Imagine hanging cabinets using educated guesswork.
The potential result: a wobbly kitchen.
And yet, just a few years ago, before the arrival of robotic-assisted surgery, three-dimensional imaging and custom-fit implants, this was the challenge surgeons faced when performing knee and hip replacements. Perfect alignment of implants could be hit and miss. Patients endured longer recovery times because muscles were cut. Rehabilitation was beset by limitations and requirements, which made knee and hip replacement a less-than-thrilling prospect for the hundreds of thousands of people who suffer from arthritis or joint injuries.
“Despite the fact we did do a good job with hip replacement, to pat yourself on the back for a procedure that hadn’t changed in 30 to 40 years isn’t perfect,” said Dr. David Padden, orthopedic surgeon at Holy Cross Hospital in Fort Lauderdale.
But now, thanks to advancements in technology, accuracy is greatly improved.
Holy Cross was an early adopter of MAKOplasty, a robotic arm-assisted device for partial knee procedures in 2006.
Since October 2011, the hospital also has used the process for hip replacements. The surgeon-controlled robotic arm system enables the accurate alignment and positioning of implants.
The system delivers a three-dimensional image of the patient’s hip from a CT scan. The surgeon uses this model to position the hip implant components — a cup and liner placed into the socket of the pelvis and a femoral component with head and stem.
A Massachusetts General Hospital study of 1,823 hip replacement patients in 2011 found that surgeons were off 50 percent of the time in the placement of these implants, some as far off as 10 degrees from optimal placement.
“If I had an instrument that could always point me to the right angle and directions and to do the carpentry to a degree of accuracy and precision we’d never seen before, I’d be foolish if I didn’t try this ... the use of the robot,” Padden said.
He explains the procedure:
“Our robot is essentially helping me by giving me actual information in real time while I’m doing the surgery. Instead of planning the surgery off a two-dimensional X-ray, I’m planning off a CAT scan representation of their hip in every direction. On the virtual computer I am able to place the actual socket and femur stem where I’d like them to be. We manipulate those things to size them better, all on the computer, before we start the surgery,” he said.
Dr. Richard Levitt, an orthopedic surgeon with Baptist Health, also uses the robot to assist in resurfacing the knee, an early-intervention procedure that can alleviate pain and improve the knee’s function by cleaning out bone spurs in the joint. The procedure can put off the need for a total knee replacement for a number of years. Levitt also uses the robot for partial knee replacement.
“The robot will only allow you to cut bone to a certain depth and certain positions by the pre-operative plan. It doesn’t allow you to cut beyond those parameters,” Levitt said. “If you can properly position that implant, it will give you a better result than one put in cockeyed or twisted. The major advantage of the robot is that it is as close to a perfect implantation as possible. We first started using it about four to five years ago for partial knee replacements and are now using it for total hip replacements. It will probably be available in the near future for total knees and, ultimately, for some work in the shoulder as well.”