ROBOTIC-assisted knee surgery has been available in Malaysia for around five years, and it's fast changing the way knee replacements are being done in the country.
In Malaysia, knee replacements are the most common orthopaedic procedures performed in both private and public hospitals, and with the use of robotic surgery, this procedure has taken on a new dimension, enabling surgeons to work more precisely and effectively when doing knee replacements.
Robotic surgery is essentially robot-assisted surgery. The surgeon still does the procedure but the robot is used to plan and assist in the surgery, explains Pantai Hospital Kuala Lumpur consultant orthopaedic and trauma surgeon Dr Gobinder Singh.
For knee replacements, a preoperative CT scan is first done, and this scan is then digitised and a model of the patient's knee programmed into the robot.
This enables a precise plan or approach for the surgery to be drawn up and surgeons are also able to virtually do the surgery first before they start the actual procedure.
Dr Gobinder says what this means is that there is almost no room for error as everything can be planned, practised, and the end results observed and analysed before surgery.
"Basically, we get a clear picture of the outcome of the surgery before we even start."
With the use of the robot, surgeons can also precisely determine the size of the knee implant that would be most suitable for a particular patient.
"It enables us to make knee implants very precise and very personalised for the patient," says Dr Gobinder.
Concerns about whether the implant would result in the knee being too tight or too loose in one direction can be eliminated as the robot can be utilised to ensure a well balanced, perfectly aligned knee for the patient.
Dr Gobinder says robot-assisted knee replacement is also very safe as the use of the robot means surgeons can cut in a very precise manner.
"You can't cut too much or too little bone or cut into an area that's dangerous like the vessels in the back of the knee, or in an area where there are tendons.
"The robot will prevent the saw from being executed if it's outside the perimeter of an area that had been mapped out earlier."
Dr Gobinder adds that worldwide, around 15 per cent of patients are not happy with the outcome after conventional knee surgery, but robot-assisted knee surgery can help improve patient satisfaction.
Patients, especially those in urban areas, are also more receptive to the idea of robotic surgery, adds Dr Gobinder, with many of them well educated on its benefits and outcome.
Generally, results indicate that robot-assisted knee surgery results in patients doing better and mobilising faster with less pain compared with conventional surgery.
Dr Gobinder says most knee replacement procedures (90 per cent of cases) can be undertaken effectively using robot-assisted surgery. Only in cases involving gross deformity of the knee (about 10 per cent of cases) would conventional surgery be called for.
RISE IN KNEE REPLACEMENTS
In Malaysia and much of Asia, knee replacements are more common than in the West, and the majority of cases take place when patients are in their mid-60s.
In the West, hip replacements are more common than knee replacements, and this can be attributed to both genetic and environmental factors.
As Malaysia shifts towards the classification of an ageing population, we can expect to see an increase in demand for knee replacements, he adds.
Furthermore, obesity also puts a strain on the knees, fuelling the need for knee replacements and this trend will be particularly felt in Malaysia as the National Health and Morbidity Survey 2023 shows that over half of the nation's adults are currently overweight or obese.
ROBOT-ASSISTED KNEE REPLACEMENT — BENEFITS
Faster/shorter recovery
Most patients are able to resume daily activities after one month as opposed to two months with conventional surgery.
Very little room for error
The use of the robot ensures precise planning and projection of outcomes.
Precise and personalised
Knee implants can be personalised to suit the individual patient to ensure maximum comfort and better quality of life.
The way forward
Most knee replacement procedures these days can be done via robot-assisted surgery and it's targeted to become the main approach in treatment in the years to come.