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Orthopedic Surgery

What is Robotic Prosthetic Surgery ?

Robotic technologies are used more widely in the world with each passing day. In parallel with the developments in technology, robots are widely used in medicine. In parallel with these developments, robotic technology has started to gain a place the field of orthopedics, as well. The number of orthopedic surgical operations performed using robotic technology is increasing day by day. Robotic technology is used in hip and knee joint replacement surgeries in the field of orthopedics. It is expected to be used in tumor removal, shoulder, and spine surgeries in the near future.

Robotic surgery involves auxiliary systems used in knee or hip replacement surgeries. The operation is planned, the patient’s data are evaluated, and the operation is performed with the help of robotic systems under the control of the surgeon. As even an experienced orthopedic surgeon is likely to adjust implant positions with a certain margin of error, new innovations have been sought. The most important features of Robotic Surgery include that the bone incisions planned to be made in the surgery are designed preoperatively in the computer environment, component positions are adjusted optimally, and bone incisions are made flawlessly with the help of a robotic arm. Thanks to positioning the implant optimally, implants lasts longer and they wear and loosen after a longer period of time. The entire procedure is performed by your physician. Robotic surgery requires special training and certification.

What is Robotic Arm Interactive Orthopedics System?

Today, there are systems for robotic or navigation surgery produced by several companies. Most of these systems just use the navigation feature. Navigation systems play a guiding role for the surgeon. The navigation system and the robotic arm interactive orthopedic system are not the same thing. The robotic system has both a guiding system and a robotic arm system that limit the margin of error to millimetric ranges during surgery. In our clinic, we use the MAKO Robotic System developed by Stryker as a Robotic Arm Interactive Orthopedics System. The MAKO system has not only be equipped with a navigation system, but also a special robotic arm developed to ensure correct bone incisions. “Robotic Arm Interactive Orthopedics System consists of three main units including a computerized control and guidance module, a camera and a display stand. Thanks to this system, the physician can make a patient-specific plan and perform the surgery accordingly. During surgery, the robotic arm guides the surgeon to ensure correct preparation and placement of the implant sockets. The special robotic arm (Picture 1), which is not available in other systems, ensures correct bone incisions during surgery. Another very important advantage of this system that is not available in other systems is the ability to minimize the risk of hip implant dislocation, especially in cases of hip implant placement because its evaluation process also includes the waist region.

Important advantages of the robotic arm Interactive Orthopedics system

• A 3-dimensional analysis of the patient’s joint structure is conducted using the computed tomography images of the patients’ joints, and then a patient-specific surgical plan is made accordingly. This prevents unnecessary bone incisions and tissue damages.
• The ability to make a patient-specific implant placement plan ensures soft tissue balance and stability as well as a joint balance suitable for the patient.
• With the support of the robotic arm, the Haptic Feedback provided to the surgeon during the surgery when he or she touches the relevant bone areas reveals the patient’s joint shape. This enables the surgeon to interactively control the data throughout the surgery, ensuring zero-error bone incisions.

Robotic Total Hip Replacement Surgery

In robotic total hip replacement surgery, the operation is planned, the patient’s data are evaluated, and the operation is performed with the help of robotic systems under the control of the surgeon. Before hip robotic total hip replacement surgery, three-dimensional planning is made using the robotic system. Since the route and range of motion of the patient’s joint is determined by the robotic system, the implant is placed in the patient’s hip structure in the most appropriate and correct way.

WHY ROBOTIC HIP IMPLANT?

Advantages of Robotic Total Hip Replacement Surgery

  • The risk of hip implant dislocation is reduced!!!!!
  • Postoperative leg length differences are prevented!!!
  • Incisions are made only on the parts of the hip bones, where incisions are need.
  • Personal implant size and alignment, suitable for the patient’s structure, are ensured.
  • Patient feels a more natural hip.
  • Faster and more painless recovery is ensured.
  • It is possible to return to daily life more quickly.
  • High accuracy placement of the implant prolongs the durability.

