Bagaria Vaibhav, Sadigale Omkar S, Pawar Prashant P, Bashyal Ravi K, Achalare Ajinkya, Poduval Murali
Department of Orthopaedics, Sir H N Reliance Foundation Hospital, Girgaum, Mumbai India.
NorthShore University Health System, Orthopaedic Surgery, University of Chicago, Chicago, IL USA.
Indian J Orthop. 2020 Apr 13;54(6):745-756. doi: 10.1007/s43465-020-00088-5. eCollection 2020 Nov.
There has been an exponential increase in knee arthroplasty over the past 20 years. This has led to a quest for improvement in outcomes and patient satisfaction. While the last decade of last century proved to be the decade for Computer-Assisted Surgery (CAS) or Computer Navigation wherein the technology demonstrated a clear benefit in terms of improving mechanical axis alignment and component positioning, this decade is likely to belong to Robotics. Robotics adds an independent dimension to the benefits that CAS offers. The article deals with the generation of robots, technical steps in robotics, advantages and downsides of robotics and way forward in the field of knee arthroplasty.
The review article was designed and edited by six different authors reviewing 32 relevant pubmed-based articles related to robotics in arthroplasty and orthopaedics. The concept, design and the definition of the intellectual content were based on the internationally published literature and insightful articles. The review is also based on the clinical experimental studies published in the literature.
The robotic arm is actively involved with surgeon to achieve the precision and outcomes that the surgeon aims for. With the concept of haptic boundaries and augmented reality being incorporated in most systems, Robotic Assisted Arthroplasty (RAA) is likely to offer several advantages. The potential advantages of these systems may include accuracy in gap balancing, component positioning, minimal bone resection, reduced soft tissue handling and trauma, patient anatomy specific resection, and real time feedback. They, however, come with their own downsides in terms of capital cost, learning curve, time consumption and unclear advantages in term of long-term clinical outcomes.
To conclude, this review article offers a balanced view on how the technology is impacting current arthroplasty practice and what can be expected in coming years. The commitment of almost all major implant manufacturers in investing in robotics likely means that the evolution of Robotic technology and this decade will be exciting with rapid strides revealing paradigm shift and evolution of technology with significant reductions of cost enabling it to be available universally. For technology to populate in operating room, I think it will be result of exposure of young surgeons to these computers and robotics, as they grow in with confidence with technology from residency days to offer better precision in future.
在过去20年里，膝关节置换术呈指数级增长。这促使人们寻求改善手术效果和患者满意度。上世纪的最后十年被证明是计算机辅助手术（CAS）或计算机导航的十年，该技术在改善机械轴对线和假体定位方面显示出明显优势，而这十年可能将属于机器人技术的时代。机器人技术为CAS带来的益处增添了一个独立的维度。本文探讨了机器人的产生、机器人技术的技术步骤、机器人技术的优缺点以及膝关节置换领域的未来发展方向。
这篇综述文章由六位不同的作者设计和编辑，他们查阅了32篇基于PubMed的与关节置换术和骨科机器人技术相关的文章。其概念、设计和知识内容的定义基于国际上发表的文献和有见地的文章。该综述还基于文献中发表的临床实验研究。
机器人手臂与外科医生积极协作，以实现外科医生所期望的精度和手术效果。随着大多数系统都融入了触觉边界和增强现实的概念，机器人辅助关节置换术（RAA）可能会带来诸多优势。这些系统的潜在优势可能包括间隙平衡的准确性、假体定位、最小化骨切除、减少软组织处理和创伤、针对患者解剖结构的特定切除以及实时反馈。然而，它们在资本成本、学习曲线、时间消耗以及长期临床效果方面的优势尚不明确等方面也存在自身的缺点。
总之，这篇综述文章对该技术如何影响当前的关节置换术实践以及未来几年的发展前景提供了一个平衡的观点。几乎所有主要植入物制造商都致力于投资机器人技术，这可能意味着机器人技术在这十年将迅速发展，带来范式转变和技术革新，同时成本大幅降低，使其能够广泛应用。对于该技术在手术室的普及，我认为这将是年轻外科医生从住院医师阶段就接触这些计算机和机器人技术的结果，随着他们对技术的信心不断增强，未来能够提供更高的精度。
