A1217. ROBOTICS AND SMART TOOLS IN TOTAL KNEE ARTHROPLASTY

Abstract

Surgical instrumentation for total knee arthroplasty has improved the accuracy, reproducibility and reliability of the procedure. In recent years, minimally invasive surgery introduced instrumentation that was reduced in size to fit within the smaller operative field; with this move the impact and influence of technology became proportionately larger. The introduction of computer navigation is an attempt to improve the surgeon’s visibility in a limited operative field, improve the position of the resection guides, and ultimately the position of the final components.

While it may be appealing to rely on computer navigation to perform a TKA, it is not artificial intelligence and does not make any of the surgical decisions. The procedure still is surgeon directed with navigation serving as a tool of confirmation with the potential for improvements in surgical accuracy and reproducibility. The accuracy of TKA has always been dependent upon the surgeon’s judgment, experience, ability to integrate images, utilize pre-operative radiographs, knowledge of anatomic landmarks, knowledge of knee kinematics, and hand eye co-ordination. Recent advances in medical imaging, computer vision and patient specific instrumentation have provided enabling technologies, which in a synergistic manner optimize the accurate performance of the surgery. The successful use of this technology requires that it not replace the surgeon, but support the surgeon with enhanced intra-operative feedback, integration of pre-operative and intra-operative information, and visual dexterity during the procedure. In developing smart tools or robotic systems, the technology must be: safe; accurate; compatible with the operative field in size and shape, as well be able to be sterilized; and must show measurable benefits such as reduced operative time, reduced surgical trauma and improved clinical outcomes. Advocates believe this is attainable and robotic assisted TKA can achieve levels of accuracy, precision and safety not accomplished by computer assisted surgery.

Smart instruments and robotic surgery are helping us take the next step into the operating room of the future. The role of robots in the operating room has the potential to increase as technology improves and appropriate applications are defined. Joint replacement arthroplasty may benefit the most due to the need for high precision in placing instruments, aligning the limb and implanting components. In addition, this technology will reduce the number of instruments needed for the procedure potentially further improving efficiency in the operating room. As technology advances, robots may be commonplace in the surgical theater and potentially transform the way total knee arthroplasty is done in the future. Robotic surgery and smart tools are new innovative technologies and it will remain to be seen if history will look on its development as a profound improvement in surgical technique or a bump on the road to something more important.