Robot-Assisted Knee Replacement Surgery? Dr. Dirk Eiwanger and Dr. Alexander Mayer Explain the Benefits

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00:00:37: Anyone who needs a knee replacement today benefits from surgical procedures that are significantly less invasive than they were just few years ago.

00:00:46: Robot-assisted procedures in particular enable highly precise execution of the necessary steps when inserting an implant.

00:00:55: That's what I'm talking about with Dr Alexander Meier and Dr Dirk Eywanger.

00:01:00: They are specialists in orthopedics and trauma surgery, as well as medical directors and practice owners of the knee-surgery unit at Athos Medical Care Centre, Visbadan.

00:01:12: Dr Maya what exactly do we mean by robot assisted knee surgery?

00:01:16: Well Robot Assisted Knee Surgery is currently alongside custom made knee implants The most modern way to implant an artificial knee joint AT ALL!

00:01:25: The robot helps us operate much more precisely AND above all in a way that is exactly tailored to the patient's individual anatomy.

00:01:35: Now, it's important to say that the robot only supports the surgeon at least with the system we use.

00:01:41: There are currently about four or five providers on the market and most of them actually large robots big machines brought into the operating room then simply cut And the surgeon no longer has any way to intervene.

00:01:55: In other words you're more-or less blindly trusting the machine.

00:02:01: What special our approach is that we essentially perform navigation.

00:02:05: That means, we first capture how the knee is positioned in three dimensions in space and during surgery.

00:02:11: We can plan the individual anatomy And prosthesis positioning very precisely... ...and then tell the robot please do this & that.

00:02:20: So the robot will never act unless you tell it exactly what to do.

00:02:24: Dr Aiwanga, doctor may have already touched on briefly.

00:02:28: What are the advantages of robot assisted knee implant surgery compared to conventional method?

00:02:34: Yes, like Dr Mayer suggested.

00:02:37: The great thing is that it's a supportive method an additional tool and It doesn't exclude what we used to do in traditional way.

00:02:45: That means still have full control before And thank goodness!

00:02:53: Otherwise, we wouldn't have any patients left.

00:02:56: So things were already going quite well before.

00:03:00: Now it's just this.

00:03:01: In addition We now have a digital method that shows us in space where we are moving with our instruments And It actually also shows Where will end up when do something?

00:03:14: You can compare to navigation.

00:03:17: for a long time I was against and never used it.

00:03:23: I'd orient myself beforehand and then set off.

00:03:27: That's also a good thing, you usually arrived.

00:03:30: all good navigation supports You in the sense that you have plan A B or C And ideally you might even get a traffic update In between.

00:03:39: that turns Plan A into b or c. it similar during surgery.

00:03:45: During the operation i can always mechanically check where I am just like used to And at the same time, I have all the digital advantages on the monitor.

00:03:56: Where is my plan right now and where will i end up?

00:03:59: That gives us a high level of accuracy so that we can actually reach the goal we have in mind.

00:04:07: For which knee problems?

00:04:08: are robot assisted operations actually suitable Dr Mayer ?

00:04:12: That's relatively easy to answer.

00:04:14: At the moment it's basically only so-to speak Knee replacements Although the system we use enables us to implant both partial replacements, The so-called unicompartmental or sled prostheses and also surface replacement.

00:04:30: What most people typically mean when they talk about an artificial knee joint Other procedures Anything else?

00:04:37: Arthroscopic procedures can't yet be mapped by navigation at this time.

00:04:49: and is it technically possible?

00:04:51: Yes, of course anyone can request it.

00:04:54: And it IS technically possible!

00:04:56: You can perform any knee replacement surgery like Dr Mayer just said partial prosthesis full prosthesis or even revision surgery with the support of our robotic navigation.

00:05:10: you Can do that Technically It's Possible...and in my view it also makes sense.

00:05:16: We're currently doing it simply because it brings us significant advantages.

00:05:46: Could you describe it?

00:05:48: Yes, I need to go a bit further back.

00:05:50: The approach to the knee joint is completely standard just like in conventional knee replacement surgery.

00:05:55: What's special Is that we then attach so-called trackers or markers To the knee.

00:06:00: these are detected by camera So the system basically knows where the knee is in space.

00:06:05: We then start moving the knee through its range of motion and tell the system for example This Knee Joint has such And Such A Degree Of Bow Leggedness Or Knock Knees.

00:06:15: It can extend well, or it has limited flexion.

00:06:19: And then we get in principle a three-dimensional image of the knee joint in space.

00:06:24: Then comes what's special about our system – digital software!

00:06:28: It works via tablet that is covered in sterile sleeve and operated in operating room….

00:06:34: …and think things through although actually do so beforehand too.

00:06:38: Where to place this prosthesis?

00:06:41: What Is The Patient's Baseline?

00:06:42: Did they have significant bow legs before or was the leg straight?

00:06:46: What is the joint line position?

00:06:48: we then plan the prosthesis in all planes so that it matches the patient's individual anatomy.

00:06:53: We can also record ligament tension, which other systems cannot do.

00:06:57: as I said In those systems The robot just cuts!

00:07:00: We check for example with major deformities whether the ligaments on one side are too tight Or to loose.

00:07:07: Once navigation and planning completed only than does actual robot come into play.

