Total knee replacements have been performed by orthopaedic surgeons all over the world for decades. We are always striving to improve patient outcomes and increase the longevity of these implants for our patients. The aim of these operations is for patients to always have good quality of life, an active and healthy lifestyle without knee pain and stiffness.
Mr K is a 55-year-old gentleman who was an active army regular during his earlier years. He used to enjoy all forms of outdoor activities, including mountain biking, trekking, tennis, and golf. Over the years, however, he has found that his left knee is increasingly painful and stiff, limiting his sporting ambitions. He had been looking forward to enjoying his retirement and spending his time with family and friends, exploring the world, and enjoying various forms of sporting activities.
When I examined Mr K’s knees, they both appeared straight and well-aligned. He had lots of pain on the inside of his knee and when he did minor squats. The range of motion of his knee was about zero to 110 degrees. This was a reasonable range of motion, but it was painful throughout. I studied his X-rays and realized that the space between his femur bone and tibia bone was narrowed. So was the space between his kneecap and femur bone. I explained to him he had knee arthritis, consistent with his age and physical activities.
From left to right: Front view, side view and skyline view of Mr K’s left knee before surgery.
Mr K was concerned that if we performed the total knee replacement (TKR) for him at 55 years old, the implants would wear out in 20 years. I explained that more than 95% of implants are still in good working condition after 20 years and are likely to last longer than that. Patients are also generally less physically active in their 70s and 80s, hence less physical stress on their implants. It was, however, crucial that the implants be placed in optimal positions in the knee so that the knee is well balanced when Mr K is standing and when he is sitting or squatting with his knees bent.
We decided to perform the Mako Robot-assisted total knee replacement for Mr K to facilitate a well-balanced knee and improve its longevity.
Step 1:
A CT scan of the knee was performed, and the images were uploaded onto computer software. The 3-dimensional image allowed me to evaluate his bone structure, disease severity, joint alignment, and even the surrounding bone and tissue. I could then determine the optimal size, placement, and alignment of his implant. A surgical plan was then made for Mr K before his surgery.
Step 2:
During surgery, I prepared the patient and made the skin incision over the knee. The Mako Robot was brought towards the patient’s knee to assess the range of motion of the knee and the flexibility of the ligaments that hold the knee together in real-time. To fine-tune the surgical plan further, some minor changes can be made to the surgical plan.
I then guided the robot arm to remove the arthritic bone and cartilage from the knee. A virtual boundary helped me stay within the boundaries of surgery defined in my surgical plan. Any deviation from this plan will trigger an alarm, and the surgery can only proceed once I return to the plan. This helps with surgical precision and improves patient safety during surgery.
Step 3:
Once the arthritic and worn-out regions of the knee were removed, the knee was washed before the implants were secured into the knee joint. The knee was straightened and flexed, and its stability was tested by stressing it in various positions. The use of pre-operative CT scans, the planning software and the robot arm helped to take the guesswork out of knee replacement surgery. The system ensured that the knee was balanced in all positions and that patients received their surgery safely and effectively.
Front view X-rays before and after surgery. - Side view X-rays before and after surgery.
Skyline view X-rays before and after surgery.
Mr K was discharged from the hospital about 5 days after surgery. During his hospital stay, he was busy with physiotherapy and rehabilitation. Having been an active and sporty person throughout his life helped him with his recovery. He was very driven and motivated to return to his active lifestyle and hobbies. We wish Mr K all the very best in his retirement and his new robotic-assisted knee replacement.