Hospital for Special Surgery

Advances in technology, surgical technique and implant design aim to optimize outcomes in joint replacement surgery. Many believe these innovations could lead to a knee or hip replacement that lasts a lifetime, even in younger patients. Although it will take time for patient registries and other forms of data collection to substantiate that view, the pinpoint accuracy of robotic-assisted surgery, newer types of prostheses and other advancements could make it possible.

Robotic-Assisted Joint Replacement

The use of robotic-assisted joint replacement with computer navigation is growing rapidly as increasing numbers of hospitals acquire the technology. The robotic systems allow for the optimal alignment, soft tissue balancing and positioning of the implant – critical to the success of joint replacement surgery.

Medical device companies have brought various robotic systems to market. At Hospital for Special Surgery (HSS), many joint replacement surgeons use the Mako image-based robot when performing hip replacement, total knee replacement or partial knee replacement surgery. A preoperative CT scan provides a 3D model of the joint, which enables the orthopedic surgeon to determine the exact size of the prosthesis, alignment and positioning even before entering the operating room.

"Robotics and computer navigation increase accuracy, but don’t forget the personal touch"

During surgery, the computer provides real-time data that allows us to assess the movement and tension of the new joint and adjust it as needed. A robotic arm controlled by the surgeon removes arthritic bone and cartilage, providing tactile resistance to help the surgeon stay within the boundaries defined in the surgical plan.

The unmatched accuracy of robotic-assisted surgery offers the additional benefit of protecting the soft tissues in the joint. We find that patients generally experience less post-operative pain and a reduced need for narcotic pain medication. They commonly reach physical therapy milestones more quickly and experience a faster recovery.

As for a surgical team’s learning curve when implementing robotics, studies have shown that while additional time may be needed to perform the surgery, especially in the beginning, the system is highly accurate, even when used for the first few cases.

Today most major residency and fellowship programs are training future orthopedic surgeons with the robotic system. At HSS, residents and fellows appreciate its value and want to make sure they have access to the system after they complete training and enter orthopedic practice.

The main barrier to adopting robotic-assisted technology is the cost. Many smaller hospitals and ambulatory surgery centers don’t have the financial resources to buy a robotic system with a price tag upwards of $800,000.

Advances in Prosthetic Design

For younger people seeking pain relief and a return to certain activities, implant longevity is a major consideration. Indeed, the number of individuals in their 50s or even late 40s seeking joint replacement to remain active has been on the upswing over the past decade.