The role of robots in knee replacement surgery

Written by: Mr James Donaldson
Edited by: Laura Burgess

Robotic technology is increasingly being used in orthopaedics as it allows more accurate placement of the prosthetic components, which should create a more ‘normal’ feeling knee with a faster recovery time. The improved accuracy may also mean the knee will last longer than with conventional techniques.

What happens during robotic knee replacement surgery?

The robots don’t operate on their own and need an orthopaedic surgeon to be in control. The surgeon builds a virtual model of the knee either before the surgery with 3-D imaging or during the robotic knee surgery with the aid of a computer. This allows the surgeon to plan each procedure around the individual patient. It also helps to determine the sizing and positioning of the implant. Using a virtual model as a guide, the surgeon uses the robot to embed the components of the knee precisely. The robot helps control some of the surgical steps and limits the surgeon from operating outside the specified dimensions.

Is there evidence that robotic-assisted replacements are more effective?

There is evidence that accuracy is improved as well as short-term outcomes scores. Long-term data is still required to definitively know whether this will result in a more effective knee replacement.

Who is to blame if something goes wrong?

The surgeon is in control of the robot the whole time and ultimately makes the all the decisions.

Is robotic really better?

Robotic-assisted surgery has the potential to speed recovery and it also allows a customised, tailored approach to the individual anatomy. Could knee replacements be fully automated in the future? Possibly, but the current commercial robots are all designed as aids to the surgeon. They potentially allow smaller incisions, less blood loss, more accurate device placement, a shorter hospital stay, better function and range of movement, and hopefully improve the longevity of the implant. The surgeon is also crucial if there are unforeseen circumstances or complications.

By Mr James Donaldson
Orthopaedic surgery

Mr James Donaldson is one of London's most highly-skilled orthopaedic surgeons. Operating from the Royal National Orthopaedic Hospital, he has a special interest in hip replacements, knee replacements, using stem cells for cartilage replacements, soft tissue knee surgery, arthroscopic knee surgery and ligament reconstruction. He is also the clinical director of the joint reconstruction unit at the Royal National Orthopaedic Hospital.

Mr Donaldson was awarded his first medical qualification at University College London Medical School in 2002, receiving a certificate of merit in his MB finals. He then worked on the Royal National Orthopeadic Hospital rotation until 2013 to complete his training. Mr Donaldson went on to complete two sub-specialist fellowships: a one-year international fellowship in Toronto, Canada and a six month fellowship at Stanmore on the joint reconstruction unit. He is currently a consultant orthopaedic surgeon at the Royal National Orthopeadic Hospital. He additionally worked as consultant at the Royal Free Hospital in Hampstead. He is on the clinical governance committee at Stanmore and also sits on a number of multidisciplinary national meetings for complex case referral. 

Throughout Mr Donaldson's illustrious career, he has been awarded ten academic prizes including a surgery distinction in 2000 and a pharmacology certificate of merit in 1998. Later on his career, he was awarded the Royal College of Surgeons Preiskel Elective Prize in 2001 and the Jacques Duparc prize from the European Federation of National Associations of Orthopaedics and Traumatology in 2009. He has written numerous textbook chapters and articles in peer-reviewed journals and has co-authored a website for junior orthopaedic trainees and medical students. He is a member of a number of professional bodies such as the British Orthopaedic Association and the Royal College of Surgeons.

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