Preoperative Preparation For Robotic Total Hip Replacement Surgery

First of all, a 3D virtual model of the hip joint is created with the X-ray and CT scan images of the patient’s hip. In 3D modeling, the locations and dimensions of the bone incisions to be made on the hip are determined. Thus, soft tissue balance and the dimensions and location of the implant to be applied to the patient are exactly planned before the operation.

Robotic Total Hip Replacement Surgery

After completion of the necessary preparations of the patient in the operating room, the surgeon places the special apparatus used in the Robotic Prosthetic Surgery in the appropriate areas. Then, the robotic systems show the bone incision points in the digital environment, while also providing the surgeon with real-time information and visual data for the placement of the hip joint implant.

During the surgery, the robotic system help evaluate the compatibility of the implants at all bending angles of the hip. Bone incisions are made with the help of the robotic arm, under the control of the surgeon, and to the extent determined by the robotic system. In this way, unnecessary or inadequate bone incisions are prevented. In addition, vascular and neural structures are preserved. When the surgeon finds the placement, alignment, and ligament balance appropriate, he or she then places the original implant. As a result of the entire surgical procedure, the total hip replacement is performed with implants suitable for the patient’s anatomy, ensuring high precision, high accuracy, and a margin of error limited to 1 millimeter and 1 degree.

Patients suitable for Robotic Total Hip Replacement Surgery

Robotic surgery (MAKOplasty) can be performed on any patient who needs a total hip replacement. It is preferred because it allows for patient-specific planning and surgery. Another patient group consists of those with congenital or acquired (fractures, etc) bone curvatures and hip dislocations which are likely to cause problems in placing the implant parts in the ideal positions during manual hip replacement surgery.

Robotic Total Knee Replacement Surgery

In robotic total knee replacement surgery, the operation is planned, the patient’s data are evaluated, and the operation is performed with the help of robotic systems under the control of the surgeon. The most important features of Robotic Surgery include that bone incisions on the knee joint planned to be made in the surgery are designed preoperatively in the computer environment, component positions are adjusted optimally, and bone incisions are made flawlessly with the help of a robotic arm. The entire procedure is performed by your physician.

It determines the joint kinematics of the person and calculates the placement of the prosthetic components in the most accurate way. During the surgery, the robotic arm guides the orthopedic surgeon to correctly align and place the implant into the bone.

WHY ROBOTIC TOTAL KNEE REPLACEMENT?

Advantages of Robotic Total Knee Replacement Surgery

  •  Incisions are made only on the parts of the knee bones, where incisions are need.
  •  Personal implant size and alignment, suitable for the patient’s structure, are ensured.
  •  Patient feels a more natural knee.
  •  Faster and more painless recovery is ensured.
  •  It is possible to return to daily life more quickly.
  •  High accuracy placement of the implant prolongs the durability.

Preoperative Preparation For Robotic Total Knee Replacement Surgery
First of all, a 3D virtual model of the knee joint is created with the X-ray and CT scan images of the patient’s knee. In 3D modeling, the locations and dimensions of the bone incisions to be made on the knee are determined. Then, the knee implants are placed into the bones in the virtual environment, and personalized implant sizes are determined for the patient. During the virtual movement of knee joint, soft tissue balance is provided.

Robotic surgery (MAKOplasty) can be performed on any patient who needs a total knee replacement. It is preferred because it allows for patient-specific planning and surgery. Another patient group consists of those with congenital or acquired (fractures, etc) bone curvatures which are likely to cause problems in placing the implant parts in the ideal positions during manual implant surgery.

Robotic Unicondylar (Half, Partial) Prosthetic Surgery

Robotic unicondylar knee replacement surgery is a treatment option used in unicondylar (partial, half) knee replacement surgery. For partial implants, the robotic system targets the knee area only, where calcification occurred, and knee replacement surgery can be performed by preserving healthy tissues surrounding that area. Applying an implant only to the inner or outer side (compartment) of the knee joint is called unicompartmental knee replacement, and applying an implant to both sides (compartments) is called bicompartmental knee replacement.

