Robotics in Arthroplasty

Robotics in Arthroplasty

Rush University Medical Center is as much a part of the history and evoluation of arthroplasty surgery as is any other institution in the world. The late Jorge O. Galante, the first chairperson of the Department of Orthopaedic Surgery at Rush (then Rush St. Luke's Presbyterian) in 1972, was a key inventor and developer of the Harris-Galante cementless total hip replacement as well as the Miller-Galante total knee. Both of these designs are the basis of modern implants and remain one of the biggest contributions to the field of joint replacement.

Since Galante's tenure, Rush has been at the forefront of innovation and technology in the field of arthroplasty and arthroplasty research. From the contributions of Joshua Jacobs, MD, in the field of metallurgy and tribology, Richard Berger, MD, in mimimally invasive surgery and Craig Della Valle,MD, in the treatment of infection, Rush continues to be a place of learning and of discovery with the end goal of treating musculoskeletal disease at the highest level. 

Rush has taken steps to be at the leading edge of orthopaedic innovation by adopting robotic assited hip and knee replacement. This technology allows surgeons submillimeter accuracy in placement of components, enhanced ability to balance ligaments around the knee, and an unprecedented level of granular intra-operative data for research. Although implant design remains unchanged, this new technology has the potential to improve, both the study of and practice arthroplasty.

Vasili Karas, MD,MS, recently joined the faculty at Rush as part of the Department of Orthopaedic Surgery, Adult Reconstruction Section, and is bullish on robotics in orthopaedics. He is a new faculty member, but a familiar face here at Rush. He completed medical school, a masters in anatomy and cellular biology, as well as fellowship in adult reconstruction within the institution. 

What was your motivation to return to Rush?

Rush is my home. Chicago is my home. I have family here. I mean I have one brother and three sisters in and around the city, but I also have surgeons, nurses, staff and colleagues who have mentored me and helped me along my path over the last decade that I wished nothing more professionally than to come back here and honor them by doing the same for the next generation of Rush Students, residents and fellows. 

Why are you interested in robotics in Arthroplasty?

I am interested in moving the needle for our patients and our profession. Patients often come into the clinic inquiring about new technology on the horizon and ask, if they wait, will there be something better out there to treat their arthritis. The honest answer is that we are not sure if robotics is this "something better". Our literature does show that robotic assisted technolgy does help us place implants into patients more accurately,within tighter tolerances, and some studies go as far as to say with more respect to a patient's soft tissues. 

I am a student of knee replacement, and believe in a surgeon's ability to achieve a long lasting and highly functional result. Through further gait analysis, biomechanical study and clinical inquiry, I think we have a chance to, yet again, put Rush on the map for being a place of high-level science in arthroplasty.

I have been using robotic assisted technology for over a year now and, certainly just anecdotally, patients who undergo these surgeries do seem to progress more quickly and reliably through their post-operative recovery. I'm at Rush because I think this is a place that will give me the necessary support to continue to push the envelope in arthroplasty and, subsequently, better the lives of my patients.

Patient Results

Below are several screens taken from a robotic assisted total knee replacement performed this year by Karas. The upper pane depicts one of the planning screens where a preoperative CT scan is utilized to assess sizing and bony morphology. Then intra-operatively, ligamentous forces are assessed and the knee is balnaced before making any bony resections. The lower plane is this patient's post-operative radiographs that demonstrate exevution of the presribed plan.