Definition

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Surgical technique with computer (Computer Assisted Othopaedic Surgery) is the use of  assistance of robot – computer in order to perform surgical procedures. It refers to an area where the surgeon’s capability collaborates with computer’s ability to complete the procedure otherwise it wouldn’t be possible. Computer assisted systems are divided into three categories: active robotic, semi-active robotic, and passive systems. The difference related with the level of involvement in the surgical procedure. Thus, active systems can perform autonomously part of the procedure, the semi-active perform under surgeons guidance and with passive systems the surgeon performs the operation under robot guidance.

Computer Navigation

The most common example of a passive robotic systems is the Computer Navigation, where information such as resection plane, orientation or limb alignment is displayed on a monitor. The aim of this development was the implant optimal application, the limb alignment and the softtissue management without the use of expensive preoperative examinations like CT or MRI scan.

This technique is in use in 30% of knee surgeries in Germany and Australia and 18% in UK.

How it works

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The surgeon fixes sensors in the part of the patient being operated on and then moves the patient’s limb in specific natural movements so that the camera receives the data and uses it to form a 3D model on the screen. The data, the 3D morphology and the size of the bone, represented on the monitor, allow the surgeon to perform the surgery with greater accuracy, as the system will be able to judge in real time when the joint is properly aligned. In addition, with better soft tissue balancing, contrarily to conventional technique, more bone stock is preservedandimplants are applied in better position. This can reduce both the mechanical and the shear stress on the bearing surfaces leading to longer longevity of the materials and better clinical result.

With software’s continuous development surgery with computer navigation can be performed quickly, securely and in comparable time with conventional technique.

Stages of surgical procedures

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  • Registration of anatomical marks
  • Kinematic data registration
  • Mechanical axis of limb representation
  • Tibial resection planning
  • Gap measurement-soft tissue balancing
  • Femoral resection planning
  • Final result with knee balanced
  • Final X-ray

“In our surgical procedures we use fast track recovery protocols”

Benefits

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During the surgical procedure and condition treatment as well, technology is once again by our side providing many benefits against conventional treatment methods.

  • Personalized treatment according to patient’s anatomy. All patients are different so are their knees!
  • We use the most advantaged, reliable, most used and twice awarded system Οrthopaedic Navigation System (Orthopilot)
  • Accurate method in implant positioning (accuracy: <0,5mm,<0,50).
  • With navigation system there is no need for expensive exams like CT or MRI scan
  • 15% time saving in surgical steps and 30% in instruments use.
  • Proven evidence in more than 300 publications.
  • Routine use in more than 350.000 cases worldwide
  • The kinematic acquisition and mechanical axis of the limb is the guarantee and therefore an important factor for an optimal surgical result
  • Soft tissue balancing. This is essential for the longevity of the implants and the optimal surgical result. Its very demanding technique but in experienced surgeon a valuable tool. On the contrary, when conventional technique is used is relied on objectivity of the surgeon thus there is a risk
  • Bone resection is minimum with no intramedullary nails,  thus minimizing bleeding and complications
  • In case of another hardware around the joint, that would be difficult or inadvisable to remove, this can be retained and the total joint arthroplasty can be performed
  • In cases of severe post traumatic extrarticular bone deformity where is difficult to carry out conventional technique
  • Early rehabilitation and shorter hospital stay
  • Same cost as the conventional technique

For more information request an appointment.

We are always contactable to inform you about this technique and it’s benefits

For more information request an appointment.

Robotic Surgery

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What this offers is another navigation system to plan the placement of the prostheses. The thing to keep in mind is that the robots involved in surgery are not completely autonomous but they’re controlled by the doctor. Thus, doctors can combine their knowledge and judgment with the precision and control of a robot.

By using CT scan information, the system can create 3-D images of the joint and enables the surgeon to plan and customize the surgical procedure with precision for your unique joint.

As the surgeon manipulates the robotic arm he is receiving a real time feedback or guidance to plan precisely the size, placement and alignment of your implants before surgery and thus to accurately position them.

Literature

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98% of patients were satisfied with their TKA in first year postoperatively

 

  • Katipalli G1, Deakin AH, Greaves J, Reynolds T, Picard F. One-year follow up of 214 total knee arthroplasties with navigated columbus implants.

Computer Assisted total knee replacement has demonstrated that the mechanical axis and the position of components are significantly better than those determined by the conventional technique

  • Mason JB, Fehring TK, Estok R, Banel D, Fahrbach K. Met analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. J Arthroplasty. 2007;22(8):1097- 106.
  • Anderson KC, Buehler KC, Markel DC. Computer assisted navigation in total knee arthroplasty: comparison with conventional methods. J Arthroplasty. 2005;20(7 Suppl 3):132-8.
  • Pitto RP, Graydon AJ, Bradley L, Malak SF, Walker CG, Anderson IA. Accuracy of a computer-assisted navigation system for total knee replacement. J Bone Joint Surg Br. 2006;88(5):601-5.
  • Bathis H, Perlick L, Tingart M, Luring C, Zurakowski D, Grifk a J. Alignment in total knee arthroplasty: a comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg Br. 2004;86(5):682-7. 17.
  • Decking R, Markmann Y, Fuchs J, Puhl W, Scharf HP. Leg axis aft er computer-navigated total knee arthroplasty: a prospective randomized trial comparing computer-navigated and manual implantation. J Arthroplasty. 2005;20(3):282-8.

Mechanical axis malalignment of greater than 30 occurred in 9% of Computer Assisted total knee replacement versus 31.8% of conventional total knee replacement.

  • Mason JB, Fehring TK, Estok R, Banel D, Fahrbach K. Met analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. J Arthroplasty. 2007;22(8):1097- 106.

Range of movement and knee score were significantly better in the navigation group than in the conventional Group in 5 years.

  • Ishida K, Matsumoto T, Tsumura N, et al. Mid-term outcomes of computer-assisted total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2011;19(7):1107-12.

Βlood loss and transfusion rates are significantly reduced when navigation is used.

  • Chauhan SK, Scott RG, Breidahl W, Beaver RJ. Computerassisted knee arthroplasty versus a conventional jig-based technique: a randomized, prospective trial. J Bone Joint Surg Br. 2004;86(3):372-7.
  • Kalairajah Y, Simpson D, Cossey AJ, Verrall GM, Spriggins AJ. Blood loss after total knee replacement: effects of computer-assisted surgery. J Bone Joint Surg Br. 2005;87(11):1480-2.

Early rehabilitation and shorter hospital stay

Choong PF, Dowsey MM, Stoney JD. (2009). Does accurate anatomical alignment result in better function and quality of life? Comparing conventional and computer-assisted total knee arthroplasty. J Arthroplasty, Vol.24, No.4, (June 2009), pp.560-569, ISSN:0883-5403