Abstract
Aim. To report our experience of using computer navigated and mini-robot assisted total knee arthroplasty and to assess its feasibility.
Methods. A retrospective analysis was done on all of the total knee arthroplasties performed between 12/07/2002 and 12/12/2003 by the lead surgeon using both the conventional technique and the computer navigated/robot assisted technique.
Results. A total of 47 patients fell between the two groups (22 in the navigation/robot assisted group and 25 in the conventional group). Osteoarthritis was the indication for surgery in all the patients.
Mean tourniquet time was 118.6 mins (range 98–143 mins) in the navigation/robotic group, which was significantly longer than the conventional group (mean 96.2 mins and range 61–131 mins). Blood loss as estimated from the difference between pre and post op haemoglobin measurements was 3.2 g/dl (range 0.2–6.2 g/dl) in the navigation/robotic group as compared to 3.1 g/dl (range 1.0–6.6 g/dl) in the conventional group. Mean length of stay was 8.7 days post op and 8.9 days post op in the navigated/robotic and conventional groups respectively.
There were no physical surgical complications in the navigated/robotic group and 3 in the conventional group (1 superficial cellulitis, 1 haematoma and 1 case of temporary sensory loss to the sole of the foot). 3 cases from the navigated/robot-assisted group had to be completed with the conventional technique due to software/hardware failure intra-operatively.
Other factors to consider, which are difficult to quantify, but which were noted in the navigated/robotic group are:
-
Training of the surgeon
-
Training of the theatre personnel
-
Cost of the system
-
Cleaning/sterilisation burden of the robot and tools, which have stringent requirements and long turn around times
-
Requirement of technical assistance with equipment and software
-
Radiographic assessment (need long leg films to accurately assess alignment)
Conclusion. The use of navigation/robot-assisted technique results in a longer tourniquet time at present, but does not increase the blood loss, affect the length of stay post operatively or increase complications. It is more demanding on the normal theatre resources and still requires refinement in order to prevent intra-operative failures. Further long-term outcome and cost-benefit studies are required to justify its widespread implementation.
Correspondence should be addressed to Roger Smith, Honorary Secretary, BASK c/o Royal College of Surgeons, 35 – 43 Lincoln’s Inn Fields, London WC2A 3PN
