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CUSTOM SURGERY

Knee Robotic Surgery

Before considering the surgical intervention of personalized knee prostheses, it is necessary to open a discussion on the most recent and innovative techniques developed in surgery thanks to the use of robotics. Robotic surgery allows extreme customization of the surgical procedure, which is based on the characteristics of each patient. With robotic surgery, there is greater precision in positioning the components and a drastic reduction in positioning errors of the knee prosthesis which results in a greater chance of success of the surgery and the saving of healthy bone and surrounding soft tissues. The positioning of prosthetic implants with greater accuracy and high precision results in better limb alignment and ligament balance, which translates into longer implant life and patient satisfaction. The robotic system allows the implantation of both total prostheses, medial and lateral unicompartmental prostheses, and patellofemoral prostheses.

ROBOTIC SURGERY

Total Knee Replacement surgery

Description of the surgery

A surgical incision is made on the knee in a total knee replacement surgery (TKR), while sensors for robotic navigation are applied to the leg and thigh. The surgeon records the ligaments’ tension by applying forces to the knee, along with a range of flexion and extension motion. Based on a three-dimensional reconstruction (3D) and a kinematic study of the knee, the prosthesis is positioned: the robot intervenes in the execution of the femoral and tibial cuts, allowing optimal positioning with a margin of error of less than 0.5 mm.

The surgery is performed, if possible, under spinal anesthesia, which limits bleeding and facilitates postoperative recovery.

Classification

Invasive

Duration of the surgery: approximately 2 hours.
What to do after surgery – postoperative care

The patient can get up and walk as early as 4 hours after surgery, following the Fast Track protocol; the hospital stay is about 2-5 days. In the initial stages of recovery, two crutches are used to facilitate walking, then a single crutch or a walking cane is used, and soon after, the patient will be able to walk independently.

In the weeks following the surgery, physiotherapy is essential to obtain a better result, combined with the intake of painkillers to control pain and perform rehabilitation exercises correctly. Daily activities are possible after 3-6 weeks with a complete reduction in pain after the first 6-12 weeks. Normal functions return within three months.

SEVERE OSTEOARTHRITIS ON THE RIGHT KNEE

ROBOTIC TKR ON THE RIGHT KNEE

ROBOTIC SURGERY

Total Knee Replacement surgery

SEVERE OSTEOARTHRITIS ON THE RIGHT KNEE

ROBOTIC TKR ON THE RIGHT KNEE

Description of the surgery

A surgical incision is made on the knee in a total knee replacement surgery (TKR), while sensors for robotic navigation are applied to the leg and thigh. The surgeon records the ligaments’ tension by applying forces to the knee, along with a range of flexion and extension motion. Based on a three-dimensional reconstruction (3D) and a kinematic study of the knee, the prosthesis is positioned: the robot intervenes in the execution of the femoral and tibial cuts, allowing optimal positioning with a margin of error of less than 0.5 mm.

The surgery is performed, if possible, under spinal anesthesia, which limits bleeding and facilitates postoperative recovery.

Classification

Invasive

Duration of the surgery: approximately 2 hours.
What to do after surgery – postoperative care

The patient can get up and walk as early as 4 hours after surgery, following the Fast Track protocol; the hospital stay is about 2-5 days. In the initial stages of recovery, two crutches are used to facilitate walking, then a single crutch or a walking cane is used, and soon after, the patient will be able to walk independently.

In the weeks following the surgery, physiotherapy is essential to obtain a better result, combined with the intake of painkillers to control pain and perform rehabilitation exercises correctly. Daily activities are possible after 3-6 weeks with a complete reduction in pain after the first 6-12 weeks. Normal functions return within three months.

MEDIAL ARTHROSIS

PARTIAL PROSTHESIS

ROBOTIC SURGERY

Partial knee replacement surgery: the unicompartmental arthroplasty

Unicompartmental knee replacement surgery is a procedure where the knee replacement is partial — in most cases at the medial compartment and much rarer at the lateral and the patellofemoral joint. This type of surgery is recommended when osteoarthritis is localized in only one compartment of the knee and the rest are in good condition. The operation is aimed at resolving the pain and restoring knee function for many years.

