Dr. deepak inamdar is excited to offer his patients Robotic TOTAL Knee Replacement. He has evaluated both the Mako and Navio /Cori systems and currently prefers the Navio /Cori for precision as well as the ability to avoid his patients undergoing costly CT scans and HARMFUL radiation exposure necessary with the Mako system.
Navio /Cori Surgical System
Mako
Other technologies, such as MAKOplasty, offer robotic assistance but involve extra steps that a Navio /Cori knee replacement does not. For a MAKOplasty, patients need to visit an imaging center for a CT scan of their knee before the surgery can be performed. Additionally, the technology places restrictions on which implants surgeons can use, requiring the use of a proprietary implant.
Pre-operative CT scans are not a standard requirement for knee replacements, this represents an extra step ,This extra procedure can cost patients additional time, money and exposure to HARMFUL radiation.
Navio /Cori knee replacement has an open approach to implant selection which makes available more choices for surgeons to use. The technology provides a collaborative approach to solving joint pain and returning patient’s to more normal function.
A robotic knee replacement is similar to a traditional knee replacement. Your surgeon removes damaged tissue in your knee and replaces it with an artificial joint. The difference is that it's done with assistance from a robotic arm or handheld robotic device.
Robotic-assisted procedures allow for greater precision and can lead to shorter recovery times and better results. In more complex cases, a robotic-assisted knee replacement offer a better balance in the soft tissues around your knee, and better align the joint.
If you're having a robotic-assisted knee replacement surgery, you don't have to prepare any differently than you would for a conventional surgery.
During robotic-assisted knee replacements, Navio and Cori take measurements of the knee, hip, and ankle. Then your leg is moved through a range of motion so the system can see how your leg and knee joint moves. Together, these measurements produce a 3-D image that’s specific to your knee. With that image, your surgeon can create a detailed surgical plan and select the optimal implant type and placement.
All this is done in the operating room, where the specialized handheld robotic cutting tool and digital 3-D model of your knee help your surgeon fine-tune your surgery.
The NAVIO Surgical System is a tool your surgeon uses to correctly size and position the total knee implant with computer and robotic assistance. Computer assistance is used to collect the unique shape and motion of your knee to virtually plan the procedure. Robotic assistance is used to accurately perform the procedure. The extra layer of planning and precision provided by the NAVIO system aims to ensure the procedure is performed exactly as your surgeon intends. The NAVIO system does not perform the procedure; rather it assists your surgeon by providing accuracy and precision3 – crucial to the success of the surgery
If you’re a good candidate for traditional knee replacement surgery, you’re a good candidate for robotic knee replacement. However, your doctor isn’t going to recommend either type of surgery during your first visit. If you aren’t able to get the relief you need from these conservative treatments, knee replacement surgery may be able to help. But because most knee replacements only last between 10 and 20 years, traditional surgery is difficult to recommend for patients under the age of 60. New procedures like robotic knee replacement are starting to change that. More accurate implant positioning means that younger patients may be able to safely undergo total knee replacement surgery and get back to living an active lifestyle.
That being said, artificial joints don’t last forever. Joint replacement surgery is still a major decision. You’ll need to talk with your doctor to find out if you’re a good candidate.
One of the most common misconceptions about robotic knee replacement is that the surgery is done 100% robotically. That’s simply not the case – while the procedure is assisted by a robotic arm, your orthopedic surgeon is still in control. The robotic arm’s only job is to help the surgeon perform with greater precision. Technology assists the procedure in other ways, too. during surgery, one creates a 3D model of the patient’s knee. This allows surgeons to more accurately place the implant. During the operation, the robotic arm uses data from the 3D model to create a predefined space for the surgeon to work in, preventing them from accidentally damaging the surrounding tissue.
Because robot-assisted techniques are still so new, many of the long-term benefits haven’t been properly studied yet. But short-term benefits, like the potential for reduced recovery time, are quickly becoming apparent. With a traditional total knee replacement, the average patient won’t be able to resume normal activities like driving and going to work until 4 to 6 weeks after surgery. Robot-assisted technology could potentially cut this recovery time in half. Smaller incisions combined with greater surgical precision means that less bone and tissue is disturbed, speeding up the body’s natural healing process.
