A fully active knee replacement surgery without ligament damage was recently performed in Delhi-NCR. DR SUJOY BHATTACHARJEE talks about the advantages of using robotic-assisted technology

This is the first time in the world that a patient’s posterior cruciate ligament (PCL) has been successfully preserved in a fully active robot-assisted total knee replacement. The 63-year-old patient Jai Narayan, a retired train driver from Hathras in Uttar Pradesh, was suffering from pain and deformity in both the knees for the last 10 years due to osteoarthritis. He was able to walk on his own just a few hours after the surgery. Dr Sujoy Bhattacharjee, HOD & Director of the hospital’s Centre for Robotic Joint Replacement, used CUVIS Joints - A Fully Active Robot system with specially developed software to perform the feat.

“We are all very proud of this achievement, which has put Faridabad on the world medical map and proved the mettle of Indian doctors to the international community. We have applied to the Guinness Book of World Records to register this feat from this part of India. The breakthrough surgery is also a testimony to our unending efforts to make available the latest technology to our patients, as evidenced by the installation of North India’s first ‘Fully Active’ Joint Replacement Robot for total knee replacement at Sarvodaya Hospital,”  Dr Rakesh Gupta, Chairman, Sarvodaya Healthcare says. 

Cruciates refer to the two cross-shaped ligaments that exist at the front (anterior) and back (posterior) of the knee, connecting the thigh bone with the shin bone. In conventional robotic-assisted TKR surgeries, both the ligaments have to be sacrificed, due to which the patient has to live with an unnatural feeling around the knee.

Dr Sujoy Bhattacharjee’s breakthrough surgery at Sarvodaya Hospital, Faridabad, marks the first time in the world that a patient’s posterior cruciate ligament (PCL) has been successfully retained in a fully active robotic-assisted TKR surgery. “Preserving one or both knee ligaments in total knee replacement is crucial as it gives a natural feel to the knee and helps stabilise the joint. Patients find their operated knee totally natural, making them forget that they are living with a knee transplant, a concept called the ‘Forgotten Knee’. This has not been possible with conventional robotic surgeries for total knee replacement that are currently performed on patients,” Dr Bhattacharjee says. 

He adds that robot-assisted surgery has huge advantages over conventional methods. These include improved accuracy and precision of implant positioning, much less possibility of human errors or soft-tissue injuries, greater operative accuracy and reduced pain after surgery, ensuring early rehabilitation and mobilisation of patients. We have now gone one step ahead of the world with the capability to preserve the knee ligaments of the patient in such surgeries, which was not possible till now. 

In preparation of the surgery, a non-contrast CT (NCCT) scan of the knees is conducted and the desired bone-cuts and implant size are decided. This information is fed into the robot before the actual surgery. During the surgery, the bone-cuts are conducted with great precision by the robot, minimising possibility of errors.

The patient Jai Narayan was delighted with the outcome of the surgery. “This feels like a second life to me,” he says, adding that he is finally free of the terrible pain he used to suffer while trying to walk on his damaged knees due to osteoarthritis. He thanks the doctors from the bottom of his heart. He is already walking and will be able to get back to day-to-day activities within 1-2 weeks of the surgery and resume normal life in a month’s time.

In knee replacement surgery, the arthritic portion of the knee is removed and replaced by an artificial joint that forms new surfaces of the knee joint. During Cuvis Joint Robot total knee replacement, the 3D images of the patient’s joint are used by the doctor for pre-planning of the surgery personalised to the patient. The doctor uses the robot to select an artificial joint for the patient and insert it accurately. The “fully active” robot reviews the data and cuts the bone precisely with respect to the dimensions of the implant decided during the pre-surgery planning stage under the supervision of an experienced surgeon.