What is robotic hip replacement surgery?

Essentially the operation is the same as a standard hip replacement, but more accurate. One of the differences is that a CT scan is done of the hip before the operation rather than a plain x-ray. The CT scan is used to develop a 3D model of the hip and then the computer can plan the perfect position for the hip replacement. During the operation Professor Middleton temporarily attaches a satellite navigation device to the top of the patient’s pelvis. This is so that the robot knows the exact position of the patient’s hip and pelvis. The operation is performed through a standard approach.

Professor Middleton then registers the patient’s anatomy to the 3D model of the hip in the computer and once this is done the robot knows exactly where the patient is. During the operation Professor Middleton performs every step of the procedure, but the robot holds the instruments he is using. If the instruments are in the perfect position the robot does nothing. If the instruments are 1mm out then the robot will nudge the instruments into the correct position. If the instruments are more than 2mm out then the robot will stop the instruments being used until they are put in the correct position.

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Robotic surgery history

Professor Middleton has been involved in the research and development of robotic assisted surgery for over 20 years. His initial work at Imperial College London was on how to make robotic surgery safe. He published on the active constraint model which means although the surgeon actively does every step of the operation; the robot constrains him from making a mistake.

This is the concept behind the mako robot. The biggest centres in North American Europe are now performing robotic assisted surgery and the Bournemouth Nuffield was one of the first centres in the UK to obtain the mako robot. Professor Middleton has the largest personal series in the UK of mako robotic assisted hip replacement.

Why choose robotic hip replacement surgery?

Patients who have had standard hip replacements and robotic assisted hip replacements report faster recovery times, some saying that they feel their recovery is twice as fast. Currently Professor Middleton is carrying out a study to look at the functional outcomes after robotic hip surgery using the GRAIL Gait Lab.

Published results about robotic assisted surgery conclusively show that component positioning is more accurate using a robot than by a human surgeon alone.

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