In recent years, a variety of advanced technologies have come into use that make the surgical procedure for hip and knee joint transplantation very precise and safe, less invasive, easier for the patient, after which the patient can return to his daily routine in a very short time. These technologies constitute a real line, and they are used throughout the entire process – starting from the stage of planning the surgery, through the surgery itself and even after it.
One of the innovations, for example, is precise preoperative planning. The beginning of the process is the performance of a variety of advanced imaging tests (CT, X-ray, MRI depending on the need), based on the results of which a virtual three-dimensional reconstruction of the damaged joint can be produced. Thus, even before the patient arrives for surgery, the surgeon has a computerized three-dimensional model of the patient’s joint, which allows him to study the structure of the joint and based on which to make measurements for the purpose of fitting the implant required for the patient. Another option is 3D printing of the joint model and fitting the implant on top of it.
This is a real breakthrough, which allows the surgeon to prepare maximally and precisely for the surgery, adjust the implant – and even perform a virtual surgery, which includes a decision on the manner and angles at which the implant will be worn on the existing joint. This design allows a very high level of accuracy in matching the implant to the patient’s joint as well as maximum accuracy in choosing the location of the implant on the bone. Beyond that, the design actually allows the duration of the surgery to be shortened, as it eliminates the need to examine the joint and take measurements on it to adjust the implant during the surgery itself.
But it doesn’t stop at the preoperative stage. In recent years, a variety of new advanced technologies have been incorporated during the surgery itself in joint replacement surgeries all over the world, and in Israel as well. For example, sensors mounted on the patient’s leg transmit directly to the computer and allow the surgeon to work on the joint with maximum precision in accordance with the pre-operative virtual analysis. This technology is also used by the surgeon in assembling the simulated implant on the joint during the operation, the purpose of which is to test the range of motion of the joint and the stability of the leg until the desired result is reached. This, before wearing the permanent implant.
In addition, the operation is accompanied by a unique robotic arm, which guarantees that the operation will proceed only in accordance with the pre-operative planning. Thus, if the robotic arm, holding the surgical instruments, detects a deviation or insufficiently accurate operation, it physically stops the surgery and does not allow it to continue without making the necessary changes in the program itself. This is how the robotic system ensures that soft tissues are not damaged during the operation.
Surgical approaches have also advanced greatly in recent years. While in the past surgeons would not place emphasis on the point of access to the joint during surgery, today there is an understanding that preserving the soft tissues surrounding the joint will contribute to faster rehabilitation after surgery, will reduce the level of pain significantly, and without activity limitations that a patient will be required to. These approaches are for example the front approach, and recently also the superior approach – which does not damage the tissues in front or behind, while preserving the joint box responsible for stability.
Beyond performing the surgery itself, the quality and durability of the implant is also of utmost importance. The last word in the field of joint replacement surgeries are implants from the “Cementals” family – an implant without cement (special glue) – made of titanium. The coating of these implants is similar to bone from a formal point of view. Thus, after it has been fixed, over time the bone grows into the implant, which becomes an integral part of it so that the body does not recognize the implant as a foreign body. These advanced implants are very durable and can last for decades, and beyond the optimal fit for the patient, they are an excellent solution for those suffering from excess weight.
In the end, there will also be the issue of post-surgery rehabilitation, one of the elements that may create fear and resistance to surgery, especially in older people. The good news in this regard is that the combination of pre-operative planning, surgical approaches that do not damage muscles or tissues, and the use of durable and adaptable implants, has led to a real revolution in hip and knee replacement surgeries. Today, patients are able to stand and even walk a few hours after surgery, and in most cases can be discharged home the same day.
This means that there is no need for hospitalization at all – this way the risk of developing post-operative infections and venous thrombosis is significantly reduced, and the patients gradually return to independent functioning, with pain that is controlled with the help of appropriate medication and a gradual return to a full routine and a new life.
The title of the article is Dr. Vadim Bankowitz, director of the orthopedic department at the Soroka Medical Center, and founder of the Yonatan Center, the Israeli Center for Joint and Back Health