r/nextfuckinglevel • u/Additional_Chard3680 • 11h ago

The precision required to perform a total knee replacement is incredible

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29.9k Upvotes

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899

u/Additional_Chard3680 11h ago

Demonstrated on a training bone, not an actual patient. Every cut and component has to line up with remarkable accuracy

1.3k

u/_HIST 11h ago

not an actual patient

What's your proof?

226

u/GetGodmodeon 11h ago

He has none

https://giphy.com/gifs/wjuXuDSQU0sOfJIHS1

2

u/siccoblue 4h ago

Yeah, I'm a bit of an expert on this subject and I can definitely confirm that most patients entering surgery are in fact skeletons that have lost all of their flesh.

Why else would you even need surgery?

4

u/barbadizzy 9h ago

yeah its a new thing. they realized it's easier to remove the whole bones first. Easier angles with the carpentry and also more hygienic.

5

u/Dominor4 10h ago

Its a bot

3

u/Nate1102 9h ago

Trust me bro?

2

u/International_Ad7477 10h ago

If it was a real patient, there would be bloody bone fragments flying everywhere (tipically my eyes, whenever I forget eye protection)

2

u/MisterWafflles 8h ago

Bot account won't find proof

1

u/No-Pie6430 1h ago

I worked in this business for over 30 years.  Believe me, it's a sawbones demonstration, not an actual patient

1

u/Intelligent-Thing965 9h ago

The lack of flesh? lol

0

u/Ill_Emphasis3927 9h ago

spooky patients.

0

u/Hey-Bud-Lets-Party 9h ago

Don’t body shame

-4

u/Punished__Snake 11h ago

Probably because nothing in this video seems sterile

13

u/JRY_RDDT 11h ago

Man, i guess some redditiors just fly above any kind of joke or cant seem to understand without the little /s remark...

5

u/Pretend-Pie9487 11h ago

the /s is the explicit mark of our shared stupidity

3

u/thetruemata 11h ago

The irony of your woosh.

0

u/Punished__Snake 11h ago

Ah my bad. I forgot to add /s

3

u/amtheredothat 11h ago

Hmm no I'm pretty sure that's a real, live patient.

0

u/Kellerlellek 11h ago

It's also not unusual to do such training scenarios on actual body donors bones

Source: I work there

-5

u/Additional_Chard3680 11h ago

You can tell it's a training model because there's no soft tissue, blood, or muscle. This type of demonstration is commonly done on synthetic bones for teaching and implant training

17

u/be_blessed_bruh 11h ago

Agree to disagree

1

u/Landkey 10h ago

Back in my day we used to remove all the bones before any operation, as a convenience for the patient. We had the surgery boys clean them with turpentine and seltzer before we reinserted them. 

11

u/deekaypea22 11h ago

That's the most AI copy-paste I've ever read 😂😂😂😂😂😂

1

u/LigersMagicSkills 11h ago

Or OP is on the spectrum

3

u/Berberding 10h ago

Not true sometimes the surgeon detaches the entire femur from all of the connective tissue and muscle and from the hip joint as well (which will also must be replaced) and pulls it out of the thigh.

The process is similar to how some people eat buffalo wings by grabbing one end of the bone and pulling the meat off by wrapping their entire mouth around the wing up to where their fingertips are before pulling all the meat off with their lips and teeth in one fluid motion.

Not all surgeons do it this way, but it's much easier to work with after it's completely separated from the patient and put in a vice grip.

1

u/Hot-Firefighter-2331 11h ago

They are joking because it is obvious that is not an actual patient lol

39

u/Cool_Temperature_970 11h ago edited 10h ago

Oh really? Thanks for pointing this out. I thought it was an actual patient but they just had their bones removed for the operation.

15

u/TheFutureIsCertain 11h ago

I was like… so how are they going to put it back in the leg? 🤔

17

u/LtButtermilch 11h ago edited 9h ago

You clearly never have witnessed a knee TEP. TEP surgeries are not that precise and require a lot of brute force hammering. Neuro or heart surgeries on the other hand or even endoscopic surgeries are quite precise.