Description of the surgery

The positioning of the unicompartmental prosthesis occurs under spinal anesthesia, using a robotic system that allows the surgeon to position the prosthetic components in a precise and optimal manner, respecting the patient’s anatomy and ligament tension. The goal is to restore the knee to a pre-arthritic mobility condition and function.

The surgeon makes a longitudinal incision of about 8-12 cm at the center of the knee. The automated program is prepared and set up on the patient to create a three-dimensional (3D) reconstruction of the knee. At this point, the surgeon positions the components with high accuracy and a margin of error of less than one millimetre. After making the bone cuts, the prosthetic parts are inserted. Compared to Total Knee Arthroplasty, the Unicompartmental prosthesis requires a smaller (minimally invasive) surgical incision, therefore the patient benefits from less blood loss, less pain, and faster recovery.

Classification

Invasive

Duration of the surgery: from 1 to 2 hours
What to do after surgery – postoperative care

The patient can get up and walk as early as 4 hours after surgery, following the Fast Track protocol; the hospital stay is about 2-4 days. In the initial stages of recovery, two crutches are used to facilitate walking, then a single crutch or a walking cane is used, and soon after, the patient will be able to walk independently.

In the weeks following the surgery, physiotherapy is essential to obtain a better result, combined with the intake of painkillers to control pain and perform rehabilitation exercises correctly. Daily activities are possible after 3-6 weeks with a complete reduction in pain after the first 6-12 weeks. Normal functions return within three months.

ROBOTIC SURGERY

Partial knee replacement surgery: the unicompartmental arthroplasty

LATERAL VIEW

AP VIEW

Unicompartmental knee replacement surgery is a procedure where the knee replacement is partial — in most cases at the medial compartment and much rarer at the lateral and the patellofemoral joint. This type of surgery is recommended when osteoarthritis is localized in only one compartment of the knee and the rest are in good condition. The operation is aimed at resolving the pain and restoring knee function for many years.

Description of the surgery

The positioning of the unicompartmental prosthesis occurs under spinal anesthesia, using a robotic system that allows the surgeon to position the prosthetic components in a precise and optimal manner, respecting the patient’s anatomy and ligament tension. The goal is to restore the knee to a pre-arthritic mobility condition and function.

The surgeon makes a longitudinal incision of about 8-12 cm at the center of the knee. The automated program is prepared and set up on the patient to create a three-dimensional (3D) reconstruction of the knee. At this point, the surgeon positions the components with high accuracy and a margin of error of less than one millimetre. After making the bone cuts, the prosthetic parts are inserted. Compared to Total Knee Arthroplasty, the Unicompartmental prosthesis requires a smaller (minimally invasive) surgical incision, therefore the patient benefits from less blood loss, less pain, and faster recovery.

Classification

Invasive

Duration of the surgery: from 1 to 2 hours
What to do after surgery – postoperative care

The patient can get up and walk as early as 4 hours after surgery, following the Fast Track protocol; the hospital stay is about 2-4 days. In the initial stages of recovery, two crutches are used to facilitate walking, then a single crutch or a walking cane is used, and soon after, the patient will be able to walk independently.

In the weeks following the surgery, physiotherapy is essential to obtain a better result, combined with the intake of painkillers to control pain and perform rehabilitation exercises correctly. Daily activities are possible after 3-6 weeks with a complete reduction in pain after the first 6-12 weeks. Normal functions return within three months.

ROBOTIC SURGERY

Partial knee replacement surgery: The patellofemoral prosthesis

Description of the surgery

In rare cases, osteoarthritis can form in the anterior compartment of the knee. When it occurs in an advanced form, a partial prosthesis of the femur’s anterior part (trochlea, or the groove where the kneecap sits) and the patella (kneecap) is recommended.

The surgery, performed under spinal or general anaesthesia, uses robotic technology to accurately position the femoral component, according to the patient’s anatomy.

The surgeon makes a 10 cm longitudinal anterior knee incision, while the computerized system is set up and maps the patient’s knee, reconstructing it three-dimensionally (3D) in real-time. The surgeon then positions the femoral component, which is anchored to the bone with cement. Only the worn bone and cartilage are removed. The patella is a prosthetic with a plastic button. The tissues are sutured in anatomical planes. The protocol calls for periarticular injection (PAI) of regional analgesia and other drugs to decrease postoperative pain and decrease blood loss.

