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Miller School Orthopaedic Surgeons Make Robotic-Assisted Total Knee Replacement Safer

Their guide, published in Arthroplasty Today, provided recommendations for limiting nerve and vessel damage during robot-assisted total knee arthroplasty.

Researchers at the University of Miami Miller School of Medicine have created a guide to make robot-assisted total knee arthroplasty (RATKA) safer for patients.

Orthopaedic surgeons use the technique to increase the accuracy of total knee replacement, aiming to reduce the likelihood of complications and speed recovery.

Precise Pin Positioning During Knee Replacement

Before the procedure, doctors insert an array of pins through the skin into the femur and tibia to guide the robot during the procedure. Complications like infection or bone fractures around the pin sites can occur and have been well studied. But potential damage to nearby nerves and blood vessels has not, until now.

Illustration of the knee and leg
Miller School orthopaedic surgeons have published a guide that shows how to accurately place pins during robotic-assisted total knee replacement.

“We are recommending how orthopaedic surgeons can place the pins safely to avoid vessels, nerves and big arteries,” said Victor H. Hernandez, M.D., associate professor in the Department of Orthopaedics and chief of the Division of Arthroplasty and Adult Joint Reconstruction at the Miller School.

Dr. Hernandez and lead study author Jaime Carvajal Alba, M.D., collaborated with colleagues from the Miller School’s Department of Orthopaedics and Department of Radiology to develop guidance based on a study of MRI images of people undergoing RATKA. They analyzed the scans to identify structures at risk, safe zones and optimal pin trajectory and insertion angles.

Their guide, “Safe Zones and Trajectory of Femoral Pin Placement in Robotic Total Knee Arthroplasty,” was published September 19 in the journal Arthroplasty Today.

Speeding Recovery Time for Knee Replacement Patients

To determine best practices, Dr. Hernandez and colleagues divided the MRI scans into zones and noted the location of nerves and blood vessels. The guide they developed demonstrates the optimal location and angle for pin insertion, which decreases the risk of damage to nerves and vessels and minimizes patient recovery time.

Victor Hernandez, M.D., and Jaime Carvajal Alba, M.D.
Victor Hernandez, M.D., and Jaime Carvajal Alba, M.D., studied MRI scans to determine nerve and vessel location during the knee replacement procedure.

The nerves and vessels around the knee differ between men and women, so the study authors also address pin placement by gender.

The work of Dr. Hernandez and colleagues is yet another example of how researchers at the Miller School stay at the forefront of the rapidly evolving world of medical technology.

“We are the ones who publish the papers that people quote or base their practices on,” Dr. Hernandez said. “We have access to three different robots—virtual, mixed and augmented reality, as well as wearable devices. There’s no facility in South Florida that has that many technologies to benefit patient care.”

Tags: Department of Orthopaedics, Dr. Jaime Carvajal Alba, Dr. Victor H. Hernandez, knee surgery, orthopedic surgery, robotic surgery, USNWR Ortho