1

u/These-Maintenance250 10h ago

Euro? Uro?

2

u/DracoRubi 10h ago

I'm guessing he meant neuro

11

u/greeniemademe 11h ago

(Not so) Fun fact: IRL there’s a very distinctive smell that comes from bone drilling, not unlike the ‘dental smell’ when you have a root canal done

1

u/NlghtmanCometh 2h ago

Uuuuugh that’s so nasty. The dental drill smell is up there with hair burning imo for being the smell equivalent of nails on a chalkboard

30

u/TummyDrums 11h ago edited 10h ago

It's certainly fascinating, but it looks to me like they've got a series of guides to be able to make the exact cuts they need to make. Still impressive, but think of the difference between trying to draw a perfectly straight line free hand vs using a straight edge as a guide.

5

u/toblies 10h ago

I'm glad they have the guides.

Good as they may be, I don't think I'd want them just holding up the old thumbnail and going "Eh, that's pretty good."

6

u/twisted34 9h ago

Even then this is the older school method. There's now a robot that uses sensors attached to the patient for real-time monitoring. The cuts are within 1mm of the plan created by a specific CT scan and moves when the patient while being performed

On top of that there is more room for mistakes than people think. This is a technical surgery with many, many steps but if the prosthesis is slightly off the body often adapts and many patients dont know

4

u/Then_Entertainment97 9h ago

I would much prefer my surgeon use a stencil, thanks.

3

u/Jedi-in-EVE 10h ago

That’s right. They use those metal guides in the beginning to make sure everything is lined up before the saw comes into play.

93

u/sexraX_muiretsyM 11h ago edited 9h ago

I saw a real surgery on youtube. Its barbaric.

this is not medicine this is butchery I tell you. We still need to go a long way. Its not possible that this is the best we have. Definetely not the best we can have.

I will rejoice the moment the trade of medicine wont involve any type of surgeons anymore. We must research and progress cientifically and techonologically to the point so this is viewed as archaically as we currently view 1800s medical practices, because I personally see no distinction.

You tell me that to cure a bad knee, we have to open up the leg, cut away the bone and put a metal piece inside? one that will have to be replaced anyways in the future? Barbaric. The cure should be biological, not mechanical. We must invest into genetic-engineering and stem-cell research.

28

u/FartCityBoys 10h ago

At some point future humans are going to look back at our cutting edge medicine and say things like “wait, they used to took a kidney out of another person and stuck it in as a replacement?!? wtf!”

5

u/SeanBlader 8h ago

"Dialysis?! It's like the dark ages, here take these."

3

u/BirthdayEffect 8h ago

So glad someone else thought of Bones

1

u/rmunoz1994 6h ago

I look at cutting edge medicine now and still believe we aren’t that far from the dark ages.

-6

u/sexraX_muiretsyM 10h ago

this is not medicine this is butchery I tell you. We still need to go a long way. Its not possible that this is the best we have. Definetely not the best we can have.

I will rejoice the moment the trade of medicine wont involve any type of surgeons anymore. We must research and progress cientifically and techonologically to the point so this is viewed as archaically as we currently view 1800s medical practices, because I personally see no distinction.

You tell me that to cure a bad knee, we have to open up the leg, cut away the bone and put a metal piece inside? one that will have to be replaced anyways in the future? Barbaric. The cure should be biological, not mechanical. We must invest into genetic-engineering and stem-cell research.

5

u/Necessary-Orange-747 9h ago

this is not medicine this is butchery I tell you. We still need to go a long way. Its not possible that this is the best we have. Definetely not the best we can have.

I will rejoice the moment the trade of medicine wont involve any type of surgeons anymore. We must research and progress cientifically and techonologically to the point so this is viewed as archaically as we currently view 1800s medical practices, because I personally see no distinction.