Classification

Invasive

Duration of the surgery: about 1 hour 30 minutes
What to do after surgery – postoperative care

After surgery, the limb is bandaged and the patient is then transferred to the ward where the postoperative Fast Track protocol begins, including radiography control and rehabilitation. The patient is discharged 2-5 days after surgery. The rehabilitation protocol uses dedicated devices such as Kinetec and the assistance of physiotherapists for gait training. Walking is initially aided with two crutches and within a couple of weeks, the patient will just need a single crutch or a walking cane to walk. Soon after he/she is able to walk without any support. The use of analgesics to control pain is recommended.

PRE-OPERATION

POST-OPERATION

ROBOTIC SURGERY

Partial knee replacement surgery: The patellofemoral prosthesis

PRE-OPERATION

POST-OPERATION

Description of the surgery

In rare cases, osteoarthritis can form in the anterior compartment of the knee. When it occurs in an advanced form, a partial prosthesis of the femur’s anterior part (trochlea, or the groove where the kneecap sits) and the patella (kneecap) is recommended.

The surgery, performed under spinal or general anaesthesia, uses robotic technology to accurately position the femoral component, according to the patient’s anatomy.

The surgeon makes a 10 cm longitudinal anterior knee incision, while the computerized system is set up and maps the patient’s knee, reconstructing it three-dimensionally (3D) in real-time. The surgeon then positions the femoral component, which is anchored to the bone with cement. Only the worn bone and cartilage are removed. The patella is a prosthetic with a plastic button. The tissues are sutured in anatomical planes. The protocol calls for periarticular injection (PAI) of regional analgesia and other drugs to decrease postoperative pain and decrease blood loss.

Classification

Invasive

Duration of the surgery: about 1 hour 30 minutes
What to do after surgery – postoperative care

After surgery, the limb is bandaged and the patient is then transferred to the ward where the postoperative Fast Track protocol begins, including radiography control and rehabilitation. The patient is discharged 2-5 days after surgery. The rehabilitation protocol uses dedicated devices such as Kinetec and the assistance of physiotherapists for gait training. Walking is initially aided with two crutches and within a couple of weeks, the patient will just need a single crutch or a walking cane to walk. Soon after he/she is able to walk without any support. The use of analgesics to control pain is recommended.

CHIRURGIA CON NAVIGAZIONE COMPUTERIZZATA

Protesi totale di ginocchio con tecnica di navigazione computerizzata

L’intervento visto da vicino

L’intervento di protesi totale con navigazione computerizzata viene eseguito in anestesia spinale o generale. Il chirurgo esegue una incisione longitudinale al centro del ginocchio e vengono posizionati dei sensori a livello del femore e della tibia. Dopo il set-up del sistema robotizzato si esegue la mappatura delle superfici articolari del femore e della tibia per ottenere una ricostruzione tridimensionale.

Durante l’intervento viene rimossa la cartilagine e l’osso danneggiato dal femore, dalla tibia e dalla rotula che sono sostituiti con una protesi artificiale in lega di metallo, fissate con il cemento. Un inserto in materiale plastico (polietilene) viene posizionata tra la tibia e il femore e il sistema robotizzato mostra al chirurgo in tempo reale tutti i parametri e dati per ottenere un risultato di elevata precisione. La rotula viene sostituita con un bottone sempre in materiale plastico. Al termine della procedura, i sensori vengono rimossi, i tessuti e la cute vengono suturati per piani anatomici.

Classificazione

Invasivo

Durata dell’intervento: 2 ore circa.
Cosa fare dopo l’intervento – il decorso post-operatorio

Il paziente è in grado di alzarsi e di camminare già a 4 ore dall’intervento, seguendo il protocollo Fast-track*, e la degenza ha una durata di  2-5 giorni. Nelle fasi iniziali della ripresa si utilizzano due stampelle per facilitare la camminata, quindi una stampella sola o un bastone per poi tornare a camminare in autonomia nell’arco di poco tempo. 

