Dr Manuj Wadhwa
manuj.wadhwa@gmail.com
For decades, the story of knee replacement surgery has been written in bone cement-a dependable “grout” that has helped millions walk again. Cemented implants brought predictability and stability, and for many years, they served patients well. However, medicine does not stand still. As knee arthritis begins affecting younger and more active individuals, expectations from joint replacement have changed. Patients today are not just asking for pain relief-they want durability, longevity, and a knee that feels natural for decades, not just years.
This shift has given rise to what many experts describe as the era of the “bionic biological knee.” Instead of relying on cement, modern uncemented knee implants are designed to integrate directly with the patient’s own bone. These implants feature porous or textured surfaces, often made of advanced titanium alloys and sometimes coated with hydroxyapatite.
Over time, the surrounding bone grows into these surfaces in a process called osseointegration, creating a strong biological bond. The result is a fixation that does not merely sit in the bone but becomes part of it
Yet, biological fixation demands something critical: absolute mechanical precision. Unlike cemented knees, where cement can compensate for minor inaccuracies, uncemented implants leave virtually no margin for error. This is where robotic technology has emerged as a decisive force.
Robotic-assisted knee replacement allows surgeons to create a detailed three-dimensional map of the patient’s knee before surgery. This enables meticulous planning of implant size, alignment, and positioning based on individual anatomy. During the operation, robotic guidance helps execute bone cuts with sub-millimetre accuracy, ensuring the implant is placed exactly as planned. Such consistency is difficult to achieve with manual techniques alone
This combination of uncemented technology and robotics represents the true breakthrough in modern knee replacement. Robotic precision ensures immediate implant stability-an essential requirement for successful bone ingrowth and long-term performance. When biology and technology work together, the chances of implant loosening, one of the leading causes of revision surgery, are significantly reduced.
Patients undergoing uncemented robotic knee replacement may experience several practical benefits. The absence of cement eliminates the risk of cement-related reactions or long-term degradation. Surgical time can be shorter, as there is no need to wait for cement to set. Robotic accuracy also helps minimise soft tissue damage, often leading to less post-operative pain and faster rehabilitation. In many cases, patients are able to stand and walk on the very same day of surgery
Advanced implant designs used in these procedures aim to replicate natural knee movement, offering better stability and comfort during everyday activities.
However, experts stress that patient selection remains vital. Good bone quality and experienced surgical hands are essential for achieving optimal outcomes.
Uncemented robotic knee replacement is more than a technological upgrade-it marks a philosophical shift in joint replacement surgery. By combining biological integration with robotic precision, knee implants are no longer just replacements; they are becoming extensions of the human body. This union of nature and technology may well define the future of knee replacement surgery.
(The author is Chairman & Executive Director ELITE Institutes of Orthopaedics & Joint Replacement, Chandigarh)
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