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Robotic-assisted joint replacement

ROBOTIC-ASSISTED JOINT REPLACEMENT

Is Robotic-Assisted Joint Replacement Right for You?

The idea of a robot performing surgery may seem like something from a science fiction film, but robots are an increasingly common sight in surgical suites. When it comes to certain types of joint replacement surgeries, robots can help improve accuracy — which can mean better outcomes for patients. If you’re facing surgery, you might be wondering if robotic-assisted surgery is appropriate for only certain patients. If you’re a good candidate for joint replacement surgery in general, robotic joint replacement is likely for you. Surgeons currently are using robotic technology for partial knee replacements, full knee replacements and hip replacements.

How robotic-assisted surgery works

Prior to surgery, a CT scan of your hip joint is taken in order to generate a 3D virtual model of your unique anatomy. The 3D model helps your doctor see things he or she can’t typically see with an x-ray alone. This additional information helps your doctor determine the optimal size, placement and positioning of your implant. The robots don’t operate on their own, of course. What they’re actually doing is helping surgeons do their jobs more precisely. Dr. Calendine completes Robotic-Assisted Total Hip Replacement using the MAKOplasty Robotic Arm. Throughout your procedure, the Mako robotic arm provides real-time data to your surgeon. This allows them to continuously assess the movement and tension of your new joint, and adjust your surgical plan if desired. In the operating room, your surgeon guides Mako’s robotic arm to remove the arthritic bone and cartilage from the hip. A virtual boundary provides tactile resistance to help the surgeon stay within the boundaries defined in your surgical plan. As the surgeon prepares to place the implant into its final position, the robotic-arm guides the implant at the desired angle defined in the surgical plan. This helps ensure the placement and alignment of the implant are performed according to plan.
Mako robotic hip replacement
If you’re one of the millions of Americans suffering from pain caused by arthritis or an injury to the hip or knee, and you haven’t experienced adequate relief with conservative treatment options, Mako Robotic-Arm Assisted Surgery might be right for you. Source: https://patients.stryker.com/hip-replacement/options/mako-robotic-arm-assisted

advantages of robotic-assisted joint replacement

Robotic-assisted surgery has the potential to speed recovery compared to standard procedures, according to Dr. Robert Molloy, Orthopedic Surgeon at Cleveland Clinic Foundation. It also allows a more customized, individually tailored approach. “What the robot allows us to do is to take into account the patient’s own anatomy, their soft tissue structure, and customize the surgery for them,...with the ability to customize joint replacement surgeries for each patient’s individual anatomy, robotic-assisted procedures offer hope for more successful hip and knee replacements." Dr. Molloy says.

The precision of robotic-assisted surgery allows for: More accurate implant positioning, which can result in a more natural feeling after surgery; Improved safety and reduced risk of injury to adjacent tissues; Small incisions; and the potential for better long-term function. In clinical studies, Mako Robotic-Assisted surgery resulted in: More accurate placement and alignment of hip implants based on the surgical plan, Less likelihood of hip dislocation, Reduced blood loss, Replication of the feeling of a natural hip, and Preservation of healthy bone. (Source: https://patients.stryker.com/hip-replacement/options/mako-robotic-arm-assisted)
Robotic-arm assisted hip replacement surgery

Is Mako an option for me?

Mako robotic-assisted joint replacement is for people with: Severe joint pain or stiffness resulting from: noninflammatory degenerative joint disease (including osteoarthritis, traumatic arthritis, or avascular necrosis), rheumatoid arthritis or post-traumatic arthritis. Those who haven’t experienced adequate relief with conservative treatment options, like bracing, medication or joint fluid supplements should speak to a board-certified, experienced surgeon about Mako robotic-assisted joint replacement.

mako robotic total hip replacement by stryker

The surgical procedure takes a few hours. Your orthopedic surgeon will remove the damaged cartilage and bone and then position new metal, plastic, or ceramic implants to restore the alignment and function of your hip. 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. You will likely stay in the hospital for one to three  days depending on your rehabilitation protocol and how fast you progress with physical therapy. This is highly dependent upon your condition before surgery, your age, and medical problems which can influence your rehabilitation. A safe discharge plan will be arranged for you by the orthopedic team.

