Dr Ranjit Singh
Chronic knee pain as you get older is usually the result of osteoarthritis.This is the major reason for knee replacement among senior citizens.
Performing knee replacement surgery in such an individual is technically a more challenging procedure, requiring more time and greater exposure for surgical sucess.
Patients are often hesitant to get operated due to their health problems.They fear from the complications involved with old age and feel that results might not be significantly improvised as compared to regular patients.
On the other hand successfully implanted total knee arthroplasty (TKA) increases physical activity and therapeutic walks which help in curing the knee pain and possibility of moving and doing normal chores.
Total knee replacement has significantly good effects on patients, enabling patients to live a healthy life after surgery.
In recent time Robotic knee Replacement is quite in the news , more so in Northern part of the country and the patients are very confused about what exactly is this surgery and whether it is superior to the conventional techniques or not.
WHAT IS ROBOTIC KNEE REPLACEMENT?
Robotic knee replacement involves performing Knee Replacement with the use of robotic arm which helps the surgeons to take bone cuts. Opening the knee joint and placement of implant which are very important steps of the surgery are done by the surgeon only.
TYPES OF SURGICAL ROBOTS
Three different robotic systems are available, based on the amount of autonomy delivered to both the surgeon and the robot, which include passive, active and semi-active. In a passive robotic system, the surgeon has continuous and direct control, while, an active robotic system is completely independent of the surgeon for performing a designated task. Therefore, active robotic systems are associated with increased chances of iatrogenic soft tissue injury. To ensure accuracy and safety against iatrogenic soft tissue or neurovascular injury, semi-active systems developed which provide tactile feedback to the surgeon, thus, helping define specific boundaries (i.e., for surgical resection or safety). The major goals of a semi-active system are to prevent gross intraoperative errors and reduce deviations from the surgical plan to ensure a safe procedure with well-aligned components. Although constant efforts have been made to improve the robotic system and decrease the associated complication, certain complications and downsides have been reported in the literature.
DOWNFALLS OF ROBOTIC KNEE REPLACEMENT
STIFFNESS :
Surgical robots are suggested to decrease post knee replacement stiffness incidence by the accurate placement of a prosthesis and precise alignment but, various research studies found that stiffness following robotic knee surgery is more than conventional surgery.
INFECTION:
Longer intraoperative time with robotic systems is due to insertion and removal of pins in the thigh bone and leg bone, registration of the knee joint with the robotic system, and intraoperative planning. Longer surgical time is associated with a higher risk of infection which may result in devastating outcomes of this surgery .
FAILURE OF ROBOTIC SYSTEMS
Aborting a robotic knee surgery was another downside identified in many recent studies. Regardless of the robotic system, reported abortion rates for robotics surgery was very high.
FRACTURES
Femoral or tibial shaft fracture due to mechanical weakness caused by the pinholes is one of the most dreaded complications of the robotic .Fractures usually occur an average of 12.6 weeks after surgery, and before fracture episodes, patients experienced unusual pain for several days in the thigh. These fractures were associated with minor or indirect trauma.
PIN SITE INFECTION
Robotic surgery requires putting two metallic pins each on thigh bone and leg bone.These pins have sensors mounted on them which calibrate with the robotic sensors.
Complications associated with these pins are very common and very troubling for the patients.
Pin-site infection is another specific complication of tracker pins that may require antibiotics and dressing for an additional duration.
INTRA OPERATIVE INJURIES
Operation related soft tissue and bony injuries include patellar tendon rupture, dislocation of the patella, patellar fracture, and peroneal nerve injury
BLOOD LOSS
Greater estimated blood loss in the robotic group which may be attributed to the prolonged operative time.
LONG LEARNING CURVE
Another challenge with new technology is the learning curve. TKR robotics is associated with a learning curve that affects the comfort level of the surgical team. It has been shown that during this initial learning phase, the robotic system was associated with heightened levels of anxiety among the surgical team.
INCREASED COST
Factors responsible for higher intraoperative costs were higher anesthesia costs, operation theater supplies, robotic maintenance costs, robotic-specific disposables costs, software requirements, and additional diagnostic imaging like CT scan and MRI before Robotic Surgery.
INCREASED HOSPITAL STAY
Various studies are showing significantly longer hospital stays following robotic TKR
Due to the additional time and expense and numerous complications associated with robotic systems most of the surgeons in western countries do not recommend widespread use of robotic knee Replacement surgery.
WHAT IS ZERO TECHNIQUE ?
Zero Error techniques outshines the conventional and Robotic methods of knee replacement in such a way that age does not become a hindrance in good results. With the short surgical time of barely 20 minutes from start to finish with minimal blood loss and muscle damage, the results of surgery are remarkable and quick. The patient resumes walking within two-three hours of surgery with almost no visible pain.The patient becomes capable of climbing stairs within a few days and recovers fully in less than a month.
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