Robotic Total Knee Replacement

Knee replacement involves surgically removing the surfaces of the femur, tibia and patella that make up the knee joint, and inserting prosthetic components to resurface these bones. The materials used in this process are diverse, but ostensibly include metal such as titanium to bond to bone, plastic such as highly cross-linked polyethylene to softly take weight, and ceramic materials to make a smooth-gliding joint. “Bone cement” is frequently used in knee replacement to bond the components to the bone.

Knee replacement is generally an effective operation for restoring people’s quality of life, reducing pain and restoring the ability to walk.

This is regardless of the surgical approach used, the implant used (provided it is known to perform well) and regardless of the use of technology such as robotic guidance for its implantation.

Mr O’Bryan has trained in the use of several robotic systems for knee replacement, and preferentially uses robotic assistance for knee replacements. This is to assist in the fine-tuning of implant positioning to ensure a patient-specific alignment to either restore the patient’s natural knee position, or to “improve” it if deemed to be abnormal. It is also an unparalleled tool to map and plan the resurfacing of the patellofemoral joint, which is the focus of his PhD studies.

Mr O’Bryan preferentially uses a “muscle-sparing” approach to perform knee replacement, avoiding any incision through the quadriceps muscle or its tendon. While this does appear to have some benefit in reducing the early recovery after knee replacement, the reason for this approach is to optimise the patella tracking which is dependent on the quadriceps muscle belly.