Nelle settimane successive all’intervento, la fisioterapia è fondamentale per ottenere un miglior risultato, da combinare con l’assunzione di antidolorifici per controllare il dolore e poter eseguire in maniera corretta gli esercizi riabilitativi. 

Le attività del quotidiano si recuperano in 3-6 settimane di tempo, con una riduzione completa del dolore dopo le prime 6-12 settimane. Si torna a una buona buona funzionalità in tre mesi, ma per un recupero ottimale sono necessari 12-18 mesi.

CHIRURGIA CON NAVIGAZIONE COMPUTERIZZATA

Protesi totale di ginocchio con tecnica di navigazione computerizzata

L’intervento visto da vicino

L’intervento di protesi totale con navigazione computerizzata viene eseguito in anestesia spinale o generale. Il chirurgo esegue una incisione longitudinale al centro del ginocchio e vengono posizionati dei sensori a livello del femore e della tibia. Dopo il set-up del sistema robotizzato si esegue la mappatura delle superfici articolari del femore e della tibia per ottenere una ricostruzione tridimensionale.

Durante l’intervento viene rimossa la cartilagine e l’osso danneggiato dal femore, dalla tibia e dalla rotula che sono sostituiti con una protesi artificiale in lega di metallo, fissate con il cemento. Un inserto in materiale plastico (polietilene) viene posizionata tra la tibia e il femore e il sistema robotizzato mostra al chirurgo in tempo reale tutti i parametri e dati per ottenere un risultato di elevata precisione. La rotula viene sostituita con un bottone sempre in materiale plastico. Al termine della procedura, i sensori vengono rimossi, i tessuti e la cute vengono suturati per piani anatomici.

Classificazione

Invasivo

Durata dell’intervento: 2 ore circa.
Cosa fare dopo l’intervento – il decorso post-operatorio

Il paziente è in grado di alzarsi e di camminare già a 4 ore dall’intervento, seguendo il protocollo Fast-track*, e la degenza ha una durata di  2-5 giorni. Nelle fasi iniziali della ripresa si utilizzano due stampelle per facilitare la camminata, quindi una stampella sola o un bastone per poi tornare a camminare in autonomia nell’arco di poco tempo. 

Nelle settimane successive all’intervento, la fisioterapia è fondamentale per ottenere un miglior risultato, da combinare con l’assunzione di antidolorifici per controllare il dolore e poter eseguire in maniera corretta gli esercizi riabilitativi. 

Le attività del quotidiano si recuperano in 3-6 settimane di tempo, con una riduzione completa del dolore dopo le prime 6-12 settimane. Si torna a una buona buona funzionalità in tre mesi, ma per un recupero ottimale sono necessari 12-18 mesi.

Timeline

For knee arthroplasty

1. First visit

Based on a thorough clinical evaluation of the patient and radiological data, the patient is advised if surgery is recommended. If further tests are necessary, a second visit is scheduled.

2. If surgery is needed

The patient is informed about the type of surgery required and the hospitalization period. Upon agreement, the patient is added to the waiting list and will be contacted by the hospital clerk.

3. Eve of surgery

The patient is hospitalized and has to bring personal belongings such as undergarments, pyjamas, etc.

They have to fast from midnight.

4. Surgery day

The patient is accompanied to the operating room where and put under anaesthesia before surgery is performed. At the end of surgery, he/she is kept under observation for some time in the recovery room before being transferred to the ward. Thereafter, the Fast Track protocol begins.

5. Hospitalization

In average, hospitalization lasts 3 to 5 days. In most cases, the patient can be discharged to their own home. In some specific cases, the patient is sent to a rehabilitation centre for additional therapy.

6. After discharge

Physiotherapy should be continued as indicated in the ward. The patient will need to use crutches and go through prophylaxis for deep vein thrombosis (DVT) for 35 days.

7. Follow-up visits

7-10 days after discharge:
first medications

20 days post-surgery:
removal of sutures

6 weeks post-surgery:
checkup and x-rays

8. Further check-ups

3 months post-surgery:
checkup and x-ray

1 year post-surgery:
checkup and x-ray

Checkup and x-ray at 2, 5, 10, 15, 20 years. If there are complications, checkups will become more frequent.

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