Robotic-Assisted Joint Replacement: The Future is Here By Dr. Aman Dua, Orthopedic Surgeon Robotic-assisted joint replacement surgery is revolutionizing orthopaedics, offering enhanced precision, faster recovery, and reduced pain. As more patients seek advanced surgical options for knee and hip replacements, this technology is becoming the future of joint care. Here’s a closer look at what robotic-assisted surgery entails, its benefits, and whether it might be the right choice for you. What is Robotic-Assisted Joint Replacement? Robotic-assisted surgery uses advanced systems to assist in performing knee and hip replacements. A 3D model of the patient’s joint is created using imaging technology, and during surgery, the robotic system provides real-time feedback for precise bone cuts and implant placement. This ensures better alignment and fit, improving joint function and implant longevity. Benefits include smaller incisions, less tissue damage, reduced blood loss, and faster recovery. Ideal candidates are those with severe joint damage from osteoarthritis. A common myth is that the robot performs the surgery independently—I remain in full control, using the system to enhance accuracy.

**Ligament Reconstruction** is a surgical procedure used to repair or replace a torn or damaged ligament, typically in a joint, in order to restore stability and function. Ligaments are strong, fibrous tissues that connect bones to one another and help stabilize joints. Injuries to ligaments, especially in the knee, ankle, shoulder, and elbow, can severely impair movement and function. Common causes of ligament damage include sports injuries, trauma, or degenerative conditions. ### Common Types of Ligament Reconstruction 1. **Anterior Cruciate Ligament (ACL) Reconstruction**: - The ACL is one of the major ligaments in the knee, crucial for stabilizing the joint during activities like running, jumping, and pivoting. - ACL tears are common in athletes, particularly in sports like soccer, basketball, and skiing. - The reconstruction typically involves using a graft (often from the patient's own body, such as the hamstring tendon or patellar tendon, or from a donor). 2. **Posterior Cruciate Ligament (PCL) Reconstruction**: - The PCL is another key ligament in the knee that helps control the backward movement of the tibia relative to the femur. - PCL tears, while less common than ACL injuries, can occur due to high-impact trauma or falls. 3. **Medial Collateral Ligament (MCL) Reconstruction**: - The MCL is located on the inner side of the knee and helps stabilize the knee from side-to-side movements. - While many MCL injuries can be treated non-surgically, some severe tears require reconstruction, particularly when other knee structures are also damaged. 4. **Lateral Collateral Ligament (LCL) Reconstruction**: - The LCL stabilizes the outer side of the knee and is less commonly injured than the ACL or MCL. However, when torn, it can require surgical reconstruction, particularly in athletes or people involved in high-impact activities. 5. **Shoulder Ligament Reconstruction**: - Commonly performed for injuries to the shoulder's rotator cuff or the labrum (glenoid labrum), where a torn ligament may lead to instability, dislocations, or chronic pain. - The procedure might involve repairing or reconstructing ligaments that have been damaged due to traumatic injury or repetitive use. 6. **Ankle Ligament Reconstruction**: - Often needed when ligaments in the ankle (such as the anterior talofibular ligament) are torn or stretched beyond repair, often due to chronic instability or recurrent sprains. - This can be done using autografts (from the patient’s own body) or allografts (donor tissue). 7. **Elbow Ligament Reconstruction (Tommy John Surgery)**: - Common in baseball players and other athletes, particularly for the ulnar collateral ligament (UCL) of the elbow, which stabilizes the joint during throwing. - This procedure typically involves replacing the damaged ligament with a tendon taken from elsewhere in the body (often the palmaris longus or hamstring tendon). ### Surgical Process 1. **Preoperative Assessment**: - The surgeon evaluates the extent of the ligament injury, often using imaging studies like MRI or X-rays to confirm the damage. The decision about whether surgery is needed depends on factors such as the degree of instability, age, activity level, and overall health of the patient. 2. **Graft Selection**: - For ligament reconstruction, a graft is often needed to replace the damaged ligament. Grafts can be autografts (from the patient's own body), allografts (donor tissue), or synthetic materials. - **Autografts**: Tendons from the patient's own body (e.g., patellar tendon, hamstring tendon, or quadriceps tendon). - **Allografts**: Donor tissue, typically from a cadaver. - **Synthetic Grafts**: Man-made materials (less commonly used, as they may not have the same durability and biological integration as biological grafts). 3. **Surgical Procedure**: - **Arthroscopic vs. Open Surgery**: Many ligament reconstructions are done arthroscopically (minimally invasive), which involves small incisions and the use of a camera to guide the surgeon. In some cases, open surgery may be required for complex injuries. - The surgeon removes the damaged ligament (if necessary) and prepares the site for the graft. Holes or tunnels are drilled into the bone to secure the new ligament in place, which is then tightened and anchored. 