Balaguer Costafreda Abstract

V CONGRÉS D’ENGINYERIA CLÍNICA, SISTEMES DE SALUT I ÈTICA,
Robotic surgery for knee prosthesis

operations. Is it worth it?
Balaguer Montero, M. and Costafreda Martín, A.
PARAULES CLAU: osteoarthritis, robotic surgery, total knee arthroplasty
ABSTRACTE
Osteoarthritis can turn any daily activity that involves any knee function into a nightmare. That
is why when the joint is deteriorated and the pharmacological treatment is no longer effective,
it is necessary to consider a surgery that can alleviate the discomfort that occurs due to its poor
functionality.
The first total knee replacement or arthroplasty (TKR, TKA) surgery was performed in 1968. Since
then, the materials and techniques used have been improved mainly due to the large prevalence
of cases. Nowadays, knee prosthesis is the most popular joint replacement being performed.
The World Health Organization (WHO) predicted that by 2020, more than 579M people would
suffer from osteoarthritis and that half the world’s population above 60 years would be
experiencing it [1]. By looking at data from Hospital Clínic and Hospital Vall d’Hebron we find
that 500 prosthesis are being implanted per year on each hospital [2, 3]. There exist two
different procedures to perform TKA, the conventional surgery and a newer approach: robot-
assisted knee replacement. The traditional method is used in every hospital, it is reliable and has
a duration of 2 hours. On the other hand, robotic surgery is still not a common procedure to be
realized in hospitals since the cost of the instrumentation is high. However, it is beginning to be
implemented in Spain since there have already been surgeries with it in Madrid (Nov. 2020) and
Barcelona (Dec. 2020), using the ROSA Knee System from Zimmer Biomet®. The extra cost is
translated into an improved precision and reduction of the length of the surgery (60-80 min) [4].
Our objective is to analyze the current situation of knee prosthesis surgeries and to evaluate the
implementation of robotic-assisted procedures as the go-to TKA approach. We want to
determine if the technology developed has enough power to overcome the traditional method
which has been used during the last 50 years and where only little modifications have been
made.
The methodology followed has been to conduct a broad bibliographical research in order to get
familiarized with the area studied. To do so, we first performed a search in order to find recent
statistic information for osteoarthritis and TKA in the whole world (WHO) and in our country
(hospitals data). Then we moved on to check the NCBI search engine PubMed, to study how
both techniques work and the advantages and disadvantages they carry with them. Here, we
also searched for newspapers articles related to the initial surgeries performed in Spain with the
latest technique. Lastly, we dug deep into the characteristics of the two main robotic arms on
the market, by visiting the developers’ websites for technical details of each.
The conventional technique is effective having an infection rate of 2.5% [5], but the amount of
prosthesis that are being implanted each year, imply that the review surgeries to be performed
on 10-20 years is growing as well. By implementing robotic-assisted surgery in TKA, surgeons

will be helped to improve the precision and accuracy of the surgery; the advantages are
extensive. First, robotic surgeries allow a better planification of the procedure. The robot ROSA
helps the doctors perform a more exact preintervention planning by quantifying in a more
precisely all the parameters required for the intervention [6]. Furthermore, we can tune more
accurately the size and type of prosthesis for each patient and subsequently adapt the surgery
and the prosthesis itself to the characteristics of each case. Thanks to the customization, the
prosthesis implanted will present greater longevity and better clinical results. We are able to
place the prosthesis on the perfect anatomical position which also minimizes postsurgical
complications [7]. Secondly, robotic surgery grants unprecedented precision during the
intervention. ROSA is able to perform an almost perfect procedure thanks to the technology
integrated in its robotic arm [8]. There exist other robotic arms besides ROSA, like MAKO TKA
from Stryker®, but ROSA is the leader on the sector having price of 514.552,5€ [9].
As a conclusion, we can confirm that robotic surgery for knee prosthesis operations is the future
of the field. The increased accuracy, precision and efficacy present an unmatched ability to
customize surgical procedures which allows patients to get an individualized surgery adapted to
their own necessities. Regardless of the price, robotic arms will continue to perfection the
technique until revision surgeries are no longer necessary and that will make amortization of
the instrumentation affordable. But in order for this to happen, hospitals need to trust this new
instrumentation so more studies can be done to quantify their benefits and finally verify that it
is worth it to invest on it.
BIBLIOGRAFIA
[1] https://www.who.int/chp/topics/rheumatic/en/ [Accessed April 14th, 2021]
[2] https://www.clinicbarcelona.org/ca/noticies/el-clinic-primer-hospital-de-catalunya-en-realitzar-
cirurgies-robotiques-de-protesi-de-genoll [Accessed April 14th, 2021]
[3] https://hospital.vallhebron.com/es/tratamientos/protesis-total-de-rodilla [Accessed April 14th,

