Robotics, Navigation and AI in Joint Replacement

Yes. We optimise the patient's haemoglobin before surgery with hematinics or iron injections and diet, waiting a couple of weeks for it to improve. If that isn't sufficient, we use autologous transfusion: the patient's own blood is drawn and stored in advance, with no cross-matching needed, and given back to the same patient during surgery.

Templating started as physical templating, then moved to digital templating software. But since we have now shifted to more advanced techniques, we don't rely on templating anymore - intraoperative robotic-assisted guidance gives more accurate implant sizing and positioning directly.

Beyond computer navigation, robotics and AI, there has also been advancement in surgical approach. Older approaches like the posterior and direct lateral approach cut through muscle to enter the hip. The direct anterior approach (also called direct superior approach) avoids any muscle cut or nerve violation, with very minimal blood loss and a minimally invasive incision - patients can often go home after one day, or even as daycare.

In our setup, infection risk is under 0.3%. The two main factors are patient factors (immunocompromise, uncontrolled diabetes, hepatitis B, HIV or other viral disease) and surgeon/facility factors (poor surgical technique, poor OT culture, inadequate medication availability, or poor post-operative care).

There is a gut-joint axis theory: poor absorption of micronutrients, from conditions like coeliac disease, gluten allergy, Crohn's disease, ulcerative colitis or chronic acid-peptic disease, is linked to an increased chance of arthritis, whether autoimmune or degenerative. Post-operatively, any surgery causes a drop in general immunity for 12 to 20 weeks, since the patient is in a hyper-catabolic state, so we need to give a good protein diet (milk and milk products, protein powder, vegetarian protein) and increase total calories so the patient regains immunity as soon as possible.

From patient-specific instrumentation, to computer navigation, to robotic-assisted surgery, and now AI combined with robotics, which is imageless and needs no pre-operative CT/MRI or extra-articular pins.

It has moved from physical to digital templating, but robotic-assisted intraoperative guidance increasingly bypasses templating altogether for more accurate sizing.