4. **Postoperative Care**: - After surgery, the joint is typically immobilized for a period of time to allow for healing. - Physical therapy is critical to restore strength, flexibility, and function. Rehabilitation can take several months, depending on the ligament involved and the extent of the injury. ### Recovery and Rehabilitation - **Physical Therapy**: Postoperative rehab is essential to regain strength, range of motion, and function in the affected joint. The process can be lengthy, sometimes taking 6-12 months or more, depending on the ligament and activity level. - **Weight-Bearing Restrictions**: In some cases, weight-bearing activities (e.g., walking or running) may be restricted for a period, and the use of crutches or braces may be required. - **Return to Sports/Activity**: The time to return to sports or high-level activity depends on the ligament involved, the success of the surgery, and the patient's progress in rehab. For instance, an ACL reconstruction may take 6-9 months for athletes to return to competitive sports. ### Risks and Complications As with any surgery, ligament reconstruction carries certain risks: - **Infection**: A risk with any surgical procedure, though rare with modern techniques. - **Graft Failure**: The graft may fail or not heal properly, which can lead to the need for a second surgery. - **Stiffness and Loss of Motion**: Some patients may experience difficulty regaining full range of motion. - **Re-Injury**: Especially in athletes, there’s a risk of re-injuring the reconstructed ligament or damaging other structures in the joint. - **Blood Clots**: Deep vein thrombosis (DVT) can occur, particularly if the patient is not mobile for an extended period post-surgery. ### Outcomes - Most individuals experience a significant improvement in joint stability and function following successful ligament reconstruction. However, the final outcome depends on the severity of the injury, the timing of the surgery, the technique used, and the patient's commitment to rehabilitation. In summary, ligament reconstruction is an essential tool for restoring function and stability to joints following serious ligament injuries. It's a complex procedure that requires careful planning, appropriate graft selection, and a lengthy recovery process to achieve the best outcomes.

What is the Hip Joint? The hip joint is a ball and socket joint which links the pelvis with the upper end of the thigh bone. The ball is on the upper end of the thigh bone and this fits into a socket which is on the outer part of the pelvis. Arthritis A smooth, slippery, fibrous connective tissue called articular cartilage acts as a protective cushion between bones inside the joint. Arthritis develops as the cartilage begins to deteriorate or is lost because of wear and tear as part of aging or because of disease like Rheumatoid arthritis. As the articular cartilage is lost, joint space between the bones become narrow. This is an early sign of arthritis and is easily seen on X-Rays. Slowly over time bone ends rub against each other and wear away. This results in progressive pain and shortening. Normal activity becomes painful and difficult. Pain can even interfere with simple daily activities. Common arthritis symptoms include pain, stiffness, some loss of joint motion, deformity, limp and shortening of limb Who develops arthritis? Primary osteoarthritis typically affects patients over 50 years of age, but is uncommon in India It is more common in persons who are overweight, or suffering from Rheumatoid arthritis or Ankylosing spondylitis. In some patients arthritis tends to run in families. Other factors that can contribute to developing hip arthritis include injury to the hip (Acetabulum fracture or after fracture neck of femur), developmental abnormalities like dysplastic hip and Perthe disease What is the treatment of Hip arthritis? Conservative treatment does not have a significant role in management, once hip arthritis has set in. Initial treatment includes medications for pain relief, weight control and physical therapy. If all these fail to produce satisfactory response, one should consider hip replacement as the last resort treatment. Who need a Hip Replacement? If your answer is yes to most or all the questions, you probably are a candidate for Hip replacement surgery. Does severe hip pain limit your activities? (walking, climbing stairs, getting in and out of chair) Is your Hip stiff, which makes it difficult to move or your hip is fixed in one position? Pain associated with limb shortening and limp while walking Hip Arthritis Surgery Treatment Procedure Hip joint is exposed using a incision on the back of hip, over the buttock. Joint is exposed after separating the muscle and cutting through the capsule. The worn and damaged surface of bone and cartilage from upper end of femur (thigh bone) and pelvis are removed and shaped to accept the prosthetic implants. These surfaces are replaced with metal and plastic / Ceramic implants which closely mimic natural hip motion and function. Realistic expectations Ultimate goal of hip replacement surgery is pain relief and improved function. Hip replacement surgery will not treat pain arising from other joints or back. Although some improvement is expected because of improve gait or walking pattern. Restrictions like avoiding running, high impact aerobics and sports like tennis are to be practiced for rest of life. Extreme bending, squatting and sitting cross-leg should be avoided to prevent dislocation and wear or early loosening of implants. Hip replacements last many years, but may need revision surgery when they wear out or loosen. Points to remember after total Hip surgery After Hip replacement, certain important aspects of your recovery need to be kept in mind: Walking and limited post-op exercises are important and should be performed as instructed by your physiotherapist. These have to be continued lifelong. Balance rest and activity, especially early in your recovery. Follow instructions to prevent clots. Know the signs of infection. Be careful and avoid falls. Carefully adhere to restrictions. Specific precautions to prevent dislocation of hip are available as separate documents. Risks of not having Surgery Progressive loss of movement at hip making it difficult to sit and climb stairs Progressive shortening of lower limb and limp while walking Degenerative changes in spine Long delay and progressive destruction in the diseased hip can make the surgery more difficult and compromise outcome. Getting ready for the surgery List all the medications you are currently taking. You may be advised to stop certain medicines like clopidogrel and ecosprin a week before surgery. Talk to anesthetist regarding this issue at the time of your pre anesthesia checkup. List any allergies or adverse reactions to drugs or anesthesia in past. Bring your recent x-rays and all the medications you are taking at the time of hospital admission As with all operative endeavors, there is a list of potential pitfalls, problems or complications. To name a few there is risk of Infection, clots forming in the veins of the leg travelling off to the heart and lungs, Pneumonia, Nerve Injury, compartment syndrome and loosening. All the necessary precautions are observed to minimize the risk of complications. Consult the top Hip replacement specialist in Delhi if you are also facing problems with your hip joints or seeking surgery as an option

