Knee replacement surgery with a robotic arm is the last resort for knee pain. It is customary to resort to this option only after the conservative treatment methods have been exhausted, including physiotherapy to improve movement ranges and strengthen muscles and various injections for the treatment of inflammation.
What causes wear and tear of the knee joint?
The leading cause of knee replacement surgery is damage to the joint cartilage. The most common injury is degenerative erosion of the cartilage, which cannot be regenerated, especially at advanced ages. About 10-15% of the population aged 60 and older will experience knee joint erosion, while about 80% of the population aged 80 and older will have varying degrees of joint erosion.
There are other reasons for cartilage erosion besides degenerative changes including trauma to the joint (fracture, discharge), as well as other reasons, such as tumors around the joint, lack of blood supply to areas within the joint and inflammatory diseases such as rheumatism, lupus, etc.
What are the signs of cartilage degeneration?
Cartilage – tissue without nerves and without blood vessels. The cartilage receives supply of the substances it needs from the subcutaneous bone (situated under the cartilage layer), and from the joint fluid – the synovial fluid.
The changes and signs of wear and tear begin when the cartilage is injured and the bone beneath is exposed. Among these changes: limitation of joint movement, decreased activity, strong pain that increases mainly during activity, but also after a prolonged lack of movement – sitting, sleeping. The greater the degree of wear and tear, the greater the difficulty and the pain.
When is it important to seek knee replacement surgery?
Arthritis that affects the knee joint affects the ability of the knee absorb shocks effectively. The erosion of cartilage in the joint leads to pain that appears gradually, impairing the ability to function and damaging the quality of life, such that it is worth resorting to surgery when the period of time in which the pain occurs varies from intermittent pain to prolonged, chronic pain throughout the day, during any activity (limiting pain that negatively impacts the quality of life).
If you suffer from persistent pain in the knee joint, contact an orthopedic physician specializing in knees who will examine solutions, including knee replacement surgery. If you have been treated with a conservative approach that did not bring about improvement, whether it was physiotherapy, medication (usually anti-inflammatory drugs) or intra-articular injections – steroids, hyaluronic acid, PRP and other treatments – there is something you can do; you may be a candidate for knee replacement surgery.
Partial or total knee replacement
Degenerative changes in the knee can develop in one or more parts of the knee – internal (medial), external (lateral) or patella (patello-femoral). A partial knee replacement (Unicondilar Knee Replacment) will be considered when only one area is involved, while a total knee replacement (TKR) will be considered when two or three areas are involved.
What makes robotic knee replacement surgery different from Prof. Drexler’s method?
Knee replacement surgeries are considered one of the most successful in orthopedics and greatly improve the quality of life. The Drexler method, which has developed in recent years, allows patients to return to routine life soon after knee replacement surgery.
The main difference stems from performing a chain of tiny actions of cutting bone and tissue and angling the implant, with the robot facilitating optimal accuracy and balance of the new implant. During surgery, Prof. Drexler makes the small changes necessary to implant the artificial joint in the most anatomical way, with minimal damage to the tissues – muscles, tendons and ligaments around the knee, thus allowing the patient to recover and return to normal more quickly after the surgery. In addition, it is very important to get the patient up and walking within few hours after surgery.
The patient is discharged to his home the day after surgery, when he is able to walk and operate the knee. There is no need for institutional rehabilitation; a physiotherapist from the HMO comes to the patient’s home, and performs and teaches exercises for bending the knee and strengthening the muscles. Discharging the patient to his/her home allows him/her to be in a familiar and supportive environment, surrounded by family and friends. This accelerates and improves the self-rehabilitation process without compromising the patient’s safety.
Quick rehabilitation – the patient only needs to be hospitalized for one night, and the medical procedure takes one to two hours.
