Table Of ContentRobotics in Knee
and Hip Arthroplasty
Current Concepts, Techniques
and Emerging Uses
Jess H. Lonner
Editor
123
Robotics in Knee and Hip Arthroplasty
Jess H. Lonner
Editor
Robotics in Knee
and Hip Arthroplasty
Current Concepts, Techniques
and Emerging Uses
Editor
Jess H. Lonner
Department of Orthopaedic Surgery
Rothman Orthopaedic Institute,
Sidney Kimmel Medical College,
Thomas Jefferson University
Philadelphia, PA
USA
ISBN 978-3-030-16592-5 ISBN 978-3-030-16593-2 (eBook)
https://doi.org/10.1007/978-3-030-16593-2
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To the surgeons, engineers, industry leaders, and executives
who have contributed tremendous time and energy to the
advancement of robotic science and technology in surgery and
who recognize that this is just the beginning of a field that will
continue to evolve and expand throughout all aspects of
healthcare.
To my mentors, role models, and former partners – Drs. Paul
Lotke and the late Richard Rothman – who encouraged my
intellectual curiosity in the robotic space.
To our fellows and residents whom I hope will further explore
and develop the field of robotics into the future, in ways that we
are not yet considering.
Most importantly, to my wife, Ami, and our children, Carson
and Jared – my greatest joys in life.
Foreword
In the past few decades, there have been great changes in the science related
to knee and hip replacement surgery. Robotics in Knee and Hip Arthroplasty
is a testament to the newest advances in this ever-emerging process.
When total hips and total knees were first introduced four decades ago, the
acetabular reaming was guided with a drill hole in the bottom of the acetabu-
lum, in the knee the proximal tibial osteotomy was guided with the wide
osteotome placed along the long axis of the tibia, and the femoral osteotomy
was guided with an angular rod slide under the quadriceps muscles. It did not
take long to appreciate that consistent techniques for perfect position and
alignment were essential for the long-term success of a prosthesis.
We can now appreciate the evolutionary changes that have occurred dur-
ing the past few decades. These changes in techniques started with instru-
ments that allowed reproducible acetabular reaming and position, well-placed
femoral neck osteotomies in the hip, as well as accurate tibial and femoral
cuts for a total knee arthroplasty. Over the years, instrument sets have evolved,
creating reasonably reproducible results. Smaller instrumentation for smaller
incisions evolved; there has been a gradual introduction into computer-
assisted surgery; and we now have robotic-assisted surgery. This latest
advancement will allow joint replacement surgeries to achieve a level of con-
sistency and efficiency never even considered a decade ago, let alone when
joint arthroplasties were first introduced.
This text gives the reader a comprehensive synthesis of the state of the art
in robotic hip and knee surgery. It is superbly written and edited. It first out-
lines the history and evolution of robotics in healthcare and hip and knee
arthroplasty. There is a review of the advantages and disadvantages of robot-
ics. The entire second and third sections are devoted to techniques and are a
“how-to” for a variety of different hip and knee robotic applications.
This excellent, up-to-date text will serve as a testament to the emerging
science of robotic surgery: it will be a classic in this field and a guide for the
next generation of arthroplasty surgery.
Paul A. Lotke
Emeritus Professor of Orthopaedic Surgery
University of Pennsylvania School of Medicine
Philadelphia, PA, USA
vii
Preface
While manufacturing and warehousing have enjoyed longer-term use of
robotic technology to enhance their industries, healthcare – and particularly
orthopaedic surgery – has been slower to embrace robotic technologies, until
recently. The field of robotics is now hitting an inflection point in healthcare
in general, as well as arthroplasty and other sectors of orthopaedics in par-
ticular, with tremendous recent growth. When considering the dynamic trends
and attitudes toward robotics in joint arthroplasty, early scepticism was the
norm for nearly a decade when it came to robotics, and other than a relative
handful of us who were innovating in and advocating for robotics, few others
were using robotic methods. When I first began presenting on robotics at
national meetings in 2008, there were many who doubted the need for this
sort of advanced technology. After all, there were decades of reasonable out-
comes after joint arthroplasties performed with conventional tools. Happily,
the past few years have experienced a paradigm shift. A recent informal poll
of the members in attendance at the 2018 annual meeting of the American
Association of Hip and Knee Surgeons found that 30% use robotic assistance
for unicompartmental knee arthroplasty. Additionally, in some regions in the
United States, 30% of hospitals now offer robotic technology for knee or hip
arthroplasty, and some hospitals have several orthopaedic robots in their
operating rooms. Robotic technologies have expanded into their third genera-
tion, and each major company has a robot either in use or in development. As
technologies evolve, efficiencies improve, and costs are better contained, it is
likely that robotic assistance will continue to grow as a surgical tool and
beyond the operating table to improve perioperative processes within our
hospitals.
This text is designed to give a broad descriptive overview of available
robotic technologies, primarily for knee and hip arthroplasty procedures, as
well as spinal surgery. While some are available worldwide, others are emerg-
ing and at various stages of approval by regulatory bodies. By virtue of the
fact that the same technologies may be used for various kinds of procedures,
there may be some redundancy among chapters with regard to system descrip-
tions, but it is intended that each chapter can stand alone. Additionally, a sec-
tion on the emerging field of robotics for hospital process improvement is
included as a window into advances that may become more commonplace in
the next 5–10 years.
While using this text, please recognize that each surgeon contributor is
describing their personal perspective on a particular use of a particular robotic
ix
x Preface
technology or the field of robotics in general. These perspectives may not be
completely shared by the broader robotics community as a whole; subtle dif-
ferences may exist between surgeons’ preferences, protocols, and techniques
based on personal or institutional experiences and philosophies. This text is
geared toward providing the reader with a foundation upon which build their
knowledge base for the current and emerging robotic platforms. Given the
rapid evolution of robotic technologies, I suspect the next edition of this book
will need to be written in the near term.
Philadelphia, PA, USA Jess H. Lonner
Acknowledgement
I am grateful to my colleagues who shared their valuable insight into, and
experiences with, the growing field of robotics for this book and indebted to
each of you for the time you took from your families, orthopaedic practices,
and other endeavours to participate in this project.
I would like to thank the professionals at Springer, but particularly
Kristopher Spring, the visionary editor who saw value in a text on robotics in
orthopaedics, and Margaret Burns, the developmental editor, who kept us on
task and put in countless hours to see this book through to completion.
xi
Contents
Part I B asic Principles
1 A Brief History of Robotics in Surgery . . . . . . . . . . . . . . . . . . . . . 3
Jess H. Lonner and James F. Fraser
2 Evolution of Robotics in Arthroplasty . . . . . . . . . . . . . . . . . . . . . 13
Mark W. Allen and David J. Jacofsky
3 General Concepts in Robotics in Orthopedics . . . . . . . . . . . . . . . 27
Alexander H. Jinnah, T. David Luo, Johannes F. Plate,
and Riyaz H. Jinnah
4 Learning Curve for Robot- and Computer-Assisted
Knee and Hip Arthroplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Jason P. Zlotnicki and Michael J. O’Malley
5 Perioperative Protocols to Facilitate Early Discharge
and Rapid Recovery After Robotic Surgery . . . . . . . . . . . . . . . . . 45
Michael J. Feldstein and Jess H. Lonner
6 Perioperative Pain Management Protocols
for Robotic-Assisted Knee and Hip Arthroplasty . . . . . . . . . . . . 59
Richard Southgate and Derek Ward
7 Cost-Effectiveness Analysis of Robotic Arthroplasty . . . . . . . . . 67
Kevin K. Chen, Kelvin Y. Kim, Jonathan M. Vigdorchik,
Patrick A. Meere, Joseph A. Bosco, and Richard Iorio
8 Risks and Complications of Autonomous
and Semiautonomous Robotics in Joint Arthroplasty . . . . . . . . . 75
Laura J. Kleeblad and Andrew D. Pearle
Part II T echniques: Knee
9 Unicompartmental Knee Arthroplasty Technique: Navio. . . . . . 85
Jess H. Lonner and Christopher P. Bechtel
10 Unicompartmental Knee Arthroplasty Techniques: Mako . . . . . 99
Martin Roche
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