Dr Andre Morrish of Maritzburg Orthopaedic Centre talks us through the latest advancement in knee replacement surgery.
A robotic knee replacement is a combination of conventional knee surgery, which I have been doing for the past 15 years, and computer-aided surgery; done with the addition of a robotic arm which aids in improving the precision of the bony cuts.
Pre-operatively a CT scan facilitates planning and the ability to select the size of the implants as well as the optimal placement of the implants prior to theatre. Intra-operatively these predetermined positions can be modified to balance the knee by changing the bony cuts or releasing tight structures by 1-degree increments. This is
especially useful in severe deformities where prior injuries, such as femoral or tibial fractures, make conventional surgery difficult or near impossible.
A further advantage is that femoral canals are not broached, which is performed in conventional surgery, reducing intra-operative bleeding and post-operative oozing.
Robotic surgery will also decrease or eliminate outliers (positioning of implants incorrectly), and allows me to place an implant with a degree of accuracy not possible with conventional techniques.
It does however come with cost implications. Robotic surgery is currently not paid for by medical aids, however, they should cover the cost of the knee replacement – but not the pre-operative CT scan or rental of the robot intraoperatively.
New negotiations are currently underway to show that the risk of revision is reduced with robotic assistance, reducing the life time cost to the medial aids.
Robotic knee replacements are currently offered at Life Hilton Hospital.
MORE INFO: WWW.PMBORTH.CO.ZA
Dr Andre Morrish was born and raised in Durban before completing his undergraduate and postgraduate studies at the University of Cape Town. He has been in private practice since 2005 with Maritzburg Orthopaedic Centre, and specialises in hip and knee replacements and Nelson Mandela School of Medicine in Durban, where he qualified as an Orthopaedic Surgeon. Back in Pietermaritzburg he gained valuable experience at Edendale Hospital before completing a Hand Fellowship with Prof Mike Solomons at the University of Cape Town. Paul is married, has two daughters and enjoys competing in Maritzburg’s iconic sports of paddling, running and cycling.