Page 26 - Swsthya Winter Edition Vol 1 Issu 3 DEC 2020 Circulation copy BP

SURGERY

Role of Robotics in
Orthopaedic Surgery:

Will they give better outcomes?

A Sinha FRCS(Tr & Orth)

Consultant Orthopaedic Surgeon

Introduction but cutting is deactivated by some means if structure, joint alignment and surrounding
it travels beyond a boundary (NAVIO). The tissue. It provides real-time range-of-motion
Robots have been in use since the late current robotic systems are designed and data during surgery and uses a robotic arm
1980s in different surgical specialities. may be classified based on these features. to remove the bone and cartilage from the
The first use was PUMA (Programmable knee and place the implant.
Universal Manipulation Arm) in 1985 for a Specific Indications
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neurosurgical biopsy . Robotic technology Unicompartmental knee replacement Smith & Nephew already has a hand-held
in Orthopaedic surgery began in 1992, with robotic surgical system on the market. It
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the introduction of ROBODOC . This was for Specifically, the use of tactile and passive recently introduced new software for that
the planning and performance of total hip robotic systems in unicompartmental knee system, known as the Navio 7.0 for partial
replacement. The use of robotic systems replacement (UKR) has addressed some and total knee replacements.
has subsequently increased, with promising of the historical mechanisms of failure of
short-term radiological outcomes when non-robotic UKR. These systems assist Johnson & Johnson’s DePuy Synthes
compared with traditional orthopaedic with increasing accuracy of the alignment acquired the Paris based Orthotaxy system
procedures. The skeletal anatomy lends of the components and produce more in 2018. According to their brochure, “It’s
itself well to preoperative planning, consistent ligament balance. Short-term is the size of a shoebox, attaches to an
intraoperative registration and navigation. improvements in clinical and radiological operating table and includes a saw, but does
outcomes have increased the popularity of not do the sawing for the surgeon. Instead,
Classification robot-assisted UKR . the Orthotaxy platform will design the
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surgery plan and lock the saw into a plane,
Robotic systems can be classified into three There are several studies, which endorse allowing the surgeon to do the cutting.”
categories: autonomous (active), semi- Robotic-assisted medial UKR results. In one
active and passive. The active system can recent study two hundred and six patients The ROSA knee platform (Zimmer Biomet)
independently perform tasks without the (232 knees) who underwent medial includes 3D pre-operative planning tools
surgeon’s intervention, as they are pre- robotic-assisted UKR were retrospectively and real-time data on tissue and bone
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programmed for bone resection. The first studied . Femoral and tibial sagittal anatomy during procedures. This can
active system in use in Orthopaedics has and coronal alignments were measured improve bone cut accuracy and result in
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been the ROBODOC . Once programmed in the post-operative radiographs and a more precise range of motion analysis,
the surgeon could not interfere during were compared with the equivalent which can help knee replacements feel
the surgical procedure. The semi-active measurements collected during the intra- more natural.
systems robots constraint surgical operative period by the robotic system.
manipulation through feedback to restrict Mismatch between pre-planning and post- Initial outcomes have been promising
what can be done surgically. The MAKO operative radiography was assessed against but we must await long-term results
Robotic-arm assisted surgery (Stryker) is accuracy of the prosthesis insertion. with respect to clinical outcomes and
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in use in current times . Passive surgery survivorship. The costs are an important
systems, which represent a third type of The results showed accurate prosthesis factor, as the hardware may require regular
technology, have also been adopted recently position. Inaccuracy may be attributed to updates. There is also increased radiation
by orthopaedic surgeons, in particular suboptimal cementing technique. to patients with the need of imaging.
arthroscopic shoulder surgery. While
autonomous systems have fallen out of Total knee Replacement (TKR) Total Hip Replacement (THR)
favour, tactile systems with technological
improvements have become widely used. Clinical studies in total knee arthroplasty Acetabular component placement in total
have demonstrated better gap balancing hip arthroplasty is key to this surgery.
Robotic bone cutting can be designed and implant alignment using the ROBODOC The semi-active robotic systems allow the
into 3 types. The autonomous variety is system compared with conventional surgeon to control the robotic arm to ream
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independent and cuts bone without the techniques . While the ROBODOC system the acetabulum to a specified depth and
human intervention (e.g. ROBODOC). In is no longer in use, there are now new size, without having to sequentially ream
the haptic type, the surgeon allows the robotic systems in the market. larger acetabular sizes. Accurate acetabular
robot to move and cut, but the movement component placement can reduce the
is constrained as soon as it reaches the The MAKO system devised by Stryker likelihood of dislocation, leading to fewer
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border (e.g. MAKO system). In the boundary is considered the leading system robot- revision procedures . Long-term follow-
control variety, the surgeon’s intervention assisted knee and hip surgery. This robot- up at 14 years demonstrated no stem-
is required to move the robot and then it assisted system develops a 3D model of the loosening failures, less pain, and lower
remains free to move anywhere in space joint, which surgeons use to evaluate bone Western Ontario and McMaster Universities

26 Volume: 1 I Issue: 3 I 2020