Doctor explains how robotics is transforming knee replacement surgery: will surgeons become obsolete?

A robotic system has been introduced for total knee arthroplasty procedures at Meliva Hospital in Vilnius. This advanced technology helps perform procedures with greater precision and tailor them to the specific anatomy and joint characteristics of each patient.

How these surgeries are performed and how they differ from conventional ones is explained by orthopedic traumatologist Gediminas Kaupys from the Orthopedics and Traumatology Center at Meliva Diagnostics and Surgery Clinic and Meliva Hospital (formerly Kardiolitos Klinikos), according to a press release.

The robot does not replace the surgeon

According to the orthopedic traumatologist, the term "robotic surgery" creates a misleading impression that the procedure is performed entirely by a robot while the surgeon merely observes the process. In reality, all decisions are made by the specialist, and the robotic system only assists in planning and executing the intended actions with greater accuracy.

"During surgery, the system captures data regarding the specific patient's knee anatomy, limb alignment, joint kinematics, and ligament balance. Based on this data, we can plan the exact positioning for the components of the endoprosthesis. The robotic arm assists the surgeon in executing this plan and controlling instrument positioning. It does not make independent decisions and cannot operate autonomously. The specialist maintains full control throughout the entire process and can adjust the plan if necessary," explains G. Kaupys.

At Meliva Hospital in Vilnius, total knee arthroplasties using the "ROSA" robotic system are performed by orthopedic traumatologists G. Kaupys, Prof. Habil. Dr. Narūnas Porvaneckas, and Dr. Giedrius Kvederas. The hospital has already successfully completed 15 such operations

Patient Benefits: Higher precision and personalized surgery

One of the primary advantages of this technology is the ability to adapt the procedure to the individual anatomical features of the patient. Every person's knee joint differs in bone structure, limb alignment, pattern of deformity, and ligament balance. Special sensors within the robotic system allow the assessment of joint stability and performance across various positions. Based on this real-time data, the surgeon can refine the surgical plan even before making bone cuts. This allows for a more precise fit of the endoprosthesis, restoring a joint function that feels as natural as possible.

 

An equally significant benefit of the robotic system is its precision during critical phases of the procedure.

"This technology allows for highly accurate control of bone cuts and component positioning. During surgery, we can objectively assess joint balance and select the ideal implant placement based on the patient's unique anatomy. I view the robotic system as an exceptionally accurate supplementary tool in the hands of a specialist, providing greater possibilities to personalize the procedure and restore optimal, natural joint function," says G. Kaupys.

The fundamental steps remain the same

The orthopedic surgeon notes that the core steps of a total knee replacement remain unchanged: the worn joint surfaces are removed, and the endoprosthesis components are implanted. The distinction lies in the execution: during conventional surgery, the direction of bone cuts and implant placement are determined using manual instruments, whereas the robotic system provides real-time, objective data regarding bone orientation, limb axis, and joint balance. The system enables bone cuts to be executed with an accuracy of within 0.5 mm.

"Preoperative preparation is essentially identical to conventional knee replacement. Necessary diagnostic tests are conducted prior to surgery, assessing the patient's overall health, current medications, and infection risks. Postoperatively, early mobilization is encouraged; knee range-of-motion and muscle activation exercises, along with gait training using assistive devices, begin as early as the next day," says G. Kaupys.

The robotic system can be utilized for the vast majority of patients undergoing primary total knee replacement. However, the decision is made on a case-by-case basis after evaluating joint deformity, bone quality, previous surgical history, existing metal implants, and whether the required prosthesis is compatible with the system. "The criteria for contraindicating or delaying surgery do not differ significantly from conventional joint replacement. These may include active infection, severe comorbidities, or other conditions that preclude elective surgical intervention. Using a robotic system is not an end in itself; the priority is selecting a safe, appropriate surgical method for every patient," stresses the surgeon.

The role of robotic systems in orthopedics will only grow

According to G. Kaupys, operating a robotic system requires a thorough foundational knowledge of conventional knee replacement, joint anatomy, and biomechanics. While technology provides the surgeon with enhanced data and precision, it remains the specialist's responsibility to interpret the information and make clinical decisions. Operating the system also requires specialized training to master surgical planning principles and equipment control. "I believe the role of robotic systems in orthopedics will continue to expand. Technology will provide surgeons with increasingly objective data, aiding in precise planning and personalization. Looking ahead, robotic solutions will likely be integrated with artificial intelligence with increasing frequency," the specialist adds.