Innovations – robots in orthopaedic surgery




Robots like this one, coordinated with 3D models of the patient created with CT scans, allow an orthopaedic surgeon to control instruments very precisely.
Orthopaedic surgeons are using technology to navigate their patients’ bodies with unprecedented precision during surgery.

Computers can enable surgeons to monitor movements in a patient’s body during surgery, and they show where the surgeon’s instruments are in relation to particular parts of the body.

Prior to surgery, the machines use CT, MRI and PET scans to build a 3D model of the patient’s body. This is then electronically matched to the patient during surgery using infrared cameras, so the surgeon can see the precise location of bone, nerves and blood vessels.

“If I move the patient around, the patient’s avatar on the screen moves, so the computer says if you’re at this angle and you want to change to this angle, you must make the following cut.

"It shows how many degrees and how many millimetres. It’s very much like flying a plane at night."
    - Peter Choong
The machines mean surgeons can operate on patients with previously inoperable tumours in difficult to reach places where there was a risk of cutting vital nerves and blood vessels - or of spreading cancerous tumour cells.

Some orthopaedic surgery may now also be undertaken using a robot. Robots may be used for joint replacement, spine and bone cancer surgery.
Robots have been used in Australia for over 10 years to assist with cardiac, kidney and other surgeries. In a robotically-assisted operation, planning for the optimal positioning of the joint replacement components to fit the patient’s anatomy is done by specialist engineers, in collaboration with the surgeon. The robot creates a 3D representation that matches a CT scan of the patient’s body.
Once the robot understands the individual patient’s ‘geometry’, it is able to follow movement using a signal transmitted by trackers fixed to the bones.
During the surgery the robot helps the surgeon to scale their movements and correctly place the components of the prosthesis in the body, while a 3D camera gives a view of the operative field. At the console the surgeon controls the surgical instruments and cutting tools with sensitive thumb and finger grips, while foot pedals control the 3D magnifying camera.

The AOA National Joint Replacement Registry monitors the uses of new technology as part of its collection of data related to joint replacement surgery.

Most significant for the patient’s outcome remains that any operation is performed by a skilled orthopaedic surgeon, whatever technology may or may not be used. However, it is expected that in future, more complex cases may be particularly aided with the use of surgical robots.