Dr. Richard Illgen on Robotic-Assisted Knee Replacement Surgery

>>The focus today is going to be the
talk about total knee replacement. I’d like to discuss briefly how I used to do it
and how I’m currently doing knee replacement, and then I’d like to discuss
why we made that chance. First, what we do. This is your tibia and this is your femur. This is your leg bone, OK? And in the middle is your knee. To do a knee replacement we have to remove some
bone from the top of your tibia or shin bone and the end of your thigh bone or your femur. I think it’s important to
understand the differences between manual total knee
replacement and robotic total knee. When cases are done manually, a device like this
goes on the leg and then a saw blade, free hand, just in my hand rest on a device like
this and we use regional anatomy. We try and line this up and
use this as a plum line to make a cut that’s perpendicular
to the shin bone. That’s the way the vast majority of knees
in the Unites States are done right now. In order to improve accuracy and reproducibility
we started introducing robotic-assisted surgery. So instead of using plain x-rays
and two-dimensional image, we’re now using a CT scan,
a three-dimensional image. We can plan substantially more
accurately because of that. Better planning coupled with better execution. This is a patient’s knee and
in all the different planes in know exactly what size is going to fit that
patient perfectly, how much deformity they have, whether or not I’m going to
line up the femoral component or thigh piece right, the tibia piece right. And it’s going to be rotated
properly and slopped property. Each of those things have an
important impact and outcome. We then have a patient lying on an
operating room table just like this. We have to put pins into the bone
because I have to educate the computer about where that patient is in space. The computer knows exactly what they look like. I have to teach them where they are in space. In order to do that, we need a reference frame. That’s these pins in the tibia
and these pins in the femur. So patients will have two small poke holes above their knee incision
and blow their knee incision. The reason for that is so that these arrays can
be present such that we can register the patient and tell this computer where
that person is in space. So instead of using your eyeballs or
hands or experience and tools like this, we’re now using a sophisticated robotic-assisted
device to be able to shape the bone. So now, when I want to cut exactly eight
millimeters of bone from the end of the femur, this will literally lock
in to the right position. And will only allow me to remove the
bone I planned on removing as you can see on our three-dimensional plane preoperatively. All the different cuts are now driven by CT
guided robotic-assisted bone preparation instead of using eyes, hands, experience
and two-dimensional images.

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