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Name:
Robotic Partial Knee Replacement
Description:
Robotic Partial Knee Replacement
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https://cadmoremediastorage.blob.core.windows.net/d7e9e9ef-347f-453f-8150-7be3842184bf/videoscrubberimages/Scrubber_1.jpg
Duration:
T00H10M56S
Embed URL:
https://stream.cadmore.media/player/d7e9e9ef-347f-453f-8150-7be3842184bf
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/d7e9e9ef-347f-453f-8150-7be3842184bf/Robotic partial knee replacement..mp4?sv=2019-02-02&sr=c&sig=17TpPr577O019PBiNBfOc%2FvrmayOvjuPPs4otAASTWk%3D&st=2024-11-23T09%3A39%3A06Z&se=2024-11-23T11%3A44%3A06Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
ANOOP JHURANI: Hello, friends. This video is about partial knee replacement with the help of a robotic arm. And you can see this is a 55-year-old lady with medial compartment osteoarthritis, bone on bone, because of cartilage loss. A normal lateral compartment, about a 5-degree correctable varus deformity, and you can see we should take full length x-rays to see the amount of varus deformity.
ANOOP JHURANI: Patient should not ideally have more than 5 degree flexion deformity, or more than 10 degree virus. In a lateral view, we can see that the ACL is intact, which is denoted by a concavity of the medial tibial condyle. The medial tibial condyle is flat, that means ACL is functionally not intact. Patella patellofemoral joint is all right, there is no significant arthritic changes except a shade once on the medial condyle.
ANOOP JHURANI: This is a live surgery video, so the incision is larger. Otherwise you can do through a small incision. We have inspected the lateral compartment, the cartilage looks very nice. There is no cartilage defect on the lateral side, as you can see that the ACL is intact, as is evident, and the patella is also intact, except a few changes on the medial trochlea, which can be ignored. The lateral part of the patella should be intact.
ANOOP JHURANI: That is, the cartilage should be intact. The principles of a robotic uni are that we have, we are giving all the information to the robotic computer, and then it helps us align our components in a very accurate manner, the two pins in the femur and two pins in the tibia, you can see the RA's, and then there is the pointer, which gives all the information to make a three-dimensional image and planning on the robotic arm.
ANOOP JHURANI: This is mapping of the medial epicondyle and that's the mapping of the tibial condyle and you can see the ACL is nice and intact. The lateral compartment is nice, the cartilage is intact and the patella is also pretty good. Isolated bone on bone changes in the medial compartment are the right indication for fixed or a mobile bearing unit. That's the robotic screen. You can see that it's mapping the morphology of the medial tibial condyle.
ANOOP JHURANI: And then comes the planning part. Once we have given all the information to the computer, it gives us the size, the placement of the femoral component, and we can change it according to the size or the orientation. And you can see that the dark yellow part is the bone and the medial uni component is also there and it's all showing how it will be placed in real time. So all this planning we can do pre-op, and we can see that we can move the screen up and down to see the three-dimensional placement of the partial knee component.
ANOOP JHURANI: The thin yellow line is the bone and the components are evident. Now this is the planning of the tibia, and we can see that the slope is anywhere between 5 to 7, depending on what the patient's slope is. Ideally, component alignment in plus-minus 1 varus valgus, the tibia especially. And then we come to the third screen, which shows us the gap balancing, and that's the key. The fourth screen does, this one, shows the loading of the femur on the tibial component.
ANOOP JHURANI: That's, that's very important because there has to be no edge loading for the success of uni, and you can see that those dots on the femur and tibial component shows how the femur is going to play on the tibia. Once we have done all of that and we can adjust all gaps accordingly, so that there is 1 or 2 millimeter opening in the gaps, and the uni works nicely without being tight or loose.
ANOOP JHURANI: And all this planning we can do on the computer screen, and that is finally implemented on the bone once we start burring, and you can see that we are burring the femur now with this robotic burr, and the burr is in surgeon's hands, but it allows very accurate burring of the femur and the burring stops as soon as you go in 0.5 millimeter outside the planned zone. The violet indicates about 3 millimeters of bone.