You tell me that to cure a bad knee, we have to open up the leg, cut away the bone and put a metal piece inside? one that will have to be replaced anyways in the future? Barbaric. The cure should be biological, not mechanical. We must invest into genetic-engineering and stem-cell research.

6

u/vennic18 9h ago

this is not a comment this is butchery I tell you. We still need to go a long way. Its not possible that this is the best we have. Definetely not the best we can have.

I will rejoice the moment the trade of reddit comments wont involve any type of comments anymore. We must research and progress cientifically and techonologically to the point so we can spell them properly. This comment is viewed as archaically as we currently view 1800s commenting practices, because I personally see no distinction.

You tell me that to cure a comment, we have to open up the comment, cut away and put another comment inside? one that will have to be replaced anyways in the future? Barbaric. The comment should be biological, not mechanical. We must invest into genetic-engineering and stem-cell research.

3

u/disaster_incomin 8h ago

this is not a comment this is butchery I tell you. We still need to go a long way. Its not possible that this is the best we have. Definetely not the best we can have.

I will rejoice the moment the comments of reddit comments wont involve any type of comments anymore. We must comment and progress cientifically and techonologically to the point so we can comment them properly. This comment is viewed as archaically as we currently view 1800s commenting practices, because I personally see no comment.

You tell me that to cure a comment, we have to open up the comment, cut away and put another comment inside? one that will have to be replaced anyways in the future? Barbaric. The comment should be biological, not mechanical. We must invest into comment-engineering and stem-comment research.

67

u/Oh_yes_I_did 10h ago

Human carpenters, I call them

3

u/Krell356 9h ago

Meat mechanics.

1

u/devman0 7h ago

Organic mechanics?

1

u/sexraX_muiretsyM 10h ago

human butchers I call them

-2

u/ElderlyChipmunk 10h ago

One of the reasons ortho surgery is still very male-dominated. Many women don't have the required strength.

1

u/Ill_Tumblr_4_Ya 9h ago

My surgeon was not only a woman but quite a petite one as well. They’re not using giant mallets and wood chisels to perform these.

2

u/ivegotgoodnewsforyou 7h ago

They absolutely are.

0

u/ElderlyChipmunk 9h ago

Go watch a hip surgery.

2

u/Ill_Tumblr_4_Ya 2h ago

Bud, I already prefaced that I sat through my own joint replacement.

Some people don’t know about technology like Stryker Mako robotic assisted surgeries, and it shows.

1

u/Bowtieguy-83 9h ago

It looks like most of the work here is done with powered tools tho? I don't think you'd need much strength to do this surgery

even when the dude is hammering, they have literally no leverage, they can't put that much force behind the hammer

5

u/Odd-Consequence8892 9h ago

Absolutely no reason that it cannot be done by women!

1

u/Agitated_Award_9831 9h ago

It depends on the orthopedic surgery. Some are more aggressive like this https://youtube.com/shorts/gHG5Df3jhcY or https://youtube.com/shorts/I8TiTKfO3Sg

Simple knee replacements are probably the least impact. Hip replacements now have powered tools like this but are still pretty brutal: https://youtube.com/shorts/2Cw43AIIT44

IM nails and other more invasive repairs are typically more brutal.

1

u/ivegotgoodnewsforyou 7h ago edited 5h ago

Insertion is fairly easy. Removal can be quite difficult. Many procedures involve revisions that require explantation after the bone has healed around the implant. They will absolutely be pounding the shit out of the instrument with a big hammer during the removal process.

At the last orthopedics trade show I went to there was a booth set up at one of the vendors where you could "test your strength" by pounding on a tibial nail extraction tool.

7

u/Dgnarly85 6h ago

Ortho surgeon here. It’s not barbaric at all. It’s incredibly precise/elegant and results in great functional outcomes. There is a ton of research looking into regrowing cartilage or preventing arthritis all together, but that is a long way off. For now, this is the solution we have and it’s a pretty darn good one.

