This document discusses knee osteoarthritis, its causes, symptoms, and treatment options including surgery. Some key points:
- Osteoarthritis is the most common type of arthritis, affecting the knee joint in many older adults. Risk factors include age, weight, heredity, injury, and repetitive stress.
- Symptoms include knee pain that worsens with activity, swelling, stiffness, decreased mobility, and creaking sounds.
- Treatment begins with lifestyle changes like weight loss and exercise. Medications may provide pain relief. Surgery options include arthroscopy to repair damaged tissues or total knee replacement for severe cases.
- Robotic-assisted knee replacement uses imaging and computer planning for precise bone cuts
1. Future of
Arthroplasty
Dr Dibya Singha
MBBS,MS(Ortho),FKS,FJRS,FHAAS,FOT(P
&A)
Consultant Joint Replacement
Utkal Hospital, Bhubaneswar
2. Introduction
• Age is a major risk factor for osteoarthritis of
the knee but young people can get it, too.
• For some individuals, it may be hereditary.
For others, osteoarthritis of the knee can
result from injury or infection or even from
being overweight.
3.
4. Who Gets
Osteoarthritis of the
Knee?
• Osteoarthritis is the most common type of
arthritis. While it can occur even in young
people, the chance of developing
osteoarthritis rises after age 45.
• According to the Arthritis Foundation,
almost all affected with OA at the age of
70, with the knee being one of the most
commonly affected areas.
• Women are more likely to have
osteoarthritis than men.
5. What Causes Knee Osteoarthritis?
• The most common cause of osteoarthritis of the knee is “AGE”.
• Almost everyone will eventually develop some degree of
osteoarthritis.
6.
7. • Age. The ability of cartilage to heal decreases as a
person gets older.
• Weight. Weight increases pressure on all the joints,
especially the knees. Every Kilogram of weight you gain
adds 2 to 3 KGs of extra weight on your knees.
• Heredity. Genetic mutations that might make a person
more likely to develop osteoarthritis of the knee. It
may also be due to inherited abnormalities in the
shape of the bones that surround the knee joint.
• Gender. Women ages 55 and older are more likely than
men to develop osteoarthritis of the knee.
Who Gets
Osteoarthritis
of the Knee?
8. Who Gets Osteoarthritis of the Knee?
• Repetitive stress injuries. People with certain occupations that
include a lot of activity that can stress the joint, such as kneeling,
squatting, or lifting heavy weights (40 KGs or more), are more likely to
develop osteoarthritis of the knee because of the constant pressure
on the joint.
• Athletics. Athletes involved in soccer, tennis, or long-distance running
may be at higher risk for developing osteoarthritis of the knee.
• Other illnesses. People with rheumatoid arthritis are also more likely
to develop osteoarthritis. People with certain metabolic disorders,
such as iron overload or excess growth hormone, also run a higher
risk of osteoarthritis.
9. What Are the
Symptoms of
Knee
Osteoarthritis?
1. Pain that increases with activity, but gets a
little better with rest
2. Swelling
3. warmth in the joint
4. stiffness in the knee, especially in the
morning or when you have been sitting for a
while
5. decrease in mobility of the knee, making it
difficult to get in and out of chairs or cars, use
the stairs, or walk
6. creaking, crackly sound that is heard when
the knee moves
10. What Are the
Symptoms of
Knee
Osteoarthritis?
1. Pain that increases with activity, but gets a
little better with rest
2. Swelling
3. warmth in the joint
4. stiffness in the knee, especially in the
morning or when you have been sitting for a
while
5. decrease in mobility of the knee, making it
difficult to get in and out of chairs or cars, use
the stairs, or walk
6. creaking, crackly sound that is heard when
the knee moves
11. How Is
Osteoarthritis of
the Knee Treated?
• Weight loss.
• Exercise. Strengthening the muscles around the
knee makes the joint more stable and decreases
pain
• Pain relievers and anti-inflammatory drugs.
• Injections of hyaluronic acid into the knee.
Hyaluronic acid is normally present in joints as a
type of lubricating fluid.
• Using devices such as braces.
• Physical and occupational therapy. Occupational
therapists teach you ways to perform regular, daily
activities, such as housework, with less pain.
• Surgery. When other treatments don't work,
surgery is a good option.
12. Is Surgery Used
to Treat Knee
Osteoarthritis?
Arthroscopy uses a small telescope (arthroscope)
and other small instruments. The surgery is
performed through small incisions. We uses the
arthroscope to see into the joint space.
Once there, we can remove damaged cartilage or
loose particles, clean the bone surface, and repair
other types of tissue if those damages are
discovered.
The procedure is often used on younger patients (
ages 55 and younger).
13.
14.
15. Is Surgery Used to Treat Knee
Osteoarthritis?
• Joint replacement surgery, or arthroplasty, is a surgical procedure in
which joints are replaced with artificial parts made from metals or
plastic.
• The replacement could involve one side of the knee or the entire
knee. Joint replacement surgery is usually reserved for people over
age 50 with severe osteoarthritis.
• Most new joints will last over 20 years. The results are generally
very good.
16. Anaesthesia
• Upon arrival at the hospital or surgery center, you
will be evaluated by a member of the anesthesia
team.
