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What is Augmented Reality Navigation Total Knee Replacement?

Augmented reality navigation total knee replacement is an innovative augmented reality (AR)-based navigation system that promotes greater surgical efficiency and accuracy in total knee replacement. The AR-based surgical guidance system is integrated in a pair of smart glasses or a helmet-based visor and two small sensors and displays surgical targets directly in the field of view of the surgeon. The technology enables your surgeon to measure intraoperatively the effect of prosthesis alignment and positioning on soft tissue balance during total knee replacement.

Total knee replacement, also called total knee arthroplasty, is a surgical procedure in which the worn-out or damaged surfaces of the knee joint are removed and replaced with artificial knee joints called prostheses or implants. Artificial knee joints are usually made of metal, plastic, or ceramic and consist of the femoral and the tibial components.

Anatomy of the Knee

The knee is made up of the femur (thighbone), tibia (shinbone), and patella (kneecap). The lower end of the femur meets the upper end of the tibia at the knee joint. A small disc of bone called the patella rests on a groove on the front side of the femoral end. The fibula, another bone of the lower leg, forms a joint with the shinbone. The bones are held together by protective tissues, ligaments, tendons, and muscles. Synovial fluid within the joint aids in the smooth movement of the bones over one another. The meniscus, a soft crescent-shaped area of cartilage between the femur and tibia, serves as a cushion and helps absorb shock during motion.

Indications for Augmented Reality Navigation Total Knee Replacement?

Augmented reality navigation total knee replacement is usually indicated for individuals with osteoarthritis of the knee joint that is not responsive to conservative treatment. Osteoarthritis is a degenerative joint disease that causes breakdown and eventual loss of cartilage in the joint, causing a painful rubbing of bone surfaces with movement. Other knee conditions that your surgeon may recommend augmented reality navigation total knee replacement include severe knee joint fracture or trauma and failed/revision knee replacement.

Preparation for Augmented Reality Navigation Total Knee Replacement

The preoperative preparation is similar to most knee joint replacement procedures. But contrary to traditional techniques, augmented reality navigation knee replacement involves careful planning and utilizes a series of CT scans to generate 3D images of an individual’s unique knee anatomy. These images enable the surgeon to design a personalized plan tailored to an individual and help to determine the precise implant size prior to performing the surgery. 

In addition, preparation for the augmented reality navigation total knee replacement may involve the following steps:

  • A review of your medical history and a physical examination by your doctor to check for any medical issues that need to be addressed prior to surgery.
  • Diagnostic tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
  • You will be asked if you have allergies to medications, anesthesia, or latex.
  • You should inform your doctor of any medications or supplements that you are taking or any conditions you have such as heart or lung disease.
  • You may be asked to avoid medications such as blood thinners or anti-inflammatories for a specific period prior to surgery.
  • You should refrain from alcohol or tobacco at least a few days prior to the surgery and several days after as they can hinder the healing process.
  • You should not consume solids or liquids at least 8 hours prior to surgery.
  • You should arrange for someone to drive you home after surgery.
  • A signed informed consent will be obtained from you after the pros and cons of the surgery have been explained.

Procedure for Augmented Reality Navigation Total Knee Replacement

Augmented reality navigation total knee replacement is performed under spinal or general anesthesia. Your surgeon will make an incision in the skin over the affected knee to expose the knee joint. Augmented reality navigation provides your surgeon with real-time 3-D images of your mapped knee and the surgical instruments during surgery. The data for the images is provided by infrared sensors fixed to the bones of the knee and surgical instruments. The use of smart glasses and integrated sensors improves the efficiency of the procedure, particularly when coupled with single-use instrumentation. A novel protocol for soft tissue assessment allows for a 3-dimensional evaluation of the ligaments and a better measurement of the effect of tibial rotation. Augmented reality technology superimposes digital content, including data and 3D images, onto the user’s view. It allows the surgeon to view the tibial and femur axis superimposed on the surgical field through smart glasses and provides real-time information during surgery and intraoperative feedback. Surgeons use this information to be precise and receive real-time feedback when removing bone and cartilage and placing a knee implant accurately according to the preoperative surgical plan.

Postoperative Care and Recovery

In general, postoperative care instructions and recovery after augmented reality navigation total knee replacement will involve the following steps:

  • You will be transferred to the recovery area where your nurse will monitor your vital signs as your recover from the effects of anesthesia.
  • You may experience pain, swelling, and discomfort in the knee area. Pain and anti-inflammatory medications are provided as needed to address these.
  • Antibiotics are also prescribed to address the risk of surgery-related infection.
  • You are encouraged to walk with assistance as frequently as possible around the hospital bed to prevent the risk of blood clots.
  • Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.
  • You will be placed on crutches for the first few weeks with instructions on restricted weight-bearing.
  • You are advised to keep your leg elevated above the heart level for a defined period while resting to prevent swelling and pain.
  • Refrain from strenuous activities and lifting heavy weights for the first couple of months. A gradual increase in activities over a period of time is recommended.
  • An individualized physical therapy regimen is designed to help strengthen your knee muscles and optimize knee function once you are off crutches.
  • You should be able to resume your normal activities in a couple of months, but with certain activity restrictions. Returning to sports or high-intensity activities may take at least 6 months or longer.
  • Refrain from driving until you are fully fit and receive your doctor’s consent.
  • A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Augmented reality navigation total knee replacement is a relatively safe procedure; however, as with any surgery, there are risks and complications that can occur, such as:

  • Pain
  • Bleeding
  • Infection
  • Knee stiffness
  • Blood clots or deep vein thrombosis (DVT)
  • Allergic/anesthetic reactions
  • Injury to nerves or blood vessels
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