, it will not only cause continued damage to your joints and prevent you from walking; the lack of walking and exercise will also indirectly affect other health issues such as heart, lung and muscle deterioration, which will further reduce your quality of life and is very much not worth it.”

“Therefore, if you are dealing with bone and joint related problems, it is always best to face it early and seek medical attention, where your doctor will advise you on what treatment to undertake,” he stressed.

Source: Sin Chew