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The robotic revolution in knee replacement surgery

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Mr Winston Kim, FRCS(Orth)

Consultant Orthopaedic Surgeon, Specialist in Knee and Hip Surgery, BMI The Alexandra Hospital

Q&A with leading surgeon: Robotic-assisted knee replacement operations could be a game-changer for patients, improving accuracy and shortening recovery times.

Mr Winston Kim, Consultant Orthopaedic Surgeon, performed the first robotic-assisted knee replacement and partial knee replacement in the north of England, and has the largest series in the North-West. His patients include former professional footballer and CEO of the Professional Footballers’ Association, Gordon Taylor.

What are the benefits of robotic-assisted knee surgery?

“Quite rightly, knee replacement patients want and expect their new knees to feel as natural as possible. Unfortunately, knee replacement surgery – unlike hip replacement surgery – has a patient dissatisfaction rate associated with it, and it’s usually because the new knee has not been implanted in exactly the right position.

“The knee is a sophisticated joint and there isn’t a ‘one replacement fits all’ solution. Everyone has a different shaped knee with different soft tissue tension – and so, in a conventional operation, a surgeon must use a certain amount of judgement when positioning an implant. Get it slightly out of alignment and the results can feel a bit stiff.

“This is why some people say robotic-assisted knee surgery is a game-changer. The benefit is that it implants the knee replacement in exactly the right alignment and position, every time. In essence, it offers a bespoke implantation technique to individual patients.”

Is robotic-assisted surgery also available to patients who only need a partial knee replacement?

“Yes. One of the other benefits of robotic-assisted surgery is that surgeons who would always opt to perform a full knee replacement – simply because they do them more frequently – are given the confidence to perform a partial knee replacement instead. Obviously, the advantage of a partial replacement for the patient is that only the affected part of the knee is replaced, preserving most of the knee joint. That means a smaller incision, less cut muscle, less blood loss, and consequently less pain, quicker recovery, quicker return to day-to-day function and return to work.”

Are there any pre-op requirements for patients undergoing robotic-assisted knee surgery?

“Standard X-rays are the starting point, but no further imaging is necessary because the system maps the patient’s anatomy at the start of surgery. No CT scans means no radiation.

“During surgery, pins will be put into the patient’s shin bone and thigh bone – and these pins have sensors on them which communicate with the robot. This is partly why robotic-assisted surgery takes about 20-30 minutes longer than conventional surgery.”

What can patients expect with regards to recovery times?

“After any knee replacement surgery, there will be a recovery period, which can vary from three to six months to two years. With robotic-assisted knee surgery, we’ve seen remarkable, pain-free outcomes with very quick recovery times. Gordon Taylor, the professional footballer, had his knee replaced using this technology. His wife had it done, too, and both were very happy with it.”

How long has this type of technology been available?

“For around five years. From the surgeon’s point of view, the technology does cost more but, because the knee is implanted more precisely and the patient is happier with the final result, the risks of revision surgery (repeat surgery) will potentially be lower and the long-term savings will be greater. And, of course, robotic-assisted surgery technology will become further refined over time with constant innovation and improvement.”

What do you hope robotic-assisted knee surgery will ultimately achieve?

“If you’ve had a robotic-assisted knee replacement, you can be confident that your surgery was fully optimised – and you have real-time evidence that your replacement knee was implanted accurately.

“People are reassured by this technology and it allows patients to focus on the necessary rehabilitation after surgery. That’s key because, as surgeons, we need to perform knee replacements that meet the expectations and requirements of today’s patients who want the best possible function, in as short a time as possible.”

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