A U G U S T 2 0 1 7 O U T P A T I E N TS U R G E R Y. N E T 2 3
"The use of robotics is becoming a game-changer, and will continue to devel-
op as one, in terms of improving implant placement and surgeon technique,"
says Dr. Harwin.
The robotic arm Dr. Harwin uses eliminates the need for standard instrumen-
tation. He used to place a cutting block on the femur or tibia, secure it with pins
and make the necessary cuts for placing the implant. The block would invari-
ably shift slightly during surgery, so Dr. Harwin would have to reposition it
before re-cutting. The second cuts wasted valuable procedure time and weren't
always as accurate as they could have been.
Robotics eliminates those issues. Dr. Harwin's platform develops an operative
plan based on a pre-op CT scan of the patient's anatomy. Once the robot arm is
registered to anatomical landmarks, it knows where bones are in space and
makes perfect cuts for exact placement of the implant. Haptic feedback pre-
vents him from moving outside of predetermined boundaries of the optimal
operative approach. "Risk of inadvertent cuts to surrounding tissue, ligaments,
tendons, nerves or blood vessels is also virtually eliminated," says Dr. Harwin.
He believes the technology allows for better positioning and sizing of implants
and likely lets surgeons perform proper gap and ligament balancing better than
they could do manually. "But we can't yet say the technology has the ability to
improve outcomes," says Dr. Harwin. "That will be determined over the long
term."
Dr. Kayiaros employs handheld computer navigation. The technology helps
him optimize the alignment and position of the implant, which ultimately leads
to improved long-term function of the prosthesis and better longevity. The sin-
gle-use device, which contains an accelerometer and gyroscope and attaches to
conventional instrumentation, lets Dr. Kayiaros navigate in real time exactly
where to make bone cuts in the femur and tibia, so the implant is aligned exact-
ly with the mechanical axis of the leg.
The subtleties of knee replacement involve how well soft tissue is balanced,
