Masterclass 5 - Cutting Edge Technology Assisted Orthopaedic Surgery in Hong Kong

In recent years, the adoption of robotic joint replacement surgery has seen a significant increase, with numerous public and private hospitals embracing orthopedic robotic systems. Surgeons are increasingly attracted to this cutting-edge technology, offering promise to patients with severe hip and knee deformities by enabling them to regain mobility and improve their quality of life. This advancement has particularly benefited patients with complex deformities and those requiring revision surgeries by providing precise and accurate procedures unlike ever before.


The field of joint replacement surgery boasts a growing array of over 30 robotic platforms, much like the development of electric vehicles, with more innovations on the horizon. In Hong Kong, the Hospital Authority offers access to five distinct robotic platforms, including Mako, Velys, Rosa, Cori, and KunWu. While all these systems are semi-active and surgeon-controlled, each presents unique features, benefits, and limitations. The University of Hong Kong, serving as a pivotal site for the introduction of various robotic systems and a training center for robotic surgery, will provide valuable insights into the 5 available robotic systems, essential features and future advancements in robotic surgery.

In the realm of spine surgery, the integration of navigated robotic systems has emerged as a promising advancement, sparking debates on its permanence in the field. This presentation delves into the topic by exploring the evolving global trends, substantiating evidence, and contentious issues surrounding the adoption of robotics in spinal procedures.
The worldwide landscape of spine surgery is witnessing a notable shift towards the incorporation of robotic assistance. Countries across the globe are increasingly embracing navigated robotic systems as a means to enhance surgical precision, improve patient outcomes, and mitigate the inherent challenges of complex spinal interventions. This trend underscores a growing acceptance and utilization of robotic technology in the domain of spinal surgery.
Amidst the growing adoption of navigated robotic systems, a body of evidence is accumulating to support the efficacy and advantages of robotic-assisted spine surgery. Studies demonstrate enhanced accuracy in pedicle screw placement, reduced intraoperative radiation exposure, and improved postoperative recovery outcomes when compared to conventional techniques. These findings contribute to the growing body of literature advocating for the integration of robotics in spinal procedures.
However, alongside the promising advancements, controversies and challenges persist in the realm of robotic spine surgery. Criticisms include concerns regarding cost-effectiveness, the learning curve associated with robotic technology, and the potential for over-reliance on automated systems. These controversies underscore the need for continued research, training, and critical evaluation to optimize the integration of navigated robotic systems in spine surgery.
This talk aims to navigate through the changing global trends, evolving evidence base, and ongoing controversies surrounding the utilization of robotics in spinal procedures, shedding light on the potential future trajectory of robotic technology in the realm of spine surgery.

The healthcare sector is experiencing a profound transformation driven by technological advancements. One such technology in the field of Orthopaedics is the application of 3D printing. These advancements can be appreciated in a regional hospital in Hong Kong.


Application of 3D printing in prosthetics and orthotics
The key advantage of 3D printing in orthotics and prosthetics is its ability to create highly customized devices that perfectly match the anatomy of the patient. By using advanced scanning techniques, precise measurements can be taken to design orthoses and prostheses that fit comfortably and function effectively with the support of 3D printing.

Surgical Planning and Simulation
By using 3D-printed models of a patient's body parts, surgeons can plan the surgical procedure in advance before entering the operating room.


Personalized Implants
3D printing enables the creation of personalized implants, tailored to the unique anatomy of each patient.


Bone Defect Reconstruction
For major bone loss or deformities, 3D printing offers new possibilities for bone defect reconstruction. Surgeons can plan for custom-made bone grafts that precisely match the patient's bone structure, promoting faster healing and integration.


Patient-Specific Instrumentation
3D printing enables patient-specific instrumentation, such as cutting guides. These customized tools allow for more accurate and efficient bone cuts and implant positioning.


Challenges and Future Directions
While the application of 3D printing in orthopaedic surgery holds immense promise, there are still challenges that need to be addressed. These include the cost of 3D printing, the need for specialized training for surgeons, and regulatory considerations surrounding the use of 3D-printed implants in clinical practice. Despite these challenges, ongoing research and technological advancements are paving the way for the wider adoption of 3D printing in orthopaedic surgery in the future.

In orthopaedic oncology, surgical planning and intraoperative execution errors may result in positive tumor resection margins that increase the risk of local recurrence and adversely affect patients' survival. Computer navigation and 3D-printed resection guides have been reported to address surgical inaccuracy by replicating surgical plans in complex cases. However, limitations include surgeons' attention shift from the operative field and the expense of navigation facilities in computer navigation surgery. Practical concerns include the lack of real-time visual feedback for preoperative images and the lead time required for manufacturing 3D-printed objects. 
When surgeons clinically examine bone tumor patients, they must mentally process and correctly overlay the patients' virtual 2D medical images and 3D bone-tumor models onto their anatomy. Appropriate surgical exposures and osteotomies along the desired planes are then determined. This spatial ability to mentally generate and manipulate abstract models is difficult for tumors of various extents and regions with complex anatomies. Both computer navigation and 3D-printed resection guides facilitate precise osteotomies only after surgical exposure. 
Mixed Reality (MR) is an immersive technology that seamlessly merges the physical and digital worlds, allowing users to interact with digital objects in real-time. Through Head-Mounted Displays (HMDs), holographic 3D models generated from 2D medical images are superimposed on the patient's anatomy in their physical environment. It enables surgeons to better spatially understand bone tumors in actual patients before the surgery starts. The emerging MR technology adds a new dimension to digital assistive tools with a more accessible and less costly alternative in orthopaedic oncology. The MR HMD and hands-free control may enable additional on-demand medical information with online assistance from remote users, greatly facilitating clinical point-of-care both inside and outside the operating room and improving service efficiency and patient safety.


The talk covers the background of MR technology, its integration into existing clinical workflows, clinical experiences, and the Journey and challenges in implementing the new digital technology in HA Hospitals.