• The most common types of anesthesia are general
anesthesia (you are put to sleep) or spinal, epidural,
or regional nerve block anesthesia (you are awake
but your body is numb from the waist down).
• The anesthesia team, with your input, will determine
which type of anesthesia will be best for you.
17. Procedure
• The surgical procedure usually takes from 1 to 2 hours.
Your orthopaedic surgeon will remove the damaged
cartilage and bone, and then position the new metal and
plastic implants to restore the alignment and function of
your knee.
• After surgery, you will be moved to the recovery room,
where you will remain for several hours while your
recovery from anesthesia is monitored. After you wake up,
you will be taken to your hospital room and physiotherapy
doctor will assist you to walk after 3 hours of surgery.
18. Your Hospital Stay
• If you are admitted to the
hospital, you will most likely stay
from one to three days.
19. Pain Management
• After surgery, you will feel some pain. This is a natural part of
the healing process. Your doctor and nurses will work to reduce
your pain, which can help you recover from surgery faster.
• Medications are often prescribed for short-term pain relief after
surgery. Many types of medicines are available to help manage
pain, including opioids, nonsteroidal anti-inflammatory drugs
(NSAIDs), acetaminophen, and local anesthetics. Your doctor
may use a combination of these medications to improve pain
relief, as well as minimize the need for opioids.
20. Blood Clot
Prevention
• Your orthopaedic surgeon may prescribe one
or more measures to prevent blood clots
and decrease leg swelling. These may
include special support hose, inflatable leg
coverings (compression boots), and blood
thinners.
• Foot and ankle movement is also
encouraged immediately following surgery
to increase blood flow in your leg muscles to
help prevent leg swelling and blood clots.
21. Physical
Therapy
• Most patients can begin exercising their
knee hours after surgery. A physical therapist
will teach you specific exercises to
strengthen your leg and restore knee
movement to allow walking and other
normal daily activities soon after your
surgery.
22. • A robotic knee replacement
is similar to a traditional
knee replacement. The
surgeon removes damaged
tissue in your knee and
replaces it with an artificial
joint. The difference is that
it's done with assistance from
a robotic arm or handheld
robotic device (depending on
the robotic system used for
your surgery).
24. Robotic systems
Autonomous
• Surgeon performs approach, then
sets up the machine and engages the
robot
• Robot works by itself
Haptic (tactile)
• Surgeon drives the robot's arms
• Constant input from surgeon
25. Difference in systems
Robotic system
Preoperative
imaging
Kinematics Planning Function Applications
MAKO CT scan Yes Yes
Robotic arm: saw,
reamer
THA, Uni, TKA
NAVIO None Yes No
Navigated
reamer
Uni, TKA
ROSA Standard X-rays Yes Yes
Robotic arm:
cutting guide
TKA
CUVIS CT SCAN YES YES
Robotic Burr-
automatic
TKA,Uni
VELYS Standard X-Ray Yes NO Robotic arm:Saw TKA
THA: total hip arthroplasty, Uni: unicompartmental knee arthroplasty, TKA: total knee arthroplasty.
26. Classification
• Passive systems consist of an
articulated arm that holds an
instrument moved manually by
the surgeon, with the instrument's
position being recognized by the
navigation system. They do not
directly participate in carrying out
the procedure, which remains
completely under the surgeon's
control.
27. Classification
• Active systems are robots that
use preoperative and
intraoperative planning data to
perform multiplanar surgical
manipulations autonomously
(without the surgeon's
participation).
28. Classification
• Interactive systems are robots that require
an interaction between the robot and the
surgeon who constrains the robot. There are
two types of strategies in this group: semi-
active and synergistic systems. In semi-active
systems, this mechanical constraint can be
summarized as a movement without
feedback to the surgeon. Conversely, for
synergistic systems, the mechanical
constraints are programmable: these newer
systems are based on the principle of haptic
models (i.e. information feedback) with the
robot generating forces where the
amplitude and frequency reproduce true
sensations (touch, vision).
30. Complications
Complications
of the robotic
system were
Pin-hole fracture,
Pin-related infection,
Iatrogenic soft tissue and bony injury.
Downsides were longer operative duration
Higher intraoperative cost
Learning curve and aborting a robotic TKA due to different reasons
31. Mako Robotics
• The Mako process starts with a CT scan of your leg. Capturing the whole limb allows us to
view the anatomical alignment of your hip, knee
• The scan takes x-ray images of your leg from multiple angles. We use the data from these
images to generate a 3D virtual model of your knee. This is loaded into the Stryker Mako
system to create a bespoke surgical plan for your joint, from the optimal implant size to
the best angles for surgery.
• On the day of the operation, a trained specialist joins the surgical team to run through
the procedure plan, help the team prepare the Mako in theatre, and supervise it during
the operation.
• Surgeon uses the robotic arm to remove defective bone from the knee, within the
boundaries set out in the plan.
• The surgeon stays in control of the procedure, but the Mako uses real-time feedback to
guide their movements and prevent them from straying outside the boundaries (the saw
actually cuts out if the surgeon tries to do this). This builds precision into the process and
helps preserve the optimal amount of healthy tissue.