The knee arthritis treatment in Delhi is composed of three separate bones. They are the lower end of the thigh bone (the femur), the upper end of the shin bone (the tibia) and the knee cap (the patella). These three bones are joined together in a loose arrangement by a surrounding capsule. In addition, there are special ligaments which blend with the capsule outside the knee and provide additional reinforcement. In particular, there are medial and lateral ligaments which help stop the thigh bone and the shin bone from moving sideways upon each other. There are also ligaments inside the knee joint. In particular, there are the anterior cruciate and the posterior cruciate ligaments. These ligaments provide stability in a frontwards to backwards direction, and also provide rotary stability. There are two cartilages or menisci within the knee. These serve to increase the surface area for load distribution, act as cushions or shock absorbers between the femur and the tibia. A normal joint contains between 0.5ml and 2ml of fluid. The knee joint is special in that the bones can hinge, glide and rotate. The joint surfaces are covered with hyaline cartilage.

Procedure: As you will be aware your knee joint has already undergone a knee replacement either partial or complete. Unfortunately the knee replacement which has already been carried out is no longer working satisfactorily. As a result after evaluation and discussion with Dr Aman Dua / Dr Dharmesh Khatri you have decided that revision knee surgery is now are required. This involves removal of the original knee replacement implants, which is no longer functioning well and exchange / replace that with a further Revision knee replacement implant. Removal of prefixed implants may result in damage to the surrounding bone, removal of some extra bone may be required to provide a stable base into which the revision knee replacement can be cemented to bone. The new revision implant is usually more complex and constrained in order to improve your knee function and provide stability. Additional long stems inside the bones, metal augments, cones or sleeves may be required to enhace fixation of implants and to cover for bone loss. Sometimes in order to gain sufficient access in tight joints or in severe scarring, surgeons may need to release the extensor mechanism. This is repaird at the end of the procedure but can make the power of straightening the knee weak. Sometimes the under surface of the knee cap also requires replacement or exchange of the original knee cap replacement. When Surgeons are happy with the position and movements of the knee, the tissue and skin can be closed. Knee revision is usually performed when the pain from your original knee replacement is sufficiently severe for you to say that you are unable to manage given your ongoing symptoms. On occasions knee revision is required because the loosening of the original components are causing damage to the surrounding structures and on occasions because there is significant risk of infection in the joint. Usually in the case of infection the revision surgery would be carried out in 2 stages. The 1st to remove the infected implants debride the joint and replace it with antibiotic cement spacer. After stage 1 patient is followed up regularly with blood markers for infection and the 2nd stage is carried out some months later once the infection has been eradicated. Incase stage 1 procedure fails to eradicate infection, redebridement and cement spacer implantation may be required multiple times till infection is erdicated before going to stage 2. Dr Aman Dua / Dr Dharmesh Khatri has already decided for you based on your symptoms and investigations if a single stage revision can be carried out, however, there is always a possibility that when the knee replacement is opened surgically there is evidence of deep infection which may require conversion to a 2 stage revision. Alternative Procedure: Other alternatives to surgery include living with your symptoms and taking pain killers until the level of your symptoms warrant revision surgery. In the case of proven infection sometimes antibiotic suppression may be a possibility. Sometimes the use of a knee brace may be sufficient to keep your symptoms under control. Some of these alternatives may not be appropriate for you however you should discuss all possibilities with surgeons. Risks and complications The detailed risks and complications are provided as part of the consent for total knee replacement, but, Extensive exposure, longer duration of procedure, poor soft tissue, difficulty in removing the older components, poor bone quality and bone loss may increase the risk of complications like wound problems, Infection, early loosening, fractures during surgery, Instability, decreased range of motion and need for braces and walking aids. The period of recovery in typically longer than in primary knee replacement and you may be advised non-weight bearing mobilization for initial few months Consult from the best Revision Joint replacement doctor in Delhi about your joint issues and its surgery and recovery