Robotic Total Knee Replacement

What Is Robotic Total Knee Replacement?

First, let’s recall that total knee replacement (TKA) surgery involves removing the worn and damaged knee joint surfaces (the surfaces of the thigh bone, shin bone, and sometimes the kneecap) and replacing them with artificial joint (prosthesis) components made of metal and special polyethylene (plastic) materials.

Robotic total knee replacement, on the other hand, is the performance of this surgery with the assistance of a robotic system. The important point here is this: it is not the robot itself that performs the surgery. The robotic system is an advanced technology tool, under the surgeon’s control, that assists with preoperative planning and with precise bone cuts and prosthesis placement during the operation. The surgeon retains full control throughout the surgery; the robotic arm merely guides the surgeon in making the planned cuts with millimetric precision or finding the correct angle. The main goal of the surgery is to position the prosthesis in the way best suited to the patient’s anatomy, providing a more natural knee feel and potentially a longer-lasting prosthesis.

What Are the Potential Advantages of Robotic Knee Replacement?

The potential advantages robotic surgery may offer compared to traditional methods are as follows:

• Advanced 3D Planning: A three-dimensional (3D) digital model of the patient’s knee is created using preoperative Computed Tomography (CT) or MRI images, or special measurements taken during surgery. On this model, the surgeon can virtually plan the size, placement, and angle of the prosthesis to best suit the patient’s own anatomy.
• High Precision and Accuracy: The robotic arm or robotic guidance systems help the surgeon make bone cuts that precisely match this previously prepared plan. This millimetric precision can help the prosthesis fit the bone better and allow more accurate alignment of the leg axis.
• Better Ligament Balance: Some robotic systems have the ability to dynamically measure ligament tension (ligament balance) at different ranges of motion of the knee during surgery and provide feedback to the surgeon. This can contribute to the knee feeling more stable and natural after the prosthesis is placed.
• Potentially Less Soft Tissue Damage: More precise and planned bone cuts aim to minimize damage to the surrounding healthy bone and soft tissues (muscles, ligaments). However, research is ongoing into the extent to which this translates into clinical outcomes (e.g., less pain, faster recovery).
• Potentially Faster Recovery and Better Function (Caution Required): Some studies suggest that patients experience less pain and regain function faster in the early period after robotic surgery. However, whether there is a clear advantage in the long term between a well-performed traditional knee replacement and a robotic knee replacement, in terms of functional outcomes or prosthesis lifespan, has not yet been definitively proven, and scientific studies on this subject are ongoing.

How Is Robotic Knee Replacement Surgery Performed?

The general flow of robotic knee replacement surgery is as follows:

1. Planning Stage: A 3D model of the patient’s knee is created (using preoperative CT/MRI or intraoperative mapping). The surgeon plans the most suitable prosthesis size and placement on this model.
2. Registration Stage: During surgery, special trackers placed on the patient’s knee are used to match the virtual plan with the patient’s actual knee anatomy. The robotic system tracks the knee’s position in space in real time.
3. Robot-Assisted Bone Preparation: Using the robotic arm or the cutting blocks guided by the robotic system, the surgeon makes the precise, previously planned bone cuts. The robotic system prevents the surgeon from deviating from the plan (through haptic feedback or a restricted range of motion).
4. Prosthesis Placement and Ligament Balance: After the bone cuts are completed, trial prostheses are placed. Ligament balance is checked (with robotic measurement in some systems). Once proper fit is confirmed, the permanent prosthesis components are placed and fixed.
5. Closure: The wound layers are closed according to standard procedure.

To emphasize again, control remains entirely with the surgeon at every one of these stages. The robot is a tool that helps the surgeon implement the plan with greater precision.

Who Can Be a Candidate for Robotic Knee Replacement?

In general, almost every patient who is suitable for traditional total knee replacement surgery can also be a candidate for robotic knee replacement. The potential benefits of robotic surgery may be particularly evident in the following situations:

• Patients who have previously undergone knee surgery.
• Those with significant bone deformity or alignment abnormalities.
• Cases where precise prosthesis placement is critical.
• Younger and more active patients (given the expectation of better ligament balance and potentially longer prosthesis lifespan).

