Technology is emerging and influencing the way in which orthopedic surgeries are planned and performed. Dr Ashwani Maichand, a well-known orthopedist in Delhi, believes that although technology has been applied in this industry for more than 20 years, the field of computer-assisted orthopedic surgery is still in its early days.
The goal of new technology is to develop interactive, patient specific and pre-operative planners to optimize the performance of surgery and the postoperative biological response. Latest technology also develops more precise and less interactive smart tools and sensors to assist in the accurate and precise performance of surgery. Accurate alignment of knee implants is essential for the success of total knee replacement, according to Dr Maichand, who has performed over 4,000 knee and hip replacement surgeries till date.
Although mechanical alignment guides have been designed to improve alignment accuracy, there are several fundamental limitations of this technology that will inhibit additional improvements. Various computer-assisted techniques have been developed to examine the potential to install knee implants more accurately and consistently. Computer-integrated instrumentation incorporates highly accurate measurement devices to locate joint centers, track surgical tools and align prosthetic components suggests Dr Ashwani Maichand.
Image-guided knee replacement provides a three-dimensional (3D) preoperative plan that guides the placement of cutting blocks and prosthetic components. Robotic-assisted knee replacement allows one to machine bones accurately without usingthe standard cutting blocks.The alignment and angles are calculated before surgery, and saved in the system memory that saves precious time said Dr Maichand.
How it works
A desktop computer-controlled milling device is used as a 3D printer to restore the bone intra-operatively in a structural way. It is done by adjusting the position of the customized contact faces of the template until the exact location is found. According to Dr Maichand, who is trained in minimally-invasive joint replacement surgery procedure, no additional computerized equipment or time is needed during the surgery.
The use of robotic technology will enable a patient-specific approach to implant design and surgery in the future, and someday could enable the creation of custom orthopedic implants. It has the added advantage of riding the operating room of manufacturer-specific instrumentation and the potential to eliminate bulky, heavy pans and instruments as well as the central supply sterilization nightmares.
Dr Maichand believes that computer-assisted knee replacement surgery is better than the conventional surgery as all the bone cuts are displayed on monitor in real time. He further says that the substantial amount of personnel time and manufacturer overhead is involved in creating and sterilizing the instruments to implant arthroplasty components during knee surgery. When these costs are negated, the cost basis for the robotic technology become apparent.
The disadvantages of utilizing the robotic-assisted surgery include:
- A steep learning curve and significant up-front costs
- The need for an additional personnel in the operating room
- The cost of robotic computer-assisted knee replacement, in addition to original surgery package is Rs 30,000-50,000.
Earlier, the systems required lot of time to configure. There used to be a screen in OT corner, which received signals from the OT table. Now new systems are smaller and disposable. Dr Ashwani Maichand says that there is no need to keep a screen as it works by audio signals, which means surgeons no longer need to divert their attention from OT table. The latest system is disposable (single use) hence no chance of infection.