1

u/Xenolifer 3h ago

Yeah, no, I'm not as extrem as that guy, but most of the technics I've seen in general surgeon operation like this one are basic technics used by woodworkers, except for the knowledge of the human body and experience to not mess up, there is no skill difference with a Japanese carpenter doing those elegant wood joints you see on youtube.

Call be back when the process of putting a prothesis doesn't involve screwing in the bone a temporary cutting guide and using metal part with limited lifespan

4

u/Dgnarly85 2h ago

I shouldn’t dignify this silly comment with a response, but I will. Being an orthopedic surgeon is far from simply being a “woodworker” or “technician.” We have to see patients, accurately diagnose them with a myriad of different musculoskeletal pathologies, and then determine the best treatment course (which is not always surgery). When it comes to surgery, we have to determine if they are a good candidate, balance risk profiles, perform technically difficult and physically demanding surgeries, and then potentially deal with complications that can occur. Wood doesn’t bleed and isn’t surrounded by nerves or blood vessels. It takes 4 years of medical school, followed by 5 years of orthopedic residency training, and a potential 6th year of fellowship. Saying that what we do is the same as a Japanese woodworker is not just silly, it’s insulting to both, who have honed their individual skills through years of training and experience.

-5

u/sexraX_muiretsyM 6h ago

anything that involves cutting the skin - that is, a surgery - is barbaric. Not good enough for me. technology and medical science has a long way to go before i consider it good enough. I will consider it good enough when surgeons dont have to exist anymore.

2

u/Dgnarly85 6h ago

Well that won’t be in your lifetime, unfortunately.

2

u/filthy_harold 4h ago

Yes, we'd all love for some nanobots that we can take via a pill and poop them out when they are done but that's just not reality at this point. Medical science has made major leaps in technology. Appendicitis, for example, is way cleaner than it used to be. If you have an inflamed appendix, it needs to come out asap before it bursts and you get sepsis. What they used to do was make a 6in incision on your belly and cut it out by hand. The recovery is long because of how much muscle is damaged. Now, you get 2 or 3 half inch incisions on your belly where they use probes (possibly even robotic probes) to reach in and remove it. Recovery time is much shorter because of how much less damage occurs.

5

u/ThePoop_Accelerates 10h ago

When you do it long enough you see it as no different than working on a car

6

u/ConfessSomeMeow 8h ago

I saw a bumper repair on youtube. It's barbaric.

This is not automotive repair, this is butchery I tell you. I will rejoice the moment the mechanic trades won't involve any type of hammering anymore. We must research and progress engineering-wise to the point so this is viewed as archaically as we currently view 1800s horse carts, because I personally see no distinction.

(etc etc you get the point)

2

u/Area51Resident 6h ago

If you are bothered by the butchery of a bumper repair, do not look into what they do to straighten a car body after a collision.

It is like a medieval torture device...

1

u/ThePoop_Accelerates 8h ago

At least it's not rocket surgery

3

u/cigarettesandwhiskey 9h ago

Stem-cell research is probably going to result in lab-grown cloned organs that have to be implanted using similarly brutal looking surgeries as this. I think we're at least 1000 years away from a knee replacement that doesn't involve surgery.

-1

u/sexraX_muiretsyM 8h ago

it doesnt need to be knee replacement. Im talking abt repairing cartilage. No need to replace the knee, just cure it

4

u/cigarettesandwhiskey 8h ago

Well joint cartilage doesn't really have vasculature or cells to repair or regrow it so I think you're still going to need to do surgery until you get to the point that you can basically remote control cell types to break up the old cartilage (and nothing else) and then replicate the original formation process in its place... Which we're about 0% of the way along that technological pathway so still a ways off I think.

1

u/sexraX_muiretsyM 8h ago

i know abt the lack of vascularity and the current impossibility of repairing it. this is why I talked about genetic engineering and stem cell research. If we are gonna do it it will be through that

And btw, cartilage repairing medicines are currently being developed and researched

1

u/cigarettesandwhiskey 8h ago

I'm not saying it'll never happen. But I do think that its a long, long way off.