The anesthesia stage – Spinal anesthesia and not general anesthesia (as far as possible) – For most of the population, spinal anesthesia (half of the body) is sufficient, without the need for full anesthesia. The anesthetics are injected into the lower back, into the casing of the spinal cord with a thin needle; they work for four to six hours, during which the patient will not be able to move his leg and can be operated on without pain. Partial anesthesia reduces the side effects associated with full general anesthesia such as nausea, vomiting, dizziness and so on.
The knee-cutting, grafting and stitching (suturing) phase is divided into three stages. First, preparation of the graft bones is carried out by making an incision in the front of the knee and shifting the kneecap out of place to expose the femur and calf and to remove the excess tissue (cartilage) and parts of the damaged bones. This process is performed with the help of incision patterns while gently balancing the ligaments and minimizing the cutting of bone. Next Professor Drexler, who is one of the pioneers in using a robotic arm for joint surgery, will place the implant in an anatomically accurate manner that includes continuous monitoring of the angle and placement of the implant according to the surgical plan, in order to ensure the expected result. Subsequently, the patella position and knee movement shall be examined in a bending position, and only then will closure of the incision be performed. Eventually the incision will be sewn using subcutaneous sutures that are absorbed by the skin and do not require removal.
What is the implant composed of?
The implant is made up of two parts of the knee joint. The implants are either
connected to the bone with the help of a special adhesive (“cement”) or
special implants are placed directly on the bone without adhesive with the
bone growing into them.
The dressing stage and the end of the process – the knee is dressed with
a long pressure bandage to reduce swelling, after which the patient begins to
move his legs and practice walking with the new implant.
Does knee replacement surgery involve any risks?
As with any invasive procedure, there are certain risks of complications
including: infection, damage to blood vessels and nerves, complications of
anesthesia, bone fracture around the implant, and discharge. The probability
of these complications is very low, and ranges from about 0.5% to 1%. Other
general complications: constipation, nausea, vomiting, urinary retention,
venous thrombosis, pain or stiffness in the joint area. (These usually resolve
with time.)
It is important to note that the medical staff explainsthe possible complications
and risks involved in surgery at length during the preparatory stage. In
addition, it is very important to coordinate expectations between the surgeon
and the patient. Even though the surgery has a very high success rate, it is
not usually possible to guarantee a 100% success rate. However, it is
certainly possible to achieve the main goal of the surgery, and bring about
improvement to the quality of life in such a way that the knee will cease to be
the center of life due to the limitation and pain. Therefore, an improvement of
80% or more from the pre-operative condition is considered to be a significant
success.
Does the pain go away after the surgery?
It is important to be aware that there may be pain, limitation, swelling and
stiffness in the knee. Most often, these symptoms improve over time but it is
definitely possible that they can remain at a low level.
Results of knee replacement surgery
After surgery, most patients attest to a significant improvement to their quality of life, the ability to walk and sometimes even run, while returning to a more comfortable and pleasant routine with almost no pain.
See the success stories of patients who underwent knee replacement surgery using the new method under Prof. Drexler:
Choosing the attending physician
Choosing the attending physician – When undergoing a medical
process it is of great importance that you choose the attending
physician, the equipment and the knowledge gained.
Prof. Michael Drexler- Director of the Orthopedic Department and the Joint Replacement Unit at Assuta Hospital, Ashdod. In addition to his work at Assuta, Prof. Drexler is a clinical associate professor in the Department of Orthopedics at Ben Gurion University. At the beginning of his career in the field, Prof. Drexler performed knee replacement surgery around the world, while training the best surgeons in Canada, Germany and New York. His experience and reputation make him one of the leading experts in the field of joint replacement, especially that of knee and hip replacement.
Prof. Drexler is one of the pioneers in using a robotic arm for joint surgery, and has the most experience in the field.
Prof. Drexler is a surgeon at Assuta Ramat Hahayal , Herzliya Medical Center and Rafael Hospital.
To schedule a professional consultation to determine the appropriate treatment, and to schedule an appointment for knee replacement surgery, contact Professor Drexler’s clinic today by calling 050-4378437.