ANOOP JHURANI: The green indicates about 1 millimeter of bone, and the white is where we have to be. So we have to move from violet to green to a white. The burr has different thicknesses and different speed and exposure control modes, and we can control the speed of the burr depending on what we want and where we are working. Now we are working on the posterior part of the femoral condyle, and you can see that we are working from violet down to green, down to white, and the burr will stop below white, so it won't, you can't burr more than what is planned.
ANOOP JHURANI: That's the beauty of the system. And unis can be done manually, undoubtedly, and they have a long success story, but to do unis more accurately, that is prevent any malalignment, malpositioning of component, robotic burr, it does help us to align our components to our gap planning very well, prevent tightening of the gaps, which is the commonest problem in a mobile bearing uni, which can lead to degeneration of the lateral compartment.
ANOOP JHURANI: Or in a fixed-bearing uni manually done, your components can be malaligned, which can lead to early wear. So the hypothetical proposed advantage of a robotic burr is to align your components perfectly and do your gap balancing properly, so that unis can last longer. That's the whole hypothesis. And in early studies, it is proving that the components truly are better aligned.
ANOOP JHURANI: Now we are doing both these burr holes for the femoral component in 5 to 45 degree flexion, and because the unis are aligned 45 degree flexion to the sagittal axis of the femur, which essentially means that it does not impinge on the patellofemoral joint and gives more flexion, does the burring of the two holes on the femur. Now we come on to the tibia and again the principle is to go from a violet to a green to a white, essentially burring of that much amount of bone that we have planned.
ANOOP JHURANI: Usually 4 to 5 millimeters bone is burred on the tibia, so it is bone preserving as compared to other unis where you cut with a saw at least 7 millimeters from the posterior side of the medial epicondyle. So it is bone preserving. Once we have burred all of that, we can see that the surface is a nice cancellous flat bed of bone on which the implants can be seated.
ANOOP JHURANI: This is a fixed-bearing uni, and it's the original ZUK design. Now it's marketed by, with the name of journey two. And this video is not to promote any implant or any particular technology, it's to just share the scientific principles behind doing this procedure with the robotic arm. And you can see that the body surfaces are nicely made now and we can do the trial now.
ANOOP JHURANI: The incision, as I said, is longer, because we're doing a live surgery and we're not using a tourniquet, because initially the time with the robotic arm is little longer. But as you go on, it becomes less and less. This is a trial femur component. You can see that it's nicely seated in the centre. It's not impinging anywhere outside medially or laterally. And that's the trial.
ANOOP JHURANI: And we can now see the kinematics on the robotic screen, which is the advantage, because it's the kinematics that ultimately dictate the final functional outcomes of a uni. And we can see that patient had a full range of movement. As you can see here, it goes nicely up to 135, 140 and you can see that green, sorry that orange graph that's coming above that line is showing us the kinematics.
ANOOP JHURANI: It's opening 1 or 2 millimeters, and that's what we want. We don't want it to be tight, we want it to open 1 or 2 millimeters throughout the arc of movement. Most important is that we should not over- stuff, because if we over-stuff, then the lateral compartment will degenerate and the overall alignment should be within 2 to 4 degrees of varus.
ANOOP JHURANI: Now we put up the tourniquet, and a nice pulse lavage for cementing of the components, and cement needs to be nicely pressurized. We should avoid going too much posterior, because there is very little space to remove cement posteriorly in a uni. So very thin layer of cement nicely pressurized into those holes that we prepared the tibia for, and then putting in the tibial component. All this needs to be done very meticulously, very gently, without too much force.
ANOOP JHURANI: And another advantage of doing this with robotic is that there are no tibial pins, so there is no possibility of any stress fractures on the medial tibial condyle. Again, when the femur component, very less cement posteriorly, nicely pressurized, also pressurized into the holes. Good cementation has been shown to improve the long-term outcomes of unis. So cementing is important, and we should give sufficient time and attention to it.
