Robotic-Assisted Joint Replacement at University Hospitals

Hip & Knee Joint Anatomy & Function

The Hip Joint

The largest joint in the body after the knee, the hip joint is a ball-and-socket joint that connects the thigh bone (femur) with the hip bone (pelvis). The rounded head of the femur fits into a cup-like socket in the pelvis called the acetabulum.

The function of the hip joint is to:

• Provide balance and support to your upper body.
• Provide a wide range of motion to your upper legs, including flexing, extension, rotation, back-and-forth motion and circular motion.
• Hold your entire body weight.

Knee Joint

The largest joint in the body, the knee is a hinge joint made up of three bones:

• Femur (thigh bone)
• Tibia (shin bone)
• Patella (kneecap)

The knee also contains cartilage and ligaments, including the LCL, MCL, ACL and PCL. The main function of the knee is to connect the femur to the tibia. Your knees allow your legs to bend and help support your weight and maintain your balance. Whether you’re walking, running or jumping, nearly all leg movement involves your knees.

Types of Arthritis That Affect the Hip and Knee

Arthritis is not a single disease – rather, the term is used to describe pain, swelling and stiffness in one or multiple joints. There are more than 100 types of arthritis and related conditions.

In hip and knee arthritis, the protective cartilage that surrounds the affected bones wears away or becomes inflamed. Arthritis can affect the entire hip or knee joint or just one part. Joint replacement is the primary surgical treatment for advanced hip and knee arthritis.

The most common types of hip and knee arthritis include:

• Osteoarthritis: The most common type of arthritis, osteoarthritis is a chronic disease of the joints, especially the weight-bearing knee, hip and spine joints. Osteoarthritis softens, damages and wears down the cartilage padding at the ends of the affected bones, narrowing the spaces between them. This narrowing leads to bones rubbing against one another, causing joint pain and stiffness. Osteoarthritis most often affects people when they are older (typically age 50+).
• Rheumatoid arthritis: This autoimmune disease causes chronic inflammation and thickening of the membrane that surrounds joints (the synovium). The inflammation from the condition can damage joint cartilage and cause symptoms such as pain and stiffness.
• Osteonecrosis: Also known as avascular necrosis, osteonecrosis is when an injury to the hip or knee, such as a fracture or a dislocation, blocks blood supply to the bone. The lack of blood flow can cause the surface of the bone to collapse, resulting in arthritis. In addition, certain diseases cause osteonecrosis.
• Post-traumatic arthritis: This type of arthritis can occur after a serious injury to the hip or knee injury. Post-traumatic arthritis can damage articular cartilage over time, causing joint pain and loss of joint function.
• Childhood hip disease leading to arthritis: Some babies and children have hip problems, such as abnormal development (dysplasia), that can cause arthritis to develop later in life.

Benefits of Robotic-Assisted Joint Replacement

The benefits of robotic-assisted joint replacement surgery over traditional surgery include:

• Enhanced surgical planning: Specialized 3-D images taken before and during robotic surgery allow surgeons to accurately plan the ideal size and alignment of joint components for a patient’s specific anatomy.
• Optimal joint alignment: Robotic technology enables surgeons to more precisely position the implant, which may result in a more natural-feeling replacement joint.

Other potential benefits include:

• Shorter hospitalization times.
• Reduced pain and discomfort.
• Quicker recovery times.
• Smaller incisions, resulting in less scarring and reduced risk of infection.

Limitations of Robotic-Assisted Joint Replacement

Limitations of robotic-assisted joint replacement surgery include:

• A CT scan may be needed to do the surgery, which can increase radiation exposure to the patient.
• Possible risk of fracture or infection around the navigation pin site.

Joint Replacement Surgery With Leading-Edge Robotic Tools

Surgeons and patients at UH have access to the latest innovative technologies in robotic-assisted surgery for joint replacement:

Mako Robotic-Arm Assisted Technology

With the Mako Robotic-Arm, surgeons have real-time feedback throughout the joint replacement procedure. This interactive robotics system guides optimal placement of the implant to restore alignment and range of motion. Mako technology allows surgeons to create detailed 3-D models of existing joints and develop surgical plans tailored to each patient’s diagnosis and anatomy. During surgery, all necessary adjustments can be made using the robotic arm and image-guided technology.

VELYS Robotics

The VELYS Robotic-Assisted Solution uses advanced technologies such as an infrared imaging and optical trackers to assist surgeons in performing knee replacement surgery tailored to the patient’s anatomy. The system works exclusively with the ATTUNE Knee System, which has been used in over 1.5 million patients worldwide. The VELYS Robotic-Assisted Solution offers precision, accuracy and real-time decision making without the need for CT scans, which can cut costs and time.

The VELYS Hip Navigation aids surgeons in achieving optimal accuracy and precision in hip replacement surgery. During surgery with VELYS Hip Navigation, real-time fluoroscopic imaging is used to obtain the best alignment and placement of the hip implant. This technology is designed to help personalize hip replacement surgery and optimize patient recovery.

Complications of Robotic-Assisted Total Joint Replacement

Robotic total joint replacement surgery has a high success rate. However, all major surgeries have some risk of complications. Possible complications of robotic-assisted total joint replacement are similar to those of non-robotic join replacement surgery. These include:

• Blood clots, including deep vein thrombosis and pulmonary embolism.
• Blood loss that may require a blood transfusion.
• Infection: Risk of infection occurring after robotic total joint replacement is the same as that of conventional joint replacement (less than 1%).
• Fracture: Because the implant changes the distribution of stress on the affected bones, sometimes fractures can occur. Risk of fracture is about the same as that of conventional joint replacement (less than 1%).
• Implant loosening and dislocation, which may require replacement of the implant.
• Leg-length inequality: When one leg is shorter than the other.
• Heterotopic ossification: A rare complication in which the hip grows increasingly stiff due to abnormal bone production in soft tissues.
• Nerve or blood vessel damage: Rare complications that can possibly result in loss of function or loss of limb.

Your orthopedic surgeon will talk to you about their experience with robotic-assisted joint replacement surgery and the possible risks and benefits of these techniques for your individual case.

Recovery From of Robotic-Assisted Total Joint Replacement

Most hip and knee replacement patients are able to resume everyday activities about 6 to 12 weeks after surgery.

Discharge from Hospital

Outpatient joint replacement is increasingly common. In fact, most robotic-assisted joint replacement patients can go home from the hospital the same day as their procedure. Your surgeon will let you know the likelihood of you being discharged the same day as your procedure. Some patients may have to stay in the hospital to be monitored for two or three days before they are cleared for discharge.

Walking

Depending on your doctor’s assessment and your bone strength, you should be able to put weight on your leg immediately after your surgery. However, you may need a cane, walker or crutches for the first few days or few weeks until you feel comfortable walking without assistance.

Pain Management

Some pain and discomfort during the weeks following joint replacement surgery is normal. Your doctor may prescribe pain medication to relieve symptoms and help your body recover more quickly.

Physical Therapy

If your doctor recommends physical therapy for you after surgery, your physical therapist will provide exercises to maintain and improve your range of motion while increasing your strength.

Follow-Up Visits

After your surgery, you will continue to see your surgeon for follow-up visits at regular intervals.

Meet Our Providers of Robotic-Assisted Hip and Knee Replacement Surgery

UH performs robotic-assisted hip and knee replacement surgery at five convenient locations on both the east and west sides of Cleveland. Our commitment and investment in robotics technology for joint replacement has led to surgeons from some of the country’s most prestigious orthopedic surgery fellowship programs joining our team.