Because robotic techniques allow for greater precision, surgeons can customize knee replacements to each patient’s anatomy. this leads to a more natural feeling result. joint awareness is a common problem for patients post-surgery. Ideally, you should be able to completely forget about your joint replacement as you go about your day to day life. But for many patients, simple tasks like walking down stairs or kneeling can trigger joint awareness in the form of stiffness, numbness, or even pain.
Robotic knee replacement surgery comes with the same risks as traditional knee surgery. These include, but are not limited to:
But because robot-assisted procedures require a smaller incision and can be performed with greater accuracy, doctors are hopeful that these risks can be significantly reduced. Even with traditional surgery, serious complications are rare, occurring in only about 2 % Your doctor will carefully assess your health and discuss all of the potential risks and complications associated with surgery.
There are several activities that you should plan for once you decide to have surgery.
You will be monitored as you awake from anesthesia. Once awake, you will be taken to your hospital room. Plan to stay in the hospital for several days. In addition to the incision along your knee there will be two small incisions on both your thigh and lower leg where the tracker pins were placed. Expect to feel some pain. This is a natural part of the healing process. Your doctor and nurses will work to reduce your pain.
Most patients begin exercising their knee the day after surgery, although each patient’s postoperative care will vary. A physical therapist will prescribe exercises to help restore knee strength and function, and increase range of motion in your knee. It is common to experience swelling, stiffness and tightness at this time.
Postoperative Immediately after surgery you will be monitored as you awake from anesthesia. Once awake, you will be taken to your hospital room. Plan to stay in the hospital for several days. In addition to the incision along your knee there will be two small incisions on both your thigh and lower leg where the tracker pins were placed. Expect to feel some pain. This is a natural part of the healing process. Your doctor and nurses will work to reduce your pain. Most patients begin exercising their knee the day after surgery, although each patient’s postoperative care will vary. A physical therapist will prescribe exercises to help restore knee strength and function, and increase range of motion in your knee. It is common to experience swelling, stiffness and tightness at this time.
The success of your surgery will largely depend on how well you follow your surgeon’s instructions the first few weeks following surgery. How quickly you recover depends on factors such as knee pain, flexibility, strength and balance.
Follow up visits will likely be scheduled to check up on your condition and progress as you recover. In order for you to meet the goals of knee replacement surgery, you must take ownership of the rehab process and work diligently on your own as well as with your physical therapist.
The rehabilitation process can be quite painful at times. However, if you commit to following your program and overcome the challenges in rehab, you will succeed in meeting the goals you set when deciding on surgery.
Most knee joint operations are problem-free but about 1 person in every 20 may have complications. Most of these complications are minor and can be successfully treated. The risk of complications developing will depend on a number of factors including your age and general health.
In general, a younger patient with no other medical problems will be at a lower risk of complications. These can happen despite doing all the required tests for the heart , infection screen and other physician/cardiac evaluations and when they happen you will have to be prepared for it .
It's important to remember that any drugs used throughout your stay in hospital, for example anaesthetic or painkillers, may also have side-effects. Your surgeon or anaesthetist will be able to discuss these with you.
Blood clots which form in the deep veins in the leg (deep vein thrombosis, or DVT) can cause pain and/or swelling. This is because of changes in the way blood flows and its ability to clot after surgery. There are various ways to reduce the risk of this happening, including special stockings, pumps to exercise the feet and drugs that are given by injection such as heparin.
Blood-thinning drugs can increase the risk of bleeding, bruising or infection so your surgeon will need to balance these risks The tablets are more convenient , which makes them easier to take at home. However, they still carry a risk of bleeding.
As with all operations, there’s a small risk that the wound will become infected. ( MORE COMMON IN OLDER , INFIRM , LOWER IMMUNITY, Rheumatoid arthritis , synovial osteochondromatosis and pigmented villonodular synovitis - inflammatory arthritis )
All Complication rates including infection have been shown to increase in patients with high BMI (Obese patients) smokers and in diabetics. The patient should be nicotine free before surgery
This happens in about 1 in 50 cases. Usually the infection can be treated with antibiotics.
About 1 in 100 patients develops a deep infection, which may mean removing the new joint until the infection clears up( two stage revision).
In extreme cases, where the infection can’t be cured, the KNEE has to be removed permanently and the bones fused together ( arthrodesis)so the leg no longer bends at the knee.
