Are you experiencing severe, persistent pain in your hips and knees? It might be time for a knee or hip operation. If you’re already looking into it, you’ll probably be noticing a lot of talk about robotic surgery. Here, consultant orthopaedic surgeon DR ALAN CHEUNG tells us all about how he uses robotics to assist in hip and knee replacement surgery.
You specialise in robotic surgery. Who is a candidate for this procedure?
It’s suitable for patients with severe hip or knee pain due to wear and tear (called osteoarthritis) who’ve tried all the non-surgical options such as taking pain killers, physiotherapy and even joint injections. Typically, patients with severe osteoarthritis will have their walking, stair climbing, sleep and normal exercise routine and daily activities greatly affected by pain.
What does a traditional knee or hip operation involve?
It’s a common procedure to replace worn cartilage in knees and hips. Following removal of the worn joint surface, an artificial joint is inserted to help the joint function efficiently again.
Tell us about the robots used in orthopaedic hip and knee replacement surgery.
Robots are machines that can perform a complex series of actions. There are several different types of robots in healthcare: autonomous, which are programmed to carry out a set task without any human intervention; semi-autonomous, which require some input from a human operator; and haptic, which provide sensory feedback to the human operator.
Human beings, even we orthopaedic surgeons, are prone to varying degrees of error, depending upon experience and skill levels. Robotic surgery aims to remove surgical errors and allow greater reproducibility of results.
What are the steps involved in preparing and tailoring the procedure to an individual?
Before surgery, a patient will have a special scan of their leg called a CT scan. This creates a personalised 3D map of their knee or hip. I use this map to plan, in great detail, where I am going to remove the worn-out bone, and where to place the new metal implants. The degree of accuracy in the planning of robotic surgical procedures (to within 1mm and a tenth of a degree) is not possible with a traditional knee or hip operation.
What happens during a usual knee or hip operation using robotic surgery?
First, I expose the joint through a surgical incision, then register 100 bony points on the joint using a computer. This essentially teaches the robot where it is in space, in relation to the 3D map of the knee made previously. I then use fine surgical instruments attached to a giant robotic arm to take away exactly the amount of bone I intended during the planning stage. In traditional knee replacements, a metal cutting guide called a jig is pinned to the bone, before a handheld saw is used to remove the bone. It’s much harder to achieve the degree of accuracy with these guides than robotic technology can achieve.
Once the bone surfaces have been prepared, I then implant the metal joint replacements, and hard plastic or ceramic components that sit in between, into the joint. Helpfully, the robot gives me real time “haptic” or touch feedback, and only allows removal of tissue in a preplanned area, safeguarding important structures like blood vessels, nerves and ligaments.
Unlike other robotic systems (like the Da Vinci robot) used in other types of surgery, I am right up close to the patient, and not sitting at a console several metres away.
What are the benefits of robotic surgery?
The major advantages of robotic surgery are in the planning and carrying out of a joint replacement. A surgeon may also use a smaller incision for the procedure, which may be less painful than a larger conventional incision. Personally, I find that patients who have a robotic joint replacement have a better range of movement afterwards than conventional surgery. It’s also good to know that the cost of robotic surgery is not significantly higher than for conventional surgery.
What can a patient expect recovery-wise after a knee or hip operation using robotic surgery?
The comfort of my patients is very important, so I make extra effort to ensure that their pain is under control after the surgery. This involves using a special injection of anaesthetic around the knee joint during surgery, and using a special “enhanced recovery” protocol to allow early weight bearing.
I expect all patients to be able to stand up and walk a short distance with a walking aid on the day of surgery, and some have even been able to go home within 24 hours. Most patients will take painkillers for two to three weeks and use crutches for around four to six weeks.
About the doctor
Dr Cheung is a consultant orthopaedic surgeon with over 20 years’ experience. He specialises in sports injuries and robotic joint replacement using the Makoplasty robotic surgical system.
International Orthopaedic Clinic
#05-24 Mount Elizabeth Novena Hospital, 38 Irrawaddy Road
6690 2985 | [email protected]
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