Unlocking the Potential of Computer-Navigated Knee Surgery

Dr. Deepak Kumar Mishra, Head of Orthopaedics at Asian Hospital

Dr. Deepak Kumar Mishra is a distinguished Joint Replacement Surgeon, serving as Director and Head of Orthopaedics at Asian Hospital, Faridabad. With 26 years of expertise, he specializes in Primary & revision Knee & Hip Replacement Surgeries & Arthroscopy. Dr. Mishra holds MBBS and MS (Orthopaedics) from JIPMER, Pondicherry, and pursued advanced training in Joint Replacement in the UK, gaining MRCSEd and MCh.

He's a FICS Fellow and known for stellar patient care. A published author and speaker at national/international conferences, he's recognized in Marquis’ Who's Who in Medicine. Proficient in innovative techniques, he emphasizes minimally invasive methods, contributing significantly to Orthopaedics and medical education. 

Total Knee Replacement (TKR) stands as one of today's most successful medical procedures granting relief to individuals with painful arthritic knees, enabling them to resume an active lifestyle and experience an enhanced quality—and often, quantity—of life.

Computer technology has invaded every aspect of our daily lives and it is no surprise, its presence has extended to surgical practices as well. Notably, the past decade has witnessed substantial advancements in Computer-assisted Total Knee Replacement Surgery. This innovative approach aims to assist surgeons in implanting joint replacement devices with utmost precision, thereby potentially extending the life of the replacement while minimizing the risks associated with dislocation and the need for further knee replacement surgeries. Moreover, it holds promise for enhancing stability, expanding the range of motion, and overall functionality of the Joint Replacement. Computer-Assisted surgery may allow for less-invasive surgical techniques, which have several other potential advantages, including - the use of computer navigation systems in surgery results in decreased blood loss, minimizing the need for blood transfusions. It facilitates faster recovery, leading to shorter hospital stays and abbreviated post-operative physical knee rehabilitation. Additionally, it contributes to minimal scarring.

The computer navigation system operates like a GPS navigation for a driver, guiding surgeons during the total knee replacement procedure. Using intraoperative trackers on the patient's thigh (Femur) and leg (Tibia) bones, infrared sensing of patient anatomy enables the computer to precisely direct the surgeon on the optimal placement of new knee implants.

This technology is anticipated to enhance the accuracy of total knee replacement surgery, significantly improving both short-term and long-term performance. Precision in implant placement is crucial, as malalignment stands as a major cause of failure in Total Joint Arthroplasty. This advanced navigation system holds promise in mitigating such issues and potentially revolutionizing the outcomes of knee replacement surgeries.

What is Computer navigated knee surgery?

Computer-assisted navigation serves as a guiding technology during joint replacement procedures, enabling surgeons to monitor each surgical step digitally on a screen. Using real-time infra-red wave communication, this system tracks the position of individual bones in a 3D space. This information is then showcased on a monitor as an interactive model or blueprint of the anatomy, providing the surgeon with precise angles, lines, and measurements specific to the patient's anatomy.

This technology aids in various joint replacement surgeries, including total knee replacements, offering potential advantages over traditional methods. These benefits may include improved surgical outcomes and a reduced likelihood of requiring additional knee surgeries.

The computer navigation technique uses an infrared sensor to map the arthritic knee's anatomy and neighboring bone structures (the femur and tibia), a process known as registration. Utilizing advanced software, the computer generates a 3D image of the patient's knee joint, assessing its spatial positioning and identifying any deformities or bone loss. Collaborating with the surgeon, it determines necessary adjustments, such as bone cuts and ligament balancing, to ensure the new artificial knee aligns correctly anatomically.

The computer creates a preoperative three-dimensional image of the knee's anatomy and envisages the intended post-surgery knee structure. It falls upon the surgeon to interpret this data accurately, aiming to establish the patient's normal anatomy precisely by the procedure's conclusion. Subsequently, the knee surgeon replaces the damaged bone with new artificial joint components known as prostheses or implants, designed to mimic a healthy joint. In some instances, the surgeon may use temporary pins around the incision site to provide crucial data to the computer, enhancing surgical precision. 

This meticulous approach offers patients the potential to regain optimal function and range of motion, facilitating their maximum possible recovery. Advancements in technology and alternative methods aim to reduce incisions, subsequently minimizing scarring for patients undergoing knee replacement surgery.

It's crucial to note that computer navigation serves as a guide for the surgeon and differs from robotic surgery, where the computer controls surgical instrument movements. In computer-assisted navigation, the computer provides precise insights to the surgeon but does not directly control the operation itself.

On the down side, computer navigated TKR comes with a heightened cost and hospitals incur substantial upfront expenses to acquire these navigation systems, aiming to provide advanced care to patients. However, these costs are typically not directly transferred to patients, as computer navigation surgery does not entail additional charges for them. As insurance companies and Medicare do not usually reimburse hospitals more for navigation-assisted surgery, hospitals bear the burden of these additional expenses. While not directly impacting individual patients, these escalating costs due to technological advancements contribute to broader concerns regarding healthcare expenses.

The second downside pertains to potential increased surgical duration. Surgeons utilizing computer navigation systems may extend the length of the procedure by approximately 10 to 15 minutes. Longer surgical durations theoretically heighten the risk of infections due to prolonged exposure of the surgical wound. Nevertheless, current studies have not evidenced a higher infection rate in computer navigation surgeries, likely owing to the relatively modest increase in surgical time. 

Despite these downsides, computer navigation in knee replacement surgery is a technological advancement designed to enhance the precision of placing prosthetic implants while minimizing surgical exposure. While traditional surgical methods have been highly effective, incorporating computer navigation could potentially elevate the already remarkable outcomes, benefiting numerous patients each year.

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