Mr Dinesh Nathwani, MBChB, MSc, FRCS (TR & Orth)
Consultant Orthopaedic Knee Surgeon, Imperial College Healthcare NHS Trust , Cleveland Clinic London and President of CAOS UK (Computer Assisted Orthopaedic Surgery UK)
Mr Roger Smith
Knee Replacement Patient
The patient and clinician testimonials in this article represent the individuals own opinions, findings and/or experiences. Individual results will vary.
Technology is ushering in a new era of surgery where robotic-assisted software is driving personalisation.
Knee surgery should offer patients a new lease of life. However, research published in The Bone and Joint Journal suggests that 50% who undergo conventional surgery report some movement limitation1, while around 20% are not completely satisfied.2,3,4,5
Those statistics raised concerns for 62-year-old Roger Smith who, after decades of arthritic agony, saw knee replacement as his only option. “Physically and mentally, the pain completely drains you,” says Smith.
With the potential to be unsatisfied with the possible outcomes of conventional surgery, Smith sought alternatives which led him to computer-aided robotic surgery and the support of Dinesh Nathwani, Consultant Knee Surgeon at Imperial College Healthcare NHS Trust London and Cleveland Clinic.
Robotic-assisted surgery helps provide accuracy and personalisation
Robotics certainly doesn’t abdicate responsibility to machines. Instead, it uses technology, as we do in so many other areas of life, to enhance the surgeon’s ability to precisely plan and execute personalised knee replacements.9,10,11
The CORI◊ Surgical System is designed to help surgeons achieve more accuracy in bone resection and alignment through intraoperative planning, smart mapping (no CT, MRI, or preoperative imaging required) and full range-of-motion data collection.
The system allows the surgeon to collect patient-specific anatomic and kinematic data, and the system provides a 3D model of the patient anatomy. The surgeon can size, orient and align implant components virtually on a 3D model.
With improved implant position comes fewer revisions, which means less pain and better outcomes for patients than traditional surgery.
“Conventional systems have all been designed around averages, but there is natural variation among patients that is not addressed with conventional instrumentation,”6,7,8,12,13,14 confirms Mr Nathwani.
Once the reflective markers are placed, the surgeon registers anatomical landmarks and begins to personalise a plan for the patient using an intraoperative software. The precision milling process uses a bur guided by the system to reshape damaged bone. The system maintains high levels of accuracy by preventing the surgeon from going too deep from the proposed plan.
“I can work within a degree of accuracy which we have never had with conventional instruments,” says Mr Nathwani.
Increased demand for robotic surgery
Due to the improved accuracy, robotics-assisted partial knee surgery has been shown to result in fewer revisions and better patient outcomes compared with traditional surgery.15,16,17,18,19,20,21
“Within three and a half weeks of surgery I was on a bike and within seven weeks I was bowling for Sussex over 60s,” says Smith who underwent a robotic partial knee replacement.
In Australia, the proportion of total knee arthroplasty operations conducted using computer-navigation rose from 2.4% in 2003 to 32% in 2019, according to the Australian Orthopaedic Association National Joint Replacement Registry.
In the UK, it’s just 4%, with cost and resistance to change being the major barriers.22 However, with a new generation of tech-savvy healthcare professionals coming through and patients who are actively asking for robotics, the best kept secret in orthopaedic surgery is finally getting the attention it deserves.
The testimonials in this article represent the individuals’ own opinions, findings and/or experiences. Individual results will vary.
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