Nuffield Health is using innovative hi-tech assistance to aid orthopaedic surgery at its Cambridge hospital
The challenge is to make the cuts in the right place'
Although the first tools that spring to mind when you think of surgeons at work are scalpels and saws, when it comes to orthopaedic surgery on bone and muscle they also play the roles of architect and builder.
“We’re taking elements of engineering, elements of carpentry and sculpture, and taking that into the domain of healthcare,” said Joel Melton, Cambridge University Hospitals orthopaedic surgeon, who specialises in knees.
“Accuracy is of paramount importance to restore balance to a knee.”
At Nuffield Health Cambridge Hospital the use of robotic assistance is aiming to make that accuracy ‘more perfect’.
It takes everything that I do that's perfect and allows me to do it. It takes anything that is slightly less than perfect and stops me
Mako is Robotic Arm Assisted Technology that communicates with a CT scanner. It’s the only robotic-assisted arm designed for use with orthopaedics and there are only a few in use in the country.
“From my perspective, robotic assisted surgery is the pinnacle of what the industry can offer us as surgeons to improve the accuracy of what we do,” Mr Melton said.
Better accuracy means faster recovery, a higher chance of a joint returning to normal function and a new joint that lasts longer.
The Mako assists partial knee replacement, total knee replacement and total hip replacement. According to the National Joint Registry, 50,747 hip and knee procedures have been undertaken so far this year.
Mr Melton says, on average, about 90 per cent of new joints will last more than 20 years.
He continued: “It’s good. The problem is that we don’t see perfect function in every case. So despite our best efforts we still see a rate of dissatisfaction in knee replacement of 10-15 per cent, even though we’ve done our very best to improve the symptoms by accurate implanting.
“In an arthritic joint we start to see cartilage being eroded, and bone loss in severe cases,” Mr Melton explained, “so there’s a material loss within the joint. That results in the pain and swelling and dysfunction of that joint and also often deformity of the limb. Our task with implant surgery is to replace part or all of the material that’s been lost and get back to the natural shape and alignment of that limb to restore proper function.”
That’s where the Mako comes in. In the first instance it allows more pre-op planning.
Graham Keene, consultant orthopaedic surgeon who specialises in hip replacement, said his greatest challenge is ensuring component orientation is optimal. He said: “Mako supports surgery by helping to ensure the component orientation in the pelvis is reliably matched to the individual patient and pre-operative planning.”
“In many ways, the operation has begun before the surgery has started,” said Mr Melton. In the operating theatre, the Mako uses triangulation to guide the surgeon’s tools.
“My arm is being guided by the Robotic Arm Assisted Technology. Essentially it takes everything that I do that’s perfect and allows me to do it. It takes anything that is slightly less than perfect and stops me being able to do that.”
Simon Stacey, robotics clinical service manager at Mako producers, Stryker, explained: “It’s 3D intraoperative tracking, used to keep the robotic arm within the strict parameters of the preoperative plan.
“It works like GPS as a triangulation between a base station, a satellite and a moving car. We have an infra-red camera overlooking the operating field acting as the satellite, and tracking frames attached to the patient’s bones, like base stations. The surgeon’s instruments also have tracking devices on them, so that’s your car.
“The surgeon has to touch reference points as determined by the Mako and it then identifies where the CT scan is in surgical space in relation to the patient’s anatomy.
“The whole robotic arm is then held within a fixed field. If it senses that a surgeon is moving their tool to the edge of their preoperative plan, it stops to ensure accuracy is maintained.
“It’s been in use since February and reams of data that speaks to its effectiveness is being collected.
“It’s a pleasure to use from a surgical perspective because it’s still a tool that I’m holding,” Mr Melton said. “There are many platforms I use where there might be well in excess of 100 tools to choose from. The Robotic Arm Assisted Technology is essentially a further tool.”
Mr Melton is expecting robotic assistance to become more commonplace across the healthcare sector, and says Nuffield is a great place to pioneer this new tech.
“The burden of arthritis as a disease for the globe is absolutely enormous,” he said. “Huge amounts of time and resources are put into trying to repair degenerate cartilage.
“I work in a department full of expert colleagues who are well placed to be evaluating these newer technologies and how they can benefit our patients, and that’s why we’re here: to get better outcomes for our patients.”
Innovations & Innovators
This article part of our series of features focused on Innovations & Innovators, published in association with Ensors, Nuffield Health, Cambridge Innovation Park and Hilton City Centre Hotel.
Look out for our Innovations and Innovators seriesLook out for our Innovations and Innovators series
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