However, the applicability of robotic surgery depends on the hospital’s technological infrastructure and the surgeon’s training and experience with this technology. The final decision is made after a detailed discussion between the surgeon and the patient.

Robotic vs. Traditional Knee Replacement: Differences and Considerations

• Key Difference: The level of detail in planning and the precision of bone cuts. Robotic surgery offers more personalized planning and millimetric execution.
• The Surgeon’s Role: In both methods, the most important factor in the success of the surgery is the surgeon’s knowledge, skill, and experience. The robotic system is merely an assistive tool.
• Long-Term Outcomes: The long-term success rates and prosthesis lifespans of well-performed traditional total knee replacements are already very high (over 90% at 15-20 years). Whether robotic surgery meaningfully improves these long-term outcomes further is still the subject of ongoing research.
• Other Factors: Robotic surgery may take slightly longer than the traditional method. There may also be additional costs associated with the technology.

Risks and Recovery Process

• Risks: The risks of robotic knee replacement surgery are largely the same as those of traditional knee replacement surgery: infection, deep vein thrombosis (DVT), pulmonary embolism (PE), periprosthetic fracture, loosening or wear of the prosthesis, nerve-vessel damage, knee stiffness, persistent pain, etc. In addition, there are theoretical, very rare risks specific to the robotic system (infection or fracture at tracker pin sites, system malfunction).
• Recovery Process: Robotic surgery does not change or eliminate the postoperative rehabilitation process. The recovery process is entirely the same as with traditional knee replacement:
  
  • A short hospital stay in the early period (a few days).
  • Early mobilization and walking.
  • Pain control.
  • Months of intensive physical therapy and exercise program (regaining range of motion, increasing muscle strength, gait and balance training).
  • Full recovery and return to normal activities typically takes between 6 months and 1 year.

While there is some data suggesting that robotic surgery may potentially speed up early recovery (the first few weeks) somewhat, the overall recovery process and rehabilitation needs are the same.

Robotic Knee Replacement in Ankara and Prof. Dr. Murat Bozkurt’s Approach

Robotic surgical technologies are also finding their place in modern healthcare institutions in Ankara, and there is growing interest from patients in this direction. Prof. Dr. Murat Bozkurt closely follows technological developments in orthopedic surgery and adopts evidence-based methods to provide his patients with the best outcomes.

Prof. Dr. Bozkurt’s approach to robotic knee replacement can be summarized as follows:

• Viewing Technology as a Tool: He views robotic surgery as a tool that complements the surgeon’s experience and skill, one that can be beneficial particularly in situations requiring precise planning and execution.
• Evidence-Based Practice: He takes into account the potential benefits of robotic surgery and the current level of scientific evidence. Although its long-term superiority has not yet been established, he may consider the precision advantage it offers in specific patient groups or anatomically challenging cases. (Note: information on whether Prof. Dr. Bozkurt actively uses this technology is important. If he does, his experience in this area can be highlighted. If not, his expertise and experience in achieving excellent results with traditional methods can be emphasized instead.)
• Patient-Centered Decision-Making: When choosing a treatment method, he prioritizes the patient’s individual needs, anatomical characteristics, expectations, and general health condition over the technology itself. He makes the decision of whether the surgery will be robotic or traditional after a detailed discussion with the patient, weighing the advantages and disadvantages of both methods.
• The Importance of Surgeon Experience: Regardless of which technology is used, he emphasizes that the true determinant of a surgery’s success is the surgeon’s experience, knowledge, and adherence to surgical principles.

Prof. Dr. Bozkurt aims to provide his patients undergoing knee replacement surgery in Ankara, whether by traditional or robotic method, with a safe and successful surgical experience at the highest standards.

Robotic total knee replacement is an advanced technology aimed at increasing precision in the treatment of knee osteoarthritis. However, it should not be forgotten that the most important elements are an accurate diagnosis, appropriate patient selection, the surgeon’s experience, and a successful postoperative rehabilitation process. If you are considering knee replacement surgery in Ankara, you can consult Prof. Dr. Murat Bozkurt to determine the most suitable treatment method for you.

For detailed information and appointments, you can contact Prof. Dr. Murat Bozkurt at 0312 502 70 74.