Very rarely, the leg may have to be amputated above the knee and replaced with an artificial leg – this is extremely unusual.
There's a small risk that the ligaments, arteries or nerves will be damaged during surgery.Fewer than 1 in 100 patients have nerve damage and this usually improves gradually in time. About 1 in 100 have some ligament damage – this is either repaired during the operation or protected by a brace while it heals. About 1 in 1,000 suffer damage to arteries that usually needs further surgery to repair.
The bone around the replacement joint can sometimes break after a minor fall – usually after some months or years and in people with weak bones (osteoporosis). when it happens further surgery is usually needed to fix the fracture and/or replace the joint components.
When a mobile plastic bearing is used there is a small risk of dislocation of the knee, and this would need further surgery.
A wound haematoma is when blood collects in a wound. It’s normal to have a small amount of blood leak from the wound after any surgery. Usually this stops within a couple of days. But occasionally blood may collect under the skin, causing a swelling. This can either discharge itself, causing a larger but temporary leakage from the wound usually a week or so after surgery, or it may require a smaller second operation to remove the blood collection( debridement and wash out). Drugs like aspirin and antibiotics can increase the risk of haematoma after surgery.
For most people, pain gradually eases during the first few months after surgery However, some people have ongoing pain or develop new types of pain for reasons most often not known. 10–20% of people still have moderate or severe pain in the long term. This isn’t always caused by a technical fault or recognisable complication, and therefore it can’t be fixed by a repeat operation. This complication is known as complex regional pain syndrome. Some hospitals have pain clinics that can help with this.
Some people experience continuing or increasing stiffness after surgery/ esp in patients having tendency for increased scar formation . Usually this resolves with exercise, and as the swelling improves. Pain may contribute to this complication by stopping the patient from doing physiotherapy exercises and allowing scarring to glue together the soft tissues around the joint. Occasionally knee stiffness may be treated by a manipulation of the joint under anaesthetic, followed by intensive physiotherapy.
needing prolonged icu stay and ventilatory support , this may increase duration of stay in the hospital.
needing a revision or change of poly
Intraoperative step up of implant used / increased cost estimate of surgery - the inability to balance a knee in a bad deformity or obese patient /fractures in a porotic bone may necessitate use of stems /wedges or revision implant - which may increase the cost estimates and the total bill , so a buffer has to be kept for any contingency.
Wound healing issues in patients with skin issues(psoriasis , inflammatory arthritis) and previous scars - may need a plastic surgery rarely.
Mortality or death due to any of the above complications is a possibility due to either sepsis or multiorgan failure or a massive pulmonary embolism(heart attack) .
One must understand that knee replacement is a major surgery and being done in a older and a population who have various health issues along with arthritis , so the above mentioned risks are possible despite adopting best practices and good care
Reasons for surgery Knee replacement surgery should be considered when all conservative measures fail to provide relief.
Surgery may be performed for the following reasons:
What to expect in surgery You will first be placed under anesthesia to relax your body for surgery and block pain. The correct form of anesthesia will be discussed and determined prior to surgery with your surgeon and anesthesiologist. Your surgeon will then make an incision that extends several inches above the knee cap to several inches below the knee cap. Using the NAVIO™ system, special trackers are secured to both the thigh bone (femur) and shin bone (tibia) with four small surgical pins placed through tiny incisions in the skin. These trackers are crucial to the precision of the system as they provide a constant reference point to the surgeon throughout the procedure. Using computer assistance, the unique shape and motion of your knee are collected by the surgeon. This allows for a three-dimensional model of your knee to be generated and used by the surgeon to plan the procedure. Proper implant size and position will be determined at this time.
Once your surgeon virtually determines the correct implant size and positioning, a handheld robotics-assisted tool (the NAVIO™ handpiece) is used to accurately position bone removal cut guides. These cut guides enable the surgeon to use a surgical saw to remove your damaged knee bone, making room for the implant. The extra layer of precision provided by the NAVIO system is designed to enable accurate cut guide placement. The NAVIO system does not perform the procedure; rather it assists your surgeon by providing accuracy and precision3 – crucial to the success of the surgery. Once the implant is in the final position, the incision is thoroughly cleaned and closed, completing the procedure.
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