Robotics

ROBOTICS AND COMPUTER ENHANCED HIP REPLACEMENT

This page provides information on robotics

Robotic surgery or computer enhanced surgery, for hip and knee replacement is not a new concept.

The idea has been popularized in the social press recently, specifically wrt its use in Prostate surgery (The DaVinci Robot). This robot has been a great tool because the robotic arms that the surgeon controls, are very small at the ends which facilitates surgery in tight spaces.

Robotics in orthopaedic surgery have been more to do with accurate positioning of implants. This, by way of cutting the bone exactly where the surgeon planned to and being able to measure the precise orientation of the implant during surgery. Thus, more precision. However, this must still be done through the usual incision, and historically the robots have not been very soft tissue friendly.

Also, the use of computer enhanced surgery or robotics has bee used by many surgeons to market their practices in the social webpages.

The scientific evidence on the subject does show that the surgeon will be more precise with the positioning of the implants. The computer planning and templating can be more accurately reproduced during the surgery.

However, there is no proof or conclusive scientific evidence that this will lead to less complications, less time in hospital, less pain and or that the long-term outcomes are any better.

In fact, the only parameter that has been shown to have any influence on long term outcomes, seems to be the surgeon’s experience and the number of operations they do per year.

I am part of a working group and give international lectures on the use of a particular brand of computer enhanced hip replacement surgery. This system is the only one that accounts for the movement of your pelvis and spine relative to each other. Thus, allowing for an evaluation of the stability of your hip replacement with everyday activities e.g. tying your show laces. ( CORI HIP MODELER, Smith and Nephew). This facilitates placing the implant in the optimal position of stability and muscle function for you.

This technology has definitely made me more precise. However, in my lectures on the subject I always teach that Robots do not make a poor surgeon better. The surgeon must still understand the principles and hence the correct application and planning to perform a good operation. Also, the surgeon must be meticulous and concise in execution, while being gentle when handling the soft tissues. The last two points, I feel, are perhaps even more important wrt long term outcomes with less complications.