00:07:12: You can imagine it like a milling device, attached to kind of small handle.

00:07:17: This system is also recognised in space and with that we mill the bone so that prosthesis then be applied exactly as planned digitally beforehand.

00:07:36: When we switched over and started operating with robot It did take longer.

00:07:41: That's true.

00:07:42: Capturing the instruments, The bone in space and also the ligament tension simply takes some time.

00:07:49: Now it's relatively quick so we're not losing much Time anymore!

00:07:52: The good thing is We invest the time And then make It up again later.

00:07:57: I'd say were currently looking at an additional five to ten minutes.

00:08:01: That very manageable for the amount of information and accuracy we gain.

00:08:05: So we invest something In navigation & robotics But we gain it back Later because actually have fewer steps Additional milling, additional cutting.

00:08:15: Things like that basically don't occur anymore with this system.

00:08:19: We plan something can check it and then we move relatively quickly toward the actual implantation at the end.

00:08:26: So its very positive.

00:08:27: The operating time is currently only about five to ten minutes longer.

00:08:32: And an important question for patients as always has robot assisted knee surgery become safer Dr Mayer?

00:08:40: In terms of being able to implant the prosthesis more precisely, it's definitely safer.

00:08:45: Essentially only custom-made prostheses show similarly good results.

00:08:49: Otherwise you have to say everything we align or cut manually may be good but It can't as precise navigation and robot allow.

00:08:57: A big topic regarding safety is always The surgery takes a bit longer.

00:09:02: We may manipulate slightly more.

00:09:04: What about infection rates?

00:09:06: And here we can reassure patients.

00:09:08: There is no study showing that the infection rate is higher with a robot or navigation compared to conventional knee surgery.

00:09:16: And what about the chances of success, Dr Aiwanga?

00:09:18: How long does a robot-assisted implanted knee joint last?

00:09:23: Success with a knee prosthesis isn't that easy to measure – it's about patient satisfaction which is linked to pain and mobility.

00:09:31: Can The Patient Kneel?

00:09:33: Can They Return To Sport?

00:09:35: That's very individual.

00:09:37: So it is not so easy, and orthopedists have been trying for a long time to measure precisely what is success?

00:09:45: Health insurers once measured that with knee prostheses eighty percent of patients this has being the case in many years are satisfied.

00:09:55: ten percent okay And we're not satisfied.

00:10:01: I think we're doing quite well with our follow-up data, so we are satisfied but have to get better.

00:10:09: Now robotic navigation has already produced initial figures and studies showing that you can get higher satisfaction rates... ...and THAT'S because it's accurate!

00:10:19: And one thing is very important – We don't implant all these prostheses at a strict ninety degrees in space.

00:10:26: It's about achieving a straight leg But if had a crooked leg before and not only because of the arthritis, maybe you had five degrees of bow leggedness.

00:10:36: then we want to reconstruct that as well.

00:10:38: And this precise reconstruction of pre-arthritic alignment is something we can only achieve with navigation.

00:10:47: That's why were currently seeing very good clinical results which are also starting show in study data.

00:10:55: As for long term durability an important topic there are investigations.

00:11:01: If you implant the components accurately, The way we know they should be positioned with correct load distribution on the tibial plateau then long-term durability is given.

00:11:13: And that's why basically have to assume even if it not yet visible in long term studies That robot navigated knee joints will very good durability.

00:11:24: We can assume from experience.

00:11:26: and what historically

00:11:29: If robot-assisted implantation is so much more precise, is rehabilitation afterwards faster for patients?

00:11:36: Dr.

00:11:36: Mayer

00:11:37: Patients with robot assisted knees do actually find it significantly easier.

00:11:42: That's simply because we don't force a knee that comes from pronounced bow leg alignment into straight legs like used to and then adapt the soft tissues of the bone.

00:11:51: Instead we now adapt our bones to anatomy as before which also has joint lines.

00:11:57: Very few people have a completely straight leg.

00:12:00: Prostheses are rarely perfectly parallel to the floor, The joint surfaces is always slightly inclined.

00:12:07: And if you can achieve that with navigation and robotics It feels much more normal for patients.

00:12:12: They know their feeling of knee has.

00:12:15: Of course at beginning they still feel pain And some swelling tendency But in rehabilitation they're significantly faster.

00:12:23: We like talk about forgotten knees Meaning Patients forget an artificial Knee Joint And we can achieve that on the one hand with partial replacements, and then also with robot-assisted prostheses.

00:12:46: I'll start with this.

00:12:47: health insurers do not cover it.

00:12:49: neither statutory nor private insurance covers additional costs specifically for such an operation.

00:12:56: The implant we use is the same one we also implant conventionally.

00:13:00: It's the same implant, so that part is unchanged for us.

00:13:03: So what we receive from the insurer?

00:13:05: Is a fixed amount of flat rate called a DRG.

00:13:10: in That amount a certain budget for the implants We used included.

00:13:14: it's always the same for everyone so whether we use a cheap implant or very expensive One we get the same reimbursement.

00:13:22: With robotic navigation, we actually have disposable costs.

00:13:26: These are the trackers that we use – they're discarded after surgery and cost €四 hundred.

00:13:31: We tell patients that…and say... We discuss that with the patient and tell them we have to charge it.

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