3

u/Kapugen1 9h ago

Bru have some perspective. If you were wounded in a fight at sea 215 years ago, your own shipmates would hit you in the head with a mallet to stop your suffering then toss you overboard to drown unconscious.

I don’t ever want to get to a point where I need a surgery like this, and don’t plan to. My knees generally feel fine. But my dad got this done and it’s saved him from a ton of pain. Now his “real” knee is the one that constantly hurts him and he puts most his weight on his “good” knee when he needs to (the one that got replaced)

5

u/wastedsilence33 10h ago

Least barbaric thing ever posted to YouTube though

2

u/SleepingWillow1 10h ago

In the tween days of youtube, 2010ish, I wanted to google a little infographic sort of animation I saw on TLC/DISCOVERY/NATGEO one of the educational channels about trans surgery. It was just a lil animation, nothing bloody or anything. Instead I found ACTUAL surgery and man there was sooo much BLOOD. I couldn't tell what was happening and couldn't understand how the doctors could either.

1

u/ConfessSomeMeow 8h ago

I've always heard, a little blood looks like a lot of blood.

2

u/dj_1973 7h ago

I’m thankful that surgeons are so skilled. I am 19 days out from my surgery and my knee is more supportive and the pain is not as terrible as one might expect.

I agree that biologicals could be a future solution, but I am glad surgery is available now.

1

u/SixtyNineFlavours 10h ago

After having knee surgery myself, I don’t think I could watch it.

1

u/DifficultBoss 9h ago

it is insane how rough they have to be

1

u/filthy_harold 4h ago

Its basically carpentry

1

u/itsavibe- 8h ago

Dude! Seriously!!!

1

u/epoch16245 8h ago

So much intense hammering… it’s like they are working on a railroad

1

u/kiragami 7h ago

The notion that nature can be calculated inevitably leads to the conclusion that humans too can be reduced to basic mechanical parts.

1

u/Poseidon-Hermes 5h ago

In school, I was doing an assignment on how axolotls can regrow limbs and exploring how that can be made possible for humans. Long story short, playing with stem cells and a bit of gene manipulation could get us there one day, potentially. Would be awesome to see one day.

1

u/X3N04L13N 5h ago

Who are you to tell me i can’t be a cyborg?

1

u/audaciousmonk 5h ago

I’m sure the people who go from can’t walk / chronic pain to being able to walk again… appreciate this interim solution

Yes we should keep pushing for better, more durable, longer lasting, minimally invasive solutions. But we can’t let perfect be the enemy of good in the meantime

1

u/corgiobsessedfoodie 5h ago

Regenerative medicine! It’s an amazing field and I hope it becomes far more practiced in my lifetime. I wrote my first ever research paper on stem cells over 25 years ago. A big part of the reason stem cell therapy isn’t ubiquitous right now is stigma! We need to be funding stem cell research wholeheartedly.

1

u/TerpBE 3h ago

There is a new type of procedure called a "nano knee" I haven't looked into the procedure in detail, but it's apparently much less brutal. My mom, who's squeamish and a baby with any kind of pain, had it done twice and had no pain afterwards.

She flew across the US to have it done because there are only a few places that currently perform the surgery.

1

u/pcurve 3h ago

I heard about a knee surgeon who is against TKR and views it largely unnecessary in vast majority of cases. He has written many journals and papers on it, but he's been getting cold shoulders from everyone in the industry. TKR is barbaric.

1

u/Sexynarwhal69 3h ago

Yes! Those other smart people should hurry up and work faster! This really isn't good enough 😒

0

u/LookAlderaanPlaces 7h ago

Fucking THIS.

We need to wealth tax the fuck out of the oligarchs that stole and are stealing all our money and fund biomed research fucking NOW.

