PRACTICE PEARLS: Robotics in Knee Replacement

    At ICJR meetings, faculty have addressed some of the issues – pro and con – with the use of robotic technology for unicompartmental and total knee arthroplasty. Find out what they had to say. Tomorrow, we’ll look at robotics in hip replacement.

    Robotics in Unicompartmental Knee Arthroplasty
    Yogesh Mittal, MD

    Knee arthroplasty patients want a shorter recovery and natural movement of their operated knee. The surgeon wants a successful procedure. The hospital wants a good return on investment and a competitive differentiator that attracts patients.

    Yogesh Mittal, MD, from The Orthopaedic Center in Tulsa, Oklahoma, believes robotic technology can address all these needs. In this presentation, he reviews:

    • How he uses robotics in his practice
    • How robotics help him perform a unicompartmental knee arthroplasty precisely and reproducibly
    • What economic and hospital hurdles the surgeon faces in incorporating robotics into the operating room.

    Click the image above to watch Dr. Mittal’s presentation.

    Unicondylar Arthroplasty with Robotic Technology
    Craig S. Radnay, MD, MPH

    About 47% of knee patients are candidates for unicondylar knee arthroplasty (UKA), but only 9% of all primary knee arthroplasties are UKAs. So why aren’t more UKAs done?

    In this presentation, Craig S. Radnay, MD, MPH, from the Insall Scott Kelly Institute for Orthopaedics and Sports Medicine in New York,  reviews the advantages of UKA over total knee arthroplasty and then discusses how newer, semi-autonomous robotic systems can improve the accuracy of implant alignment and soft tissue balancing in UKA – which can potentially lead to improved clinical outcomes and implant survival.

    Click the image above to watch Dr. Radnay’s presentation.

    Controversies in TKA – Techniques: Robotics
    Douglas E. Padgett, MD

    Total joint replacement is a pretty forgiving operation, but 3 big issues remain, says Douglas E. Padgett, MD, from Hospital for Special Surgery in New York:

    • Bearing wear and failure
    • Instability as it pertains to the hip
    • Patient satisfaction as it pertains to the knee

    Using unicondylar knee replacement as the case study, Dr. Padgett explores whether robotic or computer-assisted surgery could improve outcomes by enhancing the control of surgical variables such as implant positioning, soft tissue balance, and lower limb alignment.

    Click the image above to watch Dr. Padgett’s presentation.

    Debate: Robotic Knee Arthroplasty: Pro
    R. Michael Meneghini, MD

    As the first speaker in the debate over robotics in total knee arthroplasty (TKA), R. Michael Meneghini, MD, from IU Health Saxony Hospital in Fishers, Indiana, argues the case in favor of this technology.

    Robotics has been shown to provide improved precision in positioning of the components in unicondylar knee arthroplasty, leading to improved outcomes, Dr. Meneghini says. He believes these same advantages apply to robotics in TKA, improving accuracy and precision of implant positioning and alignment.

    The true value of robotics in TKA will be realized when the “target” for TKA alignment and balancing has been identified, Dr. Meneghini says.

    Click the image above to watch Dr. Meneghini’s presentation.

    Debate: Robotic Knee Arthroplasty: Con
    David F. Dalury, MD

    As the second speaker in the debate, David Dalury, MD, from Towson Orthopaedic Associates in Towson, Maryland, argues against the use of robotic technology in TKA.

    Dr. Dalury believes robotics could be useful in the future, but it’s not there just yet. He reviews the pros and cons of robotics and asks, “Do they work? Does it matter? Is it worth the time and money?”

    The literature on the use of robotics in TKA is limited, reporting only short-term follow-up studies with poor methodolgies and a small number of patients, Dr. Dalury says.

    In his opinion, robotic-assisted TKA has not been shown to be of benefit, as the cost is too high and currently data are lacking. But robotics may prove to be of value in the future.

    Click the image above to watch Dr. Dalury’s presentation.