Robotic Unicondylar knee surgery has the feature of three-dimensional planning before knee replacement. It determines the joint kinematics of the person and calculates the placement of the implant components in the most accurate way accordingly. During the surgery, the robotic arm guides the orthopedic surgeon to correctly prepare the compartment where the implant will be placed, and to place the implant into the bone. In this way, it enables the surgeon to plan and perform the surgery in the finest detail.

Robotic Unicondylar Knee Replacement Surgery

After the surgical exposure, certain points are marked on the knee bones, and the anatomy of the knee joint is revealed. Then, the robotic systems show the bone incision points in the digital environment, while also providing the surgeon with real-time information and visual data for the placement of the joint implant. While the surgeon is performing the operation, the robotic system prevents him or her from deviating from the plan and making mistakes. During the surgery, the robotic system helps kinematically evaluate the compatibility of the implants at all bending angles of the hip. Thus, it minimizes the margin of error by ensuring that the surgical procedure is performed with high precision and accuracy, in a way specific to the patient’s own anatomy. This also ensures a lower risk of unwanted complications that may develop in the future.

Advantages of Robotic Unicondylar Knee Replacement Surgery

  •  The replacement operation is performed precisely in the damaged part of the knee only.
  •  It involves with smaller surgical incisions.
  •  Tissue trauma is minimal.
  •  All ligaments in the knee are preserved.
  •  The patient feels a more natural knee.
  •  It provides faster and more painless recovery.
  •  Patients can return to their daily lives more quickly.
  •  Since the implants are placed with high accuracy, they become more durable.

In robotic unicondylar knee surgery, more natural feeling knee can be achieved, because during removal of damaged articular surface and bone structures in the knee, all other knee ligaments are preserved. In robotic knee replacement surgery, the patient recovers faster and more painlessly, and returns to his or her daily life in a shorter time, as a result of smaller incisions, minimal tissue trauma, and maximum preservation of healthy bones. Patients usually start walking the same day or the next day after surgery. Patients are allowed to return to their normal daily activities after a few weeks, depending on their general health status.

FAQ

What are the advantages of MAKOplasty?

  It enables patients to stand up much earlier and gives them mobility from the first day.

Why robotic total knee prosthesis?

  Advantages of robotic total hip replacement surgery;

  – Cutting only the necessary parts of the knee bones,

  – Prosthesis size and arrangement suitable fort he patient’s structure,

  – Giving a more natural knee feeling,

  – Faster and more painless recovery,

  – Being able to return to daily life more quickly,

  – Extending the life of the prosthesis due to the high accuracy of the prosthesis.  

What is MAKOplasty?

  MAKOplasty is a robot-assisted surgical procedure developed for minimally invasive articular operations. It was initially used in partial knee replacement surgeries. Soon later, it became popüler fort he use in total hip replacement surgeries and finally for the total knee replacement surgeries.

Which patients are treated with unicondylar (half) prosthesis surgery?

– Pure abrasion in only one area ofthe knee joint,

  – Knee joint ligaments are intact,

  – No advanced defprmity in the knee jointh.

  It can be applied successfully in paitents who are not overweight.

What are the Advantages of Robotic Prosthetic Surgery?

The most important advantage of robotic prosthetic surgery (MAKOplasty) is that it allows           the operation to be performed with millimeter precision. The most important point of the success of the prosthesis surgery is the application of the prosthesis of the appropriate size to the patient, the correct balance of the joint bone-soft tissue, and the most appropriate joint alignment. Robotic prosthesis surgery reduces the risk of possible prosthetic dislocation by providing patient-specific prosthesis application. In addition, unnecessary soft tissue damage is prevented.