Robot Surgeon

In the latest in our season on the emerging technology in knee surgery, Prof. Nick London cuts through the marketing to explore the decisions that really are critical to the success of your knee surgery.

Do a quick Google search of the latest news surrounding total or partial knee replacements and you could be forgiven for thinking that the only decision to get right is which knee specialist is going to use the smartest robot.

In reality, the technology comes a distant fourth behind other decisions that can have a profound effect on the success of your knee surgery. Here, then, is the Yorkshire Knee Clinic guide to planning your total or partial knee replacement.

1. The knee surgeon. Far and away the most vital factor in deciding the when/where/who of your surgery is the knee surgeon who will performing your knee replacement. Of course, you’d expect us to say that, but it doesn’t prevent it being true.Experience and outcomes are the key elements to consider, so if you are planning private knee surgery, ask about patient recorded outcomes and revision rates (that is, further work required to correct problems post-surgery). All Yorkshire Knee Clinic’s surgeons have very high patient outcomes and very low revision rates, which is exactly the way it should be.One of the reasons for that is the number of knee replacements we perform. For all the science surrounding it, surgery is a repetitive task. Generally speaking, the more operations you perform the better your outcomes, the lower the risk and the fewer the revisions.

2. The implant. You might expect one knee implant to be largely indistinguishable from the next, but that’s not the case. There are substantial differences in the implants available – particularly where partial knee replacements are concerned. In our opinion the established fixed bearing implant is more effective than the mobile bearing replacement, which was introduced to reduce wear and increase range of motion, but which hasn’t yet delivered any significant clinical improvement.

3. The hospital environment. No knee surgeon works alone. There’s a large and skilled team working to ensure that every part of your diagnosis, surgery and recovery go according to plan. In general terms, as is the case with knee surgeons, facilities that perform high numbers of knee replacements are more likely to deliver better outcomes and lower risk than facilities performing few knee replacements.There will always be exceptions. Not every high volume knee surgeon will have an impressive track record and not every high volume hospital will deliver better results than a lower volume one, so it is worth doing your research, but more experience usually means better results.

4. The technology. At this stage, we’re not talking about robot-enabled procedures, which as this article notes, still have some way to go. Rather, we are looking at the assistive technology (of the sort explored in this piece) which may aid knee surgeon accuracy.There may be a point at which the technology helps to cut the cost of surgery and at that point it may be that this becomes a greater factor in the decision making process. For now, however, the technology is very much a secondary factor to the far more fundamental issues explored above.

> Technology vs Experience
> In Defence of New Technology
> Decisions That Really Matter for Your Knee Surgery

Prof. Nick London

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.”

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