2021]
[4] Moon, Y. W., Ha, C. W., Do, K. H., Kim, C. Y., Han, J. H., Na, S. E., Lee, C. H., Kim, J. G., &
Park, Y. S. (2012). Comparison of robot-assisted and conventional total knee arthroplasty: a
controlled cadaver study using multiparameter quantitative three-dimensional CT assessment of
alignment. Computer aided surgery: official journal of the International Society for Computer
Aided Surgery, 17(2), 86–95. https://doi.org/10.3109/10929088.2012.654408 [Accessed April
14th, 2021]
[5] Jover Sáenz, A., Barcenilla Gaite, F., Torres Puig Gros, J., Mas Atance, J., Garrido Calvo, S., &
Porcel Pérez, J. M. (2007). Infección de prótesis total de rodilla y cadera. Epidemiología
descriptiva, terapéutica y evolución en un hospital de segundo nivel durante 10 años. Anales de
Medicina Interna, 24(1), 19-23. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0212-
71992007000100005&lng=es&tlng=es. [Accessed April 14th, 2021]
[6] BARNACLÍNIC BLOG. “Robotic Knee Replacement Surgery achieves greater precision and
customization” [available online]. https://www.barnaclinic.com/blog/en/blog/robotic-knee-
replacement-surgery/ [Accessed March 9th, 2021]
[7] PARRATE, S., PRICE, A. J., JEYS, L. M., JACKSON, W. F., & CLARKE, H. D. (2019).
Accuracy of a New Robotically Assisted Technique for Total Knee Arthroplasty: A Cadaveric
Study. The Journal of arthroplasty, 34(11), 2799–2803.
https://doi.org/10.1016/j.arth.2019.06.040 [Accessed April 3rd, 2021]
[8] KLEIN G.R., JAMES D., LONNER J.H. (2019). “Total Knee Arthroplasty Technique: ROSA ®
Knee”. Springer, Cham [available online]. https://link-springer-
com.sire.ub.edu/chapter/10.1007%2F978-3-030-16593-2_18 [Accessed April 3rd, 2021]
[9] http://www.madrid.org/cs/Satellite?op2=PCON&idPagina=1204201624785&c=CM_ConvocaPr
estac_FA&pagename=PortalContratacion%2FPage%2FPCON_contratosPublicos&language=es
&idConsejeria=1109266187224&cid=1354858637195 [Accessed April 14th, 2021]

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V CONGRÉS D’ENGINYERIA CLÍNICA, SISTEMES DE SALUT I ÈTICA,

Robotic surgery for knee prosthesis

PARAULES CLAU: osteoarthritis, robotic surgery, total knee arthroplasty

on 10-20 years is growing as well. By implementing robotic-assisted surgery in TKA, surgeons

[1] https://www.who.int/chp/topics/rheumatic/en/ [Accessed April 14th, 2021]

[3] https://hospital.vallhebron.com/es/tratamientos/protesis-total-de-rodilla [Accessed April 14th,

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