Robotic Knee Replacement Surgery in Surat

A knee replacement removes the worn surfaces of the thigh bone, the shin bone and, in many cases, the kneecap, and fits metal and plastic implants in their place. In robotic knee replacement, also called robotic knee surgery or robotic-arm assisted knee replacement, the same operation is done with the help of a robotic arm that the surgeon holds and controls.

The aim is the same either way: less pain from a worn knee and an easier time with walking and stairs. In Dr. Aman's practice Mako is used for both total and partial knee replacement. Here it is one of two routes, the other being conventional instrumented surgery.

Mako is the robotic-arm assisted system at Mahavir Health Campus. In outline, the operation goes like this:

1. Planning before surgery. Mako surgery needs a CT scan of the knee. In Dr. Aman's practice it is usually done the day before surgery, so it adds no waiting time. The scan is used to build a three-dimensional model on a computer, and implant size and position are planned on this model before you go to theatre.
2. Registration and checking in theatre. Registration is repeated in theatre: tracking arrays are fixed to the bones so that the system can match your actual knee to the plan. Once the knee is open, the surgeon checks how the ligaments balance and adjusts the plan where needed before any bone is cut. The system also helps balance the gap between the bones with the knee bent and with it straight.
3. Guided bone cuts. The surgeon moves the robotic arm to shape the bone. The arm sets a boundary that keeps the cuts within the planned limits.
4. Implants and finish. The surgeon fits the implants, the knee is moved through its range to test it and the wound is closed.

Stryker implants are generally used with Mako, because the robotic system is designed around specific implants; other implants can be used. Ask which implant will be used in your case.

Both are accepted ways to replace a knee. Robotic assistance has mainly been studied for how precisely the implants are positioned, and studies have not yet shown that this gives patients better results in the long run. Neither route is presented here as better than the other. In Dr. Aman's view the choice should in future be made by the surgeon according to the knee; at present it is usually made with the patient's preference.

The choice is made with you, after examination and imaging. Points usually considered:

• the shape of your knee and any deformity, such as bow legs or knock knees
• the condition of the ligaments and the quality of the bone
• whether a total or a partial knee replacement is planned
• practical points such as the extra CT scan, about 20 more minutes in theatre and the cost

Robotic surgery adds roughly Rs 65,000 to 70,000 to the cost compared with conventional knee replacement at Mahavir Health Campus. This is approximate and may change; the knee replacement cost page explains what drives the total.

The knee implant guide explains implants and robotic assistance in more detail, and the comparison of total and partial knee replacement covers that choice.

• Assessment. Examination of the knee, standing X-rays and, where needed, MRI. If the robotic route is planned, a CT scan of the knee is added, usually the day before surgery, which involves a dose of radiation. A pre-operative assessment is done so that risk can usually be anticipated, and surgery is sometimes not advised for a patient who is medically unfit.
• General fitness. Blood sugar, blood pressure, anaemia and any infection (teeth, urine, skin) are checked and treated first where needed. Activity level before surgery matters, and pre-operative physiotherapy is advised for some patients.
• Medicines. Bring a list of everything you take. Blood thinners and diabetes medicines may need to be adjusted before surgery, only as advised by your doctors.
• Home. Plan help for the first weeks. If you use an Indian-style toilet, ask about a raised seat or commode for the early period.

Recovery follows the same pathway after robotic and conventional knee replacement. Most people are helped out of bed with a physiotherapist within the first day or two. In Dr. Aman's practice the hospital stay is usually 2 to 3 days, depending on pain, and up to about 5 days when other medical conditions need attention. A walking aid is usually needed for some weeks, and light daily activity returns over the first weeks. Driving is usually allowed at about four weeks, as it is after conventional knee replacement. Many people reach their functional level between three and six months, and some improvement can continue for up to a year.

Do not expect a faster recovery just because the surgery is robotic. How quickly you recover depends mostly on your fitness beforehand and the physiotherapy you do afterwards. People who are active before surgery tend to recover better than those who have been bedridden. Timelines in more detail are in our guide to knee replacement recovery time.

Robotic assistance adds an extra charge to the bill compared with conventional knee replacement; the approximate difference is given under choosing between robotic and conventional surgery above. The total also depends on the hospital package, the implant chosen, the length of stay and your insurance cover. Ask the hospital for a written estimate that lists the robotic item separately.

What drives the figures is explained on the knee replacement cost page and in the knee implant guide.