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Joint Replacement Robotic Knee Replacement
The last decade has seen a dramatic shift in the usage of robotic in total knee replacement(TKR). In India the scenario has dramatically altered in the last couple of years with the widespread usage of robotics to improve outcomes in TKR. The advantages of TKA have been shown in the flow chart below.
The robotic platform available widely in the world and India has been mentioned in the table below. This is a rapidly evolving subject, and many more platforms are going to be developed in the world of knee replacement surgery. The table below summarizes the implant and the manufacturing companies presently around the world in total knee arthroplasty.
The workflow of a MAKO robotic knee replacement surgery is shown in the chart which will give an idea of how a robotic TKA helps in achieving the desired objective.
A knee replacement surgery is designed to provide pain free improvement in quality of life. The important determinant is alignment, ligament balance and good fixation of the implant. Since there is no one alignment that is superior to another the default standard has been “MECHANICAL NEUTRAL” approach where whatever the starting points- the aim is to get to a straight line. This approach potentially reduces the ultimate satisfaction rates
Recently, knee alignment has been found to fall into one of 9 categories and each patient who undergoes a knee replacement would fall in one of these 9 categories. The aim of conventional TKA was to get a perfect 180-degree alignment on standing view which would correspond to CPAK category V. In spite of good alignment, a section of patients arestill unhappy, and the hypothesis was that the change of CPAK category leads to dissatisfaction.
Robotic knee helps us to customize the alignment to the patient and not the patient to the alignment. The advantages of robotic knee is again Customization to patient needs, accuracy of the bone cuts, better ligament balancing and intraoperative immediate feedback for correction and modulation of the process for better outcomes.
The principle of robotic TKA is to move patients towards better alignment but retaining the patient in the same CPAK category so that there is improvement in the patient’s functional outcome and satisfaction rates. This approach is to ensure that “One size fits all” approach is not undertaken and truly individualizing the care to each patient’s needs. This technique and philosophy were advocated by Dr. Johan Bellemens group in 2021 and now evidence is emerging that the CPAK philosophy helps patient achieve better satisfaction rates and our experience of more than 100 robotic knees are pointing towards the same outcome.