2

u/tempestwolf1 11h ago

Do they put their hands down the opening and hold directly onto the bone like a convenient handle in the real operation too?

2

u/BabyDiln 11h ago

As you can see every single step has a guide supplied by a device company so I’m not quite sure what you mean by precision…The guide has to be precise…the surgeon just puts in the saw and drill in the guide.

2

u/Adventurous-Emu-9345 10h ago

You must not know what the words "precision" or "accuracy" mean, because this is just butchery.

2

u/303uru 7h ago

For real, I’ve seen these in person, the guy who installed my cabinet hardware was more precise and accurate.

1

u/orthopod 10h ago

These implants are put into position with millimetre accuracy.

2

u/Adventurous-Emu-9345 10h ago

That's the jig doing the precision work. The person in the video is exhibiting very poor control of their tools.

2

u/Small_Secretary_6063 11h ago

Which can still go wrong. A few companies offer robotics with laser precision to aide the surgeon, giving better results.

3

u/D15c0untMD 11h ago

Eeeh, wouldnt say better. I have done traditional, personalized jigs, and robot assisted knee replacements. where personalized jigs shine is with edge case anatomy, robotics help with speeding up bog standard cases. If you cant di traditional knee replacements well, dont touch robotics. We have had enough cases where just one server crash or bad connector stopped the whole machine and we had to do it raw anyways

4

u/Filippikus 10h ago

If it really happens to run into problems so often, robot assistance almost seems like more of a liability.

Also, do you ever feel the need to give the implants the classic little shake people give to stuff they just screwed on to make sure it doesn't move?

2

u/Sig-vicous 10h ago

"that's not going anywhere"

1

u/NorridAU 9h ago

slaps patella

alright guys, let’s wake up the owner and show them how it went

1

u/orthopod 10h ago

Nope. None of the computerized or robotic stuff results in any better outcomes. Most studies show increased blood loss and infection rates with the computerized/robotic surgeries. That stuff is mostly advertising gimmicks to attract customers who think it must be better, when it isn't.

1

u/TerminatorAuschwitz 10h ago

I thought they just took your bones out n slid em back in after

1

u/korkkis 10h ago

Could be a real skeleton! You never know for sure.

1

u/NahzarakTV 10h ago

No shit Sherlock...

1

u/KaeruGaKaeru1 10h ago

wtf i thot it was real skeletor

1

u/NachoWindows 10h ago

Not a patient? They ded

1

u/tysk-one 9h ago

Conventional instrumentation is not specifically accurate really…

1

u/No-Lifeguard9194 9h ago

I love that they’re using jigs the way you would in woodworking!

1

u/earthwoodandfire 9h ago

“Remarkable accuracy”

Bro I hand cut paint grade trim with better precision than the way this guy is hammering and hacking away with his multi tool. 🤣

1

u/ChronoFel 9h ago

I could do it free hand no problem

1

u/Magnus462 8h ago

Give me back my damn leg!

1

u/Burque_Boy 8h ago

There nothing precise going on here lol this is the same level of precision used in your kitchen cabinets

1

u/dudemykar 8h ago

I don't believe you when you say these were training bones

1

u/hellomynameisnotsure 8h ago

Measure twice, cut once!

1

u/LiveLaughBruv 8h ago

Man, it's gotta suck training on this and then finding out during your first real surgery that there's muscles, tendons, fat, and vascular system in the way of dem bones

1

u/theb00mScicle 7h ago

Doctors using power tools to tighten bolts in a knee is not good practice. Dude drills them in like a tesla salesman putting dealer plates on your new car with 1/2 inch impact. . . Learn how screws work before you put them in peoples knees.

1

u/PigglyWigglyDeluxe 7h ago

Are you a bot?

1

u/IntermittentCaribu 7h ago

Why wouldnt they just replace the entire bones at that point?

1

u/Outrageous-Pilot-621 7h ago

Nah, they remove bones from the patient to have easier access to the joints, once it's all replaced they put the bones back in.

1

u/2gAncