Prof. Dr. med. Michael Hirschmann is a highly respected expert in the field of knee surgery and knee arthroplasty, with outstanding expertise in all aspects of the knee joint. His impressive career has been recognized with numerous prizes and awards, particularly for his innovative achievements in joint replacement, where he is internationally renowned for his outstanding work in revision surgeries. In 2013, Prof. Dr. Hirschmann was appointed head of the Knee Surgery and Sports Orthopedics team and Chief of Orthopedics and Traumatology at the internationally renowned Baselland Cantonal Hospital. This appointment was celebrated in the region as the return of a knee specialist with an international reputation who had completed his orthopedic residency at this very hospital. During his time at the Baselland Cantonal Hospital, he played a key role in establishing Basel as a firm fixture on the global map of orthopedics and earned a reputation that extends far beyond the region.
With the drive of an athlete, Prof. Dr. Hirschmann dedicated himself to continuous specialization and gained international experience through fellowships in Germany, Italy, France, Finland, the United Kingdom, and Australia, among other countries. Particularly noteworthy was his participation in the international exchange program of the “Asian Pacific Knee Arthroscopy Society” (APKASS) in Asia. The knee specialist is known not only for his professional excellence but also for his patient-centered approach. Precision, meticulousness, and the pursuit of optimal outcomes characterize his surgical work. His clinic in Baselland benefits from his dedication and transparent communication, while his patients appreciate not only his medical expertise but also his empathetic care.
Prof. Dr. med. Michael Hirschmann is undoubtedly a key figure in the field of knee surgery and knee arthroplasty, whose expertise, research contributions, and patient-centered approach ensure orthopedic care of the highest standard. Robot-assisted surgery is becoming increasingly common in the operating room, so the editorial team at Leading Medicine Guide took the opportunity to learn more from Prof. Dr. Hirschmann about robot-assisted total knee replacement surgery.
The robot-assisted surgical procedure utilizes state-of-the-art robotics to ensure precision and accuracy in the placement and alignment of the implants. Imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI) can be used to create a detailed 3D map of the knee joint. These images can then be fed into a computer-assisted navigation system, which provides the surgeon with a precise view of the patient’s anatomy. However, image-free surgery is also possible with the robot. Robotic-assisted total knee replacement offers several potential benefits. On the one hand, the precise placement of the implants may extend the lifespan of a prosthesis, and on the other hand, it reduces the likelihood of complications or potential follow-up surgeries. Furthermore, the technology allows for a much more individualized adaptation to each patient’s anatomical characteristics.
Robot-assisted total knee replacement offers improved precision in the placement and alignment of implants compared to conventional procedures.
A key advantage lies in preoperative planning, during which, for example, 3D imaging technologies are used to create a detailed plan tailored to the patient’s individual anatomy. This plan is implemented with robotic assistance during the procedure to ensure optimal placement and alignment of the prosthetic components.
“The biggest advantage of robot-assisted total knee replacement surgery is that you can place the prosthesis exactly where you want it. With conventional methods, on the other hand, there’s always a certain degree of variation, even with experienced surgeons. Furthermore, you can also optimize ligament tension—a real navigational advantage—across the entire range of motion of the knee. You can perform the implant in a much more personalized way, because after all, every person has a knee that’s different in shape, range of motion, and ligament tension,” explains Prof. Dr. Hirschmann as we begin our conversation, adding: “There are exactly three such knee robots (Velys) in Switzerland, which are accessible to all patients. In the future, it may be necessary to classify the use of a robot as an additional service.”
Ligament tension in the knee refers to the structural tension or degree of structural strength of the ligaments surrounding the knee joint. The ligaments in the knee—such as the anterior and posterior cruciate ligaments and the collateral ligaments—provide stability and support the joint’s movements. Ligament tension is crucial for maintaining the knee joint in a stable and functional position, without being too loose or too tight. Balanced ligament tension is important for protecting the knee from injury and ensuring the joint’s normal range of motion.
Robot-assisted technology allows surgeons to correct even the smallest deviations during the procedure and achieve greater precision in implant placement. These precise adjustments and individualized alignment help restore the knee’s natural range of motion and minimize the likelihood of complications.