joint replacement recovery

The success of your surgery will depend in large measure on how well you follow your orthopedic surgeon's instructions regarding home care during the first few weeks after surgery. You may have stitches or staples running along your wound or a suture beneath your skin. The stitches or staples will be removed approximately 2 weeks after surgery.Avoid getting the wound wet until it has thoroughly sealed and dried. You may continue to bandage the wound to prevent irritation from clothing or support stockings. Some loss of appetite is common for several weeks after surgery. A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength. Be sure to drink plenty of fluids. The majority of people who undergo total hip replacement are able to participate in a majority of their daily activities by six weeks. By three months, most people have regained much the endurance and strength lost around the time of surgery, and can participate in daily activities without restriction. While daily activities have resumed, it is important to avoid high impact activities to give you the best long-term outcome with your hip.
Most surgeons and hospitals today emphasize getting you out of bed quickly. Most people are walking with the assistance of a walker on the day after surgery. Early ambulation has been shown to reduce the risk of a post-operative blood clot and is an important part of your recovery. Progression to using a cane or nothing at all typically occurs within the first month or two after surgery and depends on each individual’s progress. Despite the rapid progression to moving without assistance, it is typically not recommended that you return to sporting activities until the third month after surgery. Most surgeons allow patients to drive at four to six weeks after surgery, and sometimes sooner if the operative leg is the left leg. There is some literature that states that your reaction time will not be back to normal prior to six weeks. You should not drive while on narcotics, and should discuss returning to driving with your operating surgeon. Returning to work is highly dependent on your general health, activity level and demands of your job. If you have a sedentary job, such as computer work, you can expect to return to work in four to six weeks. If you have a more demanding job that requires lifting, walking, or travel, you may need up to three months for full recovery.

physical therapy and recovery following joint replacement

Initially, you will receive some physical therapy while in the hospital. Depending on your preoperative conditioning and support, you may or may not need additional therapy as an outpatient. Much of the therapy after hip replacement is walking with general stretching and thigh muscle strengthening, which you can do on your own without the assistance of a physical therapist. To assure proper recovery and prevent dislocation of the prosthesis, you may be asked to take special precautions when sitting, bending, or sleeping — usually for the first 6 weeks after surgery. These precautions will vary from patient to patient, depending on the surgical approach your surgeon used to perform your joint replacement.Prior to discharge from the hospital, your surgeon and physical therapist will provide you with any specific precautions you should follow.

To assure proper recovery and prevent dislocation of the prosthesis, you may be asked to take special precautions when sitting, bending, or sleeping — usually for the first 6 weeks after surgery. These precautions will vary from patient to patient, depending on the surgical approach your surgeon used to perform your hip replacement. Prior to discharge from the hospital, your surgeon and physical therapist will provide you with any specific precautions you should follow.

You may feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending. These differences often diminish with time, and most patients find these are minor compared with the pain and limited function they experienced prior to surgery.Your new hip may activate metal detectors required for security in airports and some buildings. Tell the security agent about your joint replacement if the alarm is activated. You may ask your orthopedic surgeon for a card confirming that you have an artificial joint.

follow-up and precautions following joint replacement

A fall during the first few weeks after surgery can damage your new joint and may result in a need for more surgery. Stairs are a particular hazard until your hip is strong and mobile. You should use a cane, crutches, a walker, or handrails or have someone help you until you improve your balance, flexibility, and strength.Your orthopedic surgeon and physical therapist will help you decide which assistive aides will be required following surgery, and when those aides can safely be discontinued.

It is important to follow up with your surgeon after your joint replacement. In most cases, joint replacements last for many years. You need to meet with your treating doctor after surgery to ensure that your replacement is continuing to function well. In some cases, the replaced parts can start to wear out or loosen.The frequency of required follow up visits is dependent on many factors including the age of the patient, the demand levels placed on the joint, and the type of replacement. Your physician will consider all these factors and tailor a follow-up schedule to meet your needs.In general seeing your surgeon every three to five years is recommended.
Source: American Academy of Orthopaedic Surgeons, https://orthoinfo.aaos.org/; American Association of Hip and Knee Surgeons, https://hipknee.aahks.org/total-hip-replacement/; Cleveland Clinic Foundation, https://health.clevelandclinic.org/; Stryker, https://patients.stryker.com/hip-replacement/options/mako-robotic-arm-assisted
Cory Calendine, MD is an Orthopedic Surgeon and founding partner of the Bone and Joint Institute of Tennessee at Williamson County Hospital in Franklin, TN. Dr. Calendine is an expert in Joint Replacement, specializing in Hip and Knee Surgery. From diagnosis through treatment, the Orthopedic Surgical experts at the Bone and Joint Institute use the latest techniques and technology to improve care for people with musculoskeletal problems. For more information, please contact our office or schedule your appointment today.  
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