There is a role for emerging technology in knee surgery. In the latest in our technology season, Yorkshire Knee Clinic explores the assistive tech likely to become more commonplace in the operating theatre soon.
If you are something of a regular to these pages, you may have noticed something of a theme developing. We take issue with those marketing robot ‘enabled’ knee surgery who, often by implication, are giving patients the impression that it is in some way better than – or even a major departure from – traditional techniques. Neither is the case, and Yorkshire Knee Clinic’s Prof. Nick London explores why experience still trumps robotic technology here.
But just because the state of robotics is not (yet) advanced enough to deliver on its potential, that doesn’t mean there are no other fields of emerging technology showing real signs of making a difference. And they’re likely to become far more commonplace in operating theatres long before the next generation of robotics arrives.
So here’s one area of emerging technology that we’re excited about now, and which genuinely appears to offer something new and beneficial in an increasingly cost effective way.
You may be familiar with the concepts of augmented or mixed reality, even without necessarily knowing those terms. If you or someone you know has played Pokémon Go – the game that places animated characters into the live image picked up by your phone’s camera – they’ve been dabbling in augmented reality (AR). Similarly if you’ve been shopping in any store which blends a live camera image with a product (some high end fashion stores are using smart mirrors that can show you ‘wearing’ a product without ever needing to set foot in the changing room) then that’s AR too.
In the operating theatre, AR operates by a sort of ‘heads up display’ projected onto smart glasses. As this US study noted, the AR can help knee surgeons (and others) visualise critical structures such as major blood vessels and nerves – something that can be particularly useful in training, or with inexperienced surgeons. Because the image is transparent and overlaid directly onto the working area, the surgeon does not need to look away to refer to other notes, images or data – it’s all presented on the display before them. AR may also benefit surgeon accuracy – improving the alignment of cuts and the positioning of blades and pins.
With improvements in voice recognition also removing the need for tapping keyboards or tablets, this form of assistive technology is expected to reduce operative time and cut risk.
There remain challenges to overcome – not least that the information out can only ever be as good as the data that’s put in, but the next decade is likely to see more assistive technology that can aid some or all knee surgeons and, crucially, do so in a way that isn’t cost prohibitive.
Assistive that really assists
Without doubt there is room for technology to assist surgeons to improve accuracy and reduce complications and operative time. To date, robotics has increased time in surgery but hasn’t make any difference clinically. This is the critical difference in the state of technology at present. Like the artificial intelligence powering the next generation of cars, the technology to assist is here already and, with some significant fine tuning, can benefit surgeons to the same degree it’s benefitting drivers.
It may not sound as exciting and enticing as robotics. It may not have the marketers salivating in quite the same way. Yet unlike robotics at present, it may really make a difference.
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Prof. Nick London
Specialist Knee Surgeon & Visiting Professor to Leeds Beckett University
“An excellent knee surgeon. He probably does as many partial knee replacements as anyone in the country.”