Top 6 New Knee Replacement Surgery Techniques

Total knee arthroplasty (TKA), or  knee replacement surgery, has transformed the lives of countless patients with severe arthritis, traumatic injuries, and degenerative joint diseases.

This article overviews six of the most innovative, currently discussed technologies for reshaping TKA and includes their key features, advantages, and clinical potential.

Six New Knee Replacement Surgery Techniques

Conventional techniques rely, at best, on 2D imaging and surgeons' personal experience to perform bone cutting and implant positioning. While very effective, these manual approaches can sometimes be replete with inaccuracies, including but not limited to component malalignment and uneven bone cuts that may eventually lead to patients' dissatisfaction and suboptimal long-term results.

Over the past few years, great strides have been accomplished in new knee replacement surgery techniques that have augmented precision, improved surgical efficiency, and allowed better patient recovery. By utilizing innovations such as robotic guidance, computer-assisted systems, and patient-specific planning, surgeons can now offer highly tailored, minimally invasive operations.

1. Computer-Assisted Navigation (CAN)

The use of technology to aid surgeons during knee replacements is considered one of the early and time-tested techniques: Computer-Assisted Navigation, or CAN. This technique employs infrared trackers along with 3-D models generated from the patient's anatomy to accomplish accurate bone alignment and positioning of the implant during TKA.

Clinical benefits:

Increased precision and reproducibility of surgery

The better alignment of the limbs, diminishing implant wear and improving long-term results

Immediate feedback to surgeons on optimal joint balance

Evidence and Use:

Many clinical studies have identified that CAN reduces outliers in alignment and can increase implant longevity. It remains a reliable and economical option in hospitals with basic navigation setups.

2. Augmented Reality (AR)

Among the most recent methods and techniques of knee replacement surgery is Augmented Reality, which merges digital imaging with real-world surgical visualization. By using special headsets or tablets, AR projects real-time virtual overlays of anatomical structures and surgical landmarks onto the operating field.

Advantages:

Improved spatial awareness without bulky navigation consoles

Smaller surgical exposure; quicker setup

Improved training and intraoperative decision-making

Current Evidence:

Although the AR-assisted knee replacement techniques are still under development, early reports from some centers have indicated increased precision of the implant and lesser learning curve in comparison to the conventional navigation systems.

3. Robot-Assisted Total Knee Arthroplasty

Robotic-assisted knee replacement surgery, such as Mako, ROSA, and NAVIO, represents major leaps in precision and patient-specific planning. These robots create a detailed 3D model of the patient's knee pre-operatively and then assist in bone resection and implant placement down to millimeter-level accuracy.

Advantages:

Excellent consistency, reproducibility

Minimized soft tissue trauma and blood loss

Possibly earlier rehabilitation and better early function

Clinical Practice:

Robotic-assisted TKA has gained wide acceptance in most parts of the world. Long-term trials have shown improving alignment and lowering revision rates.

4. Intraoperative Sensors

Innovation in knee surgery includes the introduction of intraoperative sensors. These wireless sensors, placed temporarily during the operation, are used to measure joint balance, ligament tension, and the distribution of load in real time.

Advantages:

Objective, data-driven guidance for soft tissue balancing

Reduced risk of instability and postoperative pain

Improved patient satisfaction and early mobilization

Clinical Relevance:

Intraoperative sensors eliminate the guesswork, enabling surgeons to fine-tune each Total Knee Arthroplasty according to the individual anatomy and further personalize the treatment outcome.

5.3D Printing Technology

Among the latest technologies in knee replacement surgery is 3D printing, which has redefined the manufacture of implants and surgical guides. Using reconstructions based on CT or MRI, engineers and surgeons team up to design customized knee replacement parts that match up perfectly with patient anatomy.

Advantages:

Custom-made implants and PSI guides for high-precision bone cutting

Optimized preoperative planning by iterative digital design.

Shorter operating times and better fitting of prosthetic parts

Clinical Evidence:

The integration of patient-specific data with Computer-Assisted Surgery systems makes 3D printing a key driver of individualized precision for TKA.

In China, one of the leading researchers in the field of applications of 3D-printed technology in TKA is Professor Bin Yang from Peking University International Hospital. Several of his publications illustrate the safety, accuracy, and accessibility of these techniques in routine clinical use[1,2].

6. Patient-Specific Instrumentation

As a direct clinical application of the 3D printing technology described above, PSI has become a cornerstone in a new approach to knee replacements. In PSI, principles of Computer-Assisted Surgery are used to design customized surgical guides (printed via 3D technology) that are matched to the patient's particular bone structure based on preoperative CT or MRI scans.

Advantages:

Improved accuracy in alignment and surgical efficiency.

Operative time and blood loss were reduced.

Increased affordability compared to full robotic systems

Clinical Development:

The rapid evolution of PSI enables precise and reproducible cutting guides. Several studies have shown comparable or even superior accuracy compared to robotic systems in selected patients. This approach is of special value for hospitals that have limited resources but handle a high volume of surgeries, offering a balance between precision and cost.

Technology Selection and Future Directions in Knee Replacement

While new technologies have demonstrated great promise in knee replacement surgery, several clinical and logistical factors affect the choice. Surgeons have to take into account the patient's knee deformity, the quality of the bone, the availability of equipment in the hospital, and their personal experience and preference.

CAN and Robotic vs. PSI

CAN and Robotic systems make available unparalleled precision and real-time navigation, but demand a high investment and longer setup.

On the other hand, PSI and 3D printing are methods that can offer low capital expenditure, rapid implementation, and comparable accuracy for their wide clinical adoption, particularly in developing healthcare systems.

Future Outlook

Integrating AI and smart sensor technologies will enable personalized knee replacement surgeries; these technologies will estimate the longevity of the implant and optimize postoperative rehabilitation.

Care at SunMoon

At  SunMoon, it is our mission to make the most advanced knee replacement surgery techniques accessible to each and every patient today. We combine clinical excellence, innovation, and compassionate care to help patients regain mobility and live a life free of pain. Our Orthopaedic Department brings together distinguished surgeons, engineers, and rehabilitation specialists who work collaboratively in the development and delivery of personalized treatment plans.

References

The Bony Resection Accuracy with Patient-Specific Instruments during Total Knee Arthroplasty: A Retrospective Case Series Study. BioMed Research International. 2021; 2021:8674847. DOI: 10.1155/2021/8674847

Wang, J., Wang, X., Sun, B., Yuan, L., Zhang, K., & Yang, B. (2023). 3D-printed patient-specific instrumentation decreases the variability of patellar height in total knee arthroplasty. Frontiers in Surgery, 9, 954517. https:/doi.org/10.3389/fsurg.2022.954517