Robotic Total Knee Replacement
Learn about advanced robotic knee replacement surgery By Dr Daniel Meyerkort – Perth Orthopaedic & Sports Medicine Centre
Is robotic knee replacement better?
Robotic surgery is a surgical aid to allow for accurate knee replacement surgery. The robotic systems available (MAKO / ROSA) are semi autonomous systems, meaning the surgeon is always in control of your surgery. Studies have shown that robotic assistance allows for precise bony cuts to allow accurate implant placement and low levels of soft tissue damage. Modern knee replacement has shown excellent results for improved function and pain relief after surgery. Currently, no high quality studies show that robotic knee replacement is clearly superior to conventional knee replacement surgery in terms of reducing implant failure or leading to superior functional results. This is relatively new technology with robotic assisted knee surgery being widely available in Australia since 2017. Similar to the modern safety features in your car (automatic braking, lane keep assist etc) robotic assisted surgery can be a safety aid to performing accurate surgery.
HOW MUCH DOES ROBOTIC KNEE REPLACEMENT COST?
The robotic system costs the hospital up to 1.5 million dollars. There is no cost passed on to the patient. Dr Meyerkort is a no gap provider for all health funds, meaning that Medicare and your private health insurance will cover the costs of surgery. Out of pocket costs may be charged by the anaesthetist, blood tests and hospital admission excess.
WHAT IS THE RECOVERY TIME FOR ROBOTIC KNEE REPLACEMENT SURGERY?
Most patients spend 3 – 4 days in hospital after robotic knee replacement surgery however if your pain is low and you prefer home this can be achieved earlier! Physiotherapy & muscle strengthening (prehab) before surgery is an excellent idea as it has been shown to reduce pain, length of stay and improve functional outcomes. Patients are fully weight bearing and start range of motion of the knee on the day after surgery. Most patients use crutches for the first 2 – 3 weeks post surgery. By 6 weeks after surgery most patients are returning to ‘normal’ life, work, driving etc. Your best recovery can take up to 12 months after surgery.
WHAT KNEE REPLACEMENT IS THE BEST?
There is no ‘best’ knee replacement as many have excellent long term results. The Australian Joint Replacement Registry captures this data and is is publicly available. You can talk to your surgeon about accessing this information. Dr Meyerkort uses prosthesis with excellent long term results.
IS ROBOTIC TOTAL KNEE REPLACEMENT COVERED BY MEDICARE / PRIVATE HEALTH INSURANCE
The cost of the surgical robot which is up to 1.5 million dollars is covered by Hollywood Private Hospital / SJOG Subiaco. No additional cost is passed on to the patient. Dr Meyerkort is a No Gap provider with all health funds. This means the cost of you knee replacement is covered by Medicare and your private health insurance. Out of pocket costs may be incurred for the anaesthetist, blood tests and hospital admission.
IS ROBOTIC KNEE REPLACEMENT SURGERY MINIMALLY INVASIVE?
Minimally invasive surgery has been trialed for knee replacement. It has lead to increased surgical difficulty and can compromise implant positioning. Robotic knee replacement is not minimally invasive as the knee is still opened as per a conventional knee replacement. Robotic knee replacement can lead to less soft tissue damage due to the haptic protection the robot provides. This allows the robot to cut bone but not soft tissue.
WHY DO DIFFERENT ROBOTIC SYSTEMS EXIST (MAKO / ROSA / NAVIO)
Robotic surgical aids are closed systems, meaning they are limited to the use of the company which supplies the prosthesis. The MAKO robot is for the Stryker Triathlon total knee and the ROSA is for the ZImmer Persona total knee. Each knee replacement has it’s potential advantages. Dr Meyerkort uses the MAKO for partial and total knee replacement and the ROSA for total knee replacement. Hollywood Hospital has access to both surgical robots.
WHAT CAN YOU DO AND NOT DO AFTER ROBOTIC TOTAL KNEE REPLACEMENT?
Physical activity is good after robotic total knee replacement and I encourage you to become physically active post knee replacement. Walking, hiking, swimming, bicycle riding, surfing, snow skiing, tennis and golf are all good activities after knee replacement. It is controversial whether high impact activities will lead to premature implant failure. It is probably safest to avoid high level participation in AFL, soccer, running etc.
DO YOU NEED TO DO PHYSIOTHERAPY AFTER ROBOTIC KNEE REPLACEMENT SURGERY?
Absolutely! Without good physiotherapy you are at risk of a less good result from knee replacement surgery. It is recommend to do Physiotherapy before surgery (prehab) as this has been shown to reduce length of stay, pain and improve functional outcome. Physiotherapy will start day 1 post surgery and the team will help to optimise your recovery