Expert Knee operations by Mr Andrew Byrne

Mr Byrne performs most of his total knee replacements robotically.

Robotic-assisted total knee replacement is a less invasive option to consider for a diseased knee with arthritis not responding to alternative treatments. The knee joint is opened, but we preserve the muscles, kneecap, ligaments around the knee and significant bone, essentially "resurfacing" all three parts of the knee joint with materials that restore the damaged surfaces and allow a polyethylene cushion to be inserted into the joint facilitating immediate weight bearing and movement to occur.

At the time of surgery, robotic infra-red cameras watch the operation and report to the robotic system the exact position of your leg in 3-Dimensions. This is extremely accurately measured in parts of millimetres. The robot analyses the centre of the hip joint, the centre of the knee joint and the centre of the ankle joint. The diseased knee is then opened, and all diseased areas of the existing knee are "mapped" into the robot – thousands of points of reference – to recreate the current knee in 3-Dimensions. The knee is then placed through a full range of motion, documenting the tightness or looseness of ligaments and any pre-existing deformities or issues. The robot then analyses the optimal position and size of the parts required to perform a total knee replacement to align the knee perfectly. The surgeon may override the robot, BUT before any cutting of bone occurs, the robot calculates the outcome of these changes, and the surgeon can adopt these changes based on their experience or "go back" to the original plan. Having locked in this plan, the robot ensures that this plan is executed with the utmost accuracy.

Many robot systems require scans before surgery to calibrate the system for the operation – the system Mr Byrne uses does not need this expense, radiation dose or inconvenience. The CORI robot "live maps" the patient at the time of surgery, allowing for any changes that may have developed over the time you have been waiting for your surgery to be "factored in" for your operation.

Unlike car manufacturing robots on production lines, this system (CORI – Smith & Nephew) incorporates the surgeon as the robot. The surgeon's brain, eyes, arms, and hands control the operation. The robot controls the cutting device – a burr – controlling the depth of cutting and ensuring that the amount of bone removed is exactly as planned. Not just "close" but exactly.

Parts are then inserted, and the robot checks that the plan has been accomplished. The knee is then closed and dressed.

An electronic wound dressing with a battery pack and vacuum (PICO) is applied along with a device that "kills local germs" under the dressing to minimise wound infection risks. The knee is then compressed with a "rubber-like" bandage to minimise internal bleeding and swelling. This is worn for two days. A small spinal catheter of 0.45 mm is inserted to allow pain management drugs to be injected without the need for needles after the surgery – that night and again the next morning.

No large drain tubes are required to remove blood. The elasticised bandage negates the need for this. Thus, no drains require removal post-surgery.

Most people go home in 2-3 days after this procedure. They are fully weight-bearing. Exercise therapy is advised, commencing immediately supervised by a physiotherapist or osteopath.