Knee prosthesis revision using robotic surgery, in a 66-year-old patient

Cristian, aged 66, had reached a point where he could barely move his left knee due to pain. The problems had begun five years earlier, following a motorcycle accident that resulted in severe injuries. At that time, he underwent an arthroscopy, followed by a total arthroplasty in which a knee prosthesis was implanted. Over time, the joint's mobility declined once again, necessitating a further procedure — an arthroscopic débridement to remove adhesions — which, however, brought only temporary relief.

As a rule, a knee prosthesis can restore mobility to a severely damaged joint, but there are cases in which functional outcomes deteriorate over time. Pain, stiffness, and restricted movement may call for a fresh orthopaedic assessment, and in carefully selected situations, prosthesis revision may be required — a more complex procedure than the original implantation. New robotic surgical technologies in orthopaedics allow the surgeon to plan each stage with precision and to tailor the procedure to the patient's anatomy, as was the case with Cristian.

Over time, the man's knee had become almost non-functional: he was unable to extend it fully, with extension limited to minus 15 degrees, and flexion had dropped to just 40 degrees. He walked with difficulty, and simple activities such as putting on his shoes or caring for his foot had become hard to manage without assistance.

The patient consulted Dr. Liviu Ojoga, a primary specialist in orthopaedics and traumatology and Head of the Orthopaedics and Traumatology Department at Spitalul Clinic SANADOR. X-rays showed that the existing prosthetic components were well fixed, but there were minor implantation defects: the joint line was elevated, the patella was in a low position, and fibrous tissue that had formed following the previous surgeries was restricting movement.

Following the assessment, Dr. Ojoga recommended prosthesis revision surgery. The case was challenging, as the patient had diabetes mellitus with polyneuropathy, obesity, arterial hypertension, dyslipidaemia, and cardiovascular conditions, including a history of myocardial infarction. A thorough medical evaluation was therefore required prior to the operation.

At Spitalul Clinic SANADOR, the team led by Dr. Liviu Ojoga performed the first robotic revision knee arthroplasty in Romania using the CORI system. The procedure was carried out under spinal anaesthesia. The CORI robotic system does not operate autonomously, but provides the surgeon with real-time information and enables a three-dimensional model of the knee to be created during the operation, without the need for a dedicated CT scan or MRI for planning purposes.

During the procedure, the old prosthetic components and fibrous tissue were removed, the joint line level was restored, and the new components were positioned in accordance with the plan developed using the CORI system. Additional elements were used for stability, and the patella was resurfaced, with the maximum possible amount of bone preserved.

Thanks to a favourable postoperative recovery, Cristian was discharged three days after the operation. Within fewer than three weeks, he was able to extend his knee fully, achieving 0 degrees of extension, and flexion had reached approximately 94–95 degrees. He was once again able to put on his shoes and care for his foot independently, and continued with his rehabilitation programme to improve mobility and muscular strength.

At Spitalul Clinic SANADOR, patients with knee joint conditions have access to orthopaedic consultations, imaging investigations, preoperative assessment, and robotic orthopaedic surgery — both for primary arthroplasty and for prosthesis revision, where indicated. Procedures are carried out in a suitably equipped operating theatre, supported by a Category I Anaesthesia and Intensive Care Unit. Following surgery, patients may continue to benefit from SANADOR services, including individualised medical rehabilitation programmes tailored by a specialist to the specific needs of each case.