ANOOP JHURANI: And that's the oxinium femoral component. We don't yet know the long-term outcomes with the oxinium, but with the standard components, this particular uni has given about 85% survivorship at 15 years. And that will probably improve with the robotic arm making the surgery more accurate, and it will last as good as a total knee. We can again after the implantation of the final components, again see the final kinematics and you can see we are in 3 degree varus, that's what we want, we don't want too much varus, we don't want overcorrection either.
ANOOP JHURANI: And you can see that the.... [CREDITS ROLL]
Segment:0 .
ANOOP JHURANI: Hello, friends. This video is about partial knee replacement with the help of a robotic arm. And you can see this is a 55-year-old lady with medial compartment osteoarthritis, bone on bone, because of cartilage loss. A normal lateral compartment, about a 5-degree correctable varus deformity, and you can see we should take full length x-rays to see the amount of varus deformity.
ANOOP JHURANI: Patient should not ideally have more than 5 degree flexion deformity, or more than 10 degree virus. In a lateral view, we can see that the ACL is intact, which is denoted by a concavity of the medial tibial condyle. The medial tibial condyle is flat, that means ACL is functionally not intact. Patella patellofemoral joint is all right, there is no significant arthritic changes except a shade once on the medial condyle.
ANOOP JHURANI: This is a live surgery video, so the incision is larger. Otherwise you can do through a small incision. We have inspected the lateral compartment, the cartilage looks very nice. There is no cartilage defect on the lateral side, as you can see that the ACL is intact, as is evident, and the patella is also intact, except a few changes on the medial trochlea, which can be ignored. The lateral part of the patella should be intact.
ANOOP JHURANI: That is, the cartilage should be intact. The principles of a robotic uni are that we have, we are giving all the information to the robotic computer, and then it helps us align our components in a very accurate manner, the two pins in the femur and two pins in the tibia, you can see the RA's, and then there is the pointer, which gives all the information to make a three-dimensional image and planning on the robotic arm.
ANOOP JHURANI: This is mapping of the medial epicondyle and that's the mapping of the tibial condyle and you can see the ACL is nice and intact. The lateral compartment is nice, the cartilage is intact and the patella is also pretty good. Isolated bone on bone changes in the medial compartment are the right indication for fixed or a mobile bearing unit. That's the robotic screen. You can see that it's mapping the morphology of the medial tibial condyle.
ANOOP JHURANI: And then comes the planning part. Once we have given all the information to the computer, it gives us the size, the placement of the femoral component, and we can change it according to the size or the orientation. And you can see that the dark yellow part is the bone and the medial uni component is also there and it's all showing how it will be placed in real time. So all this planning we can do pre-op, and we can see that we can move the screen up and down to see the three-dimensional placement of the partial knee component.
ANOOP JHURANI: The thin yellow line is the bone and the components are evident. Now this is the planning of the tibia, and we can see that the slope is anywhere between 5 to 7, depending on what the patient's slope is. Ideally, component alignment in plus-minus 1 varus valgus, the tibia especially. And then we come to the third screen, which shows us the gap balancing, and that's the key. The fourth screen does, this one, shows the loading of the femur on the tibial component.
ANOOP JHURANI: That's, that's very important because there has to be no edge loading for the success of uni, and you can see that those dots on the femur and tibial component shows how the femur is going to play on the tibia. Once we have done all of that and we can adjust all gaps accordingly, so that there is 1 or 2 millimeter opening in the gaps, and the uni works nicely without being tight or loose.
ANOOP JHURANI: And all this planning we can do on the computer screen, and that is finally implemented on the bone once we start burring, and you can see that we are burring the femur now with this robotic burr, and the burr is in surgeon's hands, but it allows very accurate burring of the femur and the burring stops as soon as you go in 0.5 millimeter outside the planned zone. The violet indicates about 3 millimeters of bone.
ANOOP JHURANI: The green indicates about 1 millimeter of bone, and the white is where we have to be. So we have to move from violet to green to a white. The burr has different thicknesses and different speed and exposure control modes, and we can control the speed of the burr depending on what we want and where we are working. Now we are working on the posterior part of the femoral condyle, and you can see that we are working from violet down to green, down to white, and the burr will stop below white, so it won't, you can't burr more than what is planned.