Robot-assisted technology in total knee replacement represents a significant advance in orthopedic surgery.
Precise alignment not only contributes to a customized fit but can also distribute the load more evenly across the implant. “This minimizes wear on the prosthetic components, which can potentially extend the prosthesis’s lifespan. Real-time corrections during the procedure help reduce potential errors and maximize the accuracy of implant placement.” Another advantage of robot-assisted technology is faster patient recovery. Thanks to the precise procedure, the patient can recover more quickly, which also has a positive impact on the long-term functionality of the prosthesis. The surgery itself takes about an hour, and as early as the first day, the patient can put full weight on their leg, though they use walking canes for safety. They stay in the hospital for about 3–5 days and then begin rehabilitation, which involves starting to move the knee more intensively. For 85% of patients, a prosthesis lasts about 15–20 years and would then need to be replaced if necessary. Some patients even keep their prostheses for 30 years. Overall, robot-assisted total knee replacement enables a highly precise and personalized surgical approach. “This advancement in orthopedic surgery helps maximize patients’ quality of life and optimize the effectiveness of total knee replacement surgery,” says Prof. Dr. Hirschmann.
Individual adaptation to the patient’s anatomical characteristics plays a crucial role in robot-assisted total knee replacement.
“There are two different forms of robot-assisted surgery: image-guided and non-image-guided. In image-guided surgery, a so-called CT scan is performed beforehand and displayed visually for the surgeon during the procedure. This enables a precise analysis of the knee’s anatomy, including bone structure, alignment of the joint surfaces, and individual variations. With robotic assistance, this 3D model is used during the procedure to ensure 100% precise placement of the implants. The image is superimposed onto the patient, providing all the necessary information. In image-free surgery, the surgeon uses a pointer to scan various points on the patient during the procedure. This generates a point cloud—a three-dimensional representation of points in space—and a model of the knee, which is then used as the basis for the surgery. Precise planning and measurement prior to the procedure enable the robot to assist the surgeon’s movements during the operation. The image-free method is logistically simpler, but both are equally established and effective,” explains Prof. Dr. Hirschmann.
In recent years, significant progress has been made in the development of robot-assisted total knee replacement.
“During my time in London in 2009, I gained my first experience with robot-assisted knee surgery and then continued to develop the technique myself. Here at the Baselland Cantonal Hospital, we are international scientific leaders in this field and have a state-of-the-art robotic system that has only been on the market for five years. It is very small and easy to handle, which is good, since operating rooms are often not that large,” explains Prof. Dr. Hirschmann. As the use of robot-assisted total knee replacement has increased, more and more clinical studies have been conducted to evaluate the safety, efficacy, and long-term outcomes of this technology. The findings obtained are helping to strengthen confidence in this method. Prof. Dr. Hirschmann adds: “The robot is currently approved only for initial surgeries, which means that, unfortunately, we cannot use it to perform revision surgeries. We have not observed any resistance to robotic technology on the part of the patients themselves. Most are open to the technology, and we also explain to them the advantages—namely, that the procedure simply allows for a better resection plane—and it is very important to emphasize that the surgery is still performed exclusively by the surgeon.”
Despite these advances, there are still some challenges ahead.
“What will definitely continue to evolve is the additional use of AI (artificial intelligence) to measure a patient’s individual ligament tension and alignment even more precisely. So-called treatment guidance systems are currently being developed and will likely be used in orthopedics over the next ten years; these will provide even more precise real-time information to better plan and support treatments. That would be helpful, since we don’t yet have the truly ideal solution. It would also be ideal if we could compare patients and analyze data across the board. It would also be desirable to have the option of robot-assisted revision surgery, especially since we specialize in revision surgeries here at our clinic and operate on patients who have already had knee replacements implanted but are experiencing pain due to various reasons—such as loosening, infections, or wear and tear—and come to us specifically for this purpose. “If robotic assistance could be used here, revision surgery would also be much more precise and even gentler on the patient,” says Prof. Dr. Hirschmann, who concludes our conversation with this wish.
Thank you very much, Professor Dr. Hirschmann, for the insight into this forward-looking field of orthopedics!
