3 New Technologies in Total Knee Replacement

Total Knee Replacement (TKR) is one of the most common surgeries performed to reduce pain and help restore the functionality of a patient with severe arthritis or injury to the knee. Increasing demand for TKRs requires improvements in medical technology to enhance the outcome of surgery. It also aims to decrease recovery time, and improve patient satisfaction rates. 

Three of the innovations of knee arthroplasty are: Patient Specific Instrumentation, custom  Knee Arthroplasty Implants, and Robotic-Assisted Knee Arthroplasty. These are based on modern methods of imaging, manufacturing, and automation in order to personalize the surgical procedure according to anatomy and the special needs of the patient. 

These innovations can be understood by professionals to make decisions that optimize surgical accuracy, implant fit, and overall patient health in total knee replacement procedures.

Patient Specific Instrumentation (PSI)

Patient Specific Instrumentation (PSI) is a major advancement in knee arthroplasty. It personalizes the surgical tools used during Total Knee Replacement (TKR). In this process, it starts with providing high-resolution 3D images of the patient’s knee, which are obtained before surgery, typically from CT or MRI scans. 

These images are used to develop an accurate model of the knee anatomy so that a tailored surgical plan can be developed detailing the bone resections and the positioning and alignment of the implant components.

Once the surgical plan is accepted, the orthopedic surgeon sends orders for the company to manufacture individualized cutting blocks or pin guides based on this patient’s specific anatomy. The guide is shipped pre-sterilized in a bag suitable for introduction into the sterile operating room and applied during the surgery onto the patient’s femur and tibia. 

The guides are designed to be closely contoured against the bone so that precise cuts are carried out as predetermined preoperatively. Surgeons carry out the resections of bone through the PSI guides cutting slots by using standardized surgical saws to ensure optimal alignment and positioning of the implant parts. T

Benefits

This technology has the following benefits: 

• PSI enables more accurate bone resections and placement of implants based on the patient’s anatomical features.
• It also enables less invasive surgical techniques due to the possibility of precise guiding, which could reduce the extensive exposure of bones.
• Preoperative planning could potentially shorten operative time.
• PSI guides allow for a better fit of the implant with the patient’s bone structure, thus reducing the chance of an overhang or under-coverage of the implant.
• Intramedullary canal violation may be avoided, thus lowering the chances of fat embolism and blood loss during the surgical procedure.

Customized Implants for Knee Arthroplasty

Personalized Knee Arthroplasty Implants are indeed the new direction to highly individualized solutions in the surgical procedure for knee replacement. These implants come in custom-design shapes and sizes, as against standard implants coming in fixed size and shape, and are unique to each patient’s knee anatomy. 

The process commences with a detailed imaging of the patient’s knee joint taken using modalities such as MRI or CT scans. These images are then utilized to create a precise three-dimensional (3D) model of the patient’s femur and tibia.

The implant is designed to mimic the patient’s knee structures, including the condylar radii, joint-line obliquity, and the configuration of the trochlea and tibial plateau, by using advanced manufacturing techniques such as additive manufacturing, or 3D printing. 

In this process, the engineers are able to collaborate closely with surgeons in the design to ensure the implant not only fits the bone but also meets the unique functional needs of the patient. The blocks are customized, hence the surgeon can have a template so that during surgery, the bone is cut along the same lines as planned preoperatively. 

Advantages

This technology has various benefits, they are as follows: 

• The implants are designed to fit the patient’s native anatomy of the knee, so the fit and integration with the bone is more optimal.
• Personalized implants can be used to enable better ligament balancing, reducing the risk of postoperative instability.
• These implants help in achieving more natural movement and function by replicating the geometry of the native knee.
• Custom sizing reduces the risks of implant overhang or under-coverage that may potentially lead to soft tissue irritation.
• A customized approach would result in a higher patient satisfaction rate because of better functional results and comfort.

Robotic-Assisted Knee Arthroplasty

Robotic-Assisted Knee Arthroplasty is one of the frontiers in the field of surgical precision and automation, which helps orthopedic surgeons to better perform Total Knee Replacement (TKR). Computer-assisted technologies are integrated with robotic arms for the assistance in bone preparation, implant positioning, and ligament balancing. These systems can be divided into passive, semi-autonomous, and autonomous, which provide different levels of assistance and control.

It begins with a very detailed surgical plan, either based on preoperative imaging such as CT scans or through intraoperative mapping of the bone surfaces. Image-based systems make use of a preoperative CT scan to produce a 3D model of the patient’s knee; that guides the surgical plan. Image-free systems depend on real-time intraoperative mapping without preoperative imaging. After setting the plan, the robotic arm guides the surgeon in precise cutting of the bone along the predetermined parameters. It avoids taking away bone beyond the planned limits and thereby ensures greater precision in implant placement and positioning.

In the intraoperative stage, the robotic system immediately feeds back the balance of ligaments and position of the implants. Based on this feedback, surgeons can make the necessary adjustments to ensure proper alignment and stability of the knee joint. The robotic assistance uses minimally invasive approaches by reducing the need for extensive manual bone cuts, thereby minimizing soft tissue damage and promoting faster recovery. 

Benefits

This technology has various benefits, they are as follows: 

• The robotic systems can make highly precise bone cuts and implant placement with minimal chance of malalignment.
• Real-time tension feedback during surgery helps in balancing the ligaments better, improving knee stability and function.
• Robotics eliminates human error and ensures that each surgical procedure yields consistent results irrespective of the surgeon.
• Minimal exposure of bones and manipulation of soft tissues leads to less postoperative pain and faster recovery.
• The surgical plans are customized to each patient’s anatomy through detailed imaging or intraoperative mapping.
• Risks of complications, such as infection or loosening of implants is decreased.

Conclusion

Novel technologies in TKR have improved operation precision, implant fit, and patient outcomes. Patient Specific Instrument can help with specific bone excision and implantation. Individualized knee arthroplasty implants are designed to match each patient’s unique anatomy.

Robotic-Assisted Knee Arthroplasty combines automation and accuracy to eliminate human error in ligament balance. Despite all of their benefits, these technologies have certain limitations, such as high pricing, lengthy learning curves, and reliance on sophisticated imaging and manufacturing. As these technologies grow advanced and accessible, they will play a larger part in future knee arthroplasty. 

Germanten Hospital is equipped with advanced robotic knee replacement technology and highly experienced doctors. For knee replacement surgery, call 9000900937 or visit www.germantenhospitals.com.