Description
In this detailed presentation, Akash Sharma, a consultant knee surgeon at the Birmingham Royal Orthopedic Hospital, introduces the ROSA robotic system and shares a clinical demonstration of his knee replacement procedure. He discusses the importance of pre-operative planning, including the CPAK classification for coronal plane alignment, and emphasizes the necessity of considering three-dimensional and soft tissue aspects—referred to as the fourth dimension—in knee surgery.
Sharma explains his eight-step technique, which he claims applies to about 80% of his knee replacements, particularly for varus and reducible valgus knees. He highlights the role of accurate anatomical marking during the procedure, the testing of the medial collateral ligament (MCL) to evaluate isometry, and the significance of soft tissue laxity assessments to refine surgical outcomes. He utilizes both image-based and imageless methods in planning and executing surgeries, ensuring that the joint line and ligament tautness are appropriately balanced.
The surgeon articulates the need to respect the native anatomical structures, always aiming to restore the constitutional alignment of the knee—often targeting specific degrees of varus or valgus. He further describes his methodology for performing tibial and femoral resections, correcting the knee's alignment, and achieving optimal gap balances through dynamic adjustments based on soft tissue feedback.
Through this approach, Sharma demonstrates how meticulous intraoperative assessments can enhance surgical precision, improve patient outcomes, and contribute to better functional results in knee arthroplasty. His presentation closes with a confident affirmation of the success he has encountered using ROSA in his practice.