ANOOP JHURANI: That's the beauty of the system. And unis can be done manually, undoubtedly, and they have a long success story, but to do unis more accurately, that is prevent any malalignment, malpositioning of component, robotic burr, it does help us to align our components to our gap planning very well, prevent tightening of the gaps, which is the commonest problem in a mobile bearing uni, which can lead to degeneration of the lateral compartment.
ANOOP JHURANI: Or in a fixed-bearing uni manually done, your components can be malaligned, which can lead to early wear. So the hypothetical proposed advantage of a robotic burr is to align your components perfectly and do your gap balancing properly, so that unis can last longer. That's the whole hypothesis. And in early studies, it is proving that the components truly are better aligned.
ANOOP JHURANI: Now we are doing both these burr holes for the femoral component in 5 to 45 degree flexion, and because the unis are aligned 45 degree flexion to the sagittal axis of the femur, which essentially means that it does not impinge on the patellofemoral joint and gives more flexion, does the burring of the two holes on the femur. Now we come on to the tibia and again the principle is to go from a violet to a green to a white, essentially burring of that much amount of bone that we have planned.
ANOOP JHURANI: Usually 4 to 5 millimeters bone is burred on the tibia, so it is bone preserving as compared to other unis where you cut with a saw at least 7 millimeters from the posterior side of the medial epicondyle. So it is bone preserving. Once we have burred all of that, we can see that the surface is a nice cancellous flat bed of bone on which the implants can be seated.
ANOOP JHURANI: This is a fixed-bearing uni, and it's the original ZUK design. Now it's marketed by, with the name of journey two. And this video is not to promote any implant or any particular technology, it's to just share the scientific principles behind doing this procedure with the robotic arm. And you can see that the body surfaces are nicely made now and we can do the trial now.
ANOOP JHURANI: The incision, as I said, is longer, because we're doing a live surgery and we're not using a tourniquet, because initially the time with the robotic arm is little longer. But as you go on, it becomes less and less. This is a trial femur component. You can see that it's nicely seated in the centre. It's not impinging anywhere outside medially or laterally. And that's the trial.
ANOOP JHURANI: And we can now see the kinematics on the robotic screen, which is the advantage, because it's the kinematics that ultimately dictate the final functional outcomes of a uni. And we can see that patient had a full range of movement. As you can see here, it goes nicely up to 135, 140 and you can see that green, sorry that orange graph that's coming above that line is showing us the kinematics.
ANOOP JHURANI: It's opening 1 or 2 millimeters, and that's what we want. We don't want it to be tight, we want it to open 1 or 2 millimeters throughout the arc of movement. Most important is that we should not over- stuff, because if we over-stuff, then the lateral compartment will degenerate and the overall alignment should be within 2 to 4 degrees of varus.
ANOOP JHURANI: Now we put up the tourniquet, and a nice pulse lavage for cementing of the components, and cement needs to be nicely pressurized. We should avoid going too much posterior, because there is very little space to remove cement posteriorly in a uni. So very thin layer of cement nicely pressurized into those holes that we prepared the tibia for, and then putting in the tibial component. All this needs to be done very meticulously, very gently, without too much force.
ANOOP JHURANI: And another advantage of doing this with robotic is that there are no tibial pins, so there is no possibility of any stress fractures on the medial tibial condyle. Again, when the femur component, very less cement posteriorly, nicely pressurized, also pressurized into the holes. Good cementation has been shown to improve the long-term outcomes of unis. So cementing is important, and we should give sufficient time and attention to it.
ANOOP JHURANI: And that's the oxinium femoral component. We don't yet know the long-term outcomes with the oxinium, but with the standard components, this particular uni has given about 85% survivorship at 15 years. And that will probably improve with the robotic arm making the surgery more accurate, and it will last as good as a total knee. We can again after the implantation of the final components, again see the final kinematics and you can see we are in 3 degree varus, that's what we want, we don't want too much varus, we don't want overcorrection either.
ANOOP JHURANI: And you can see that the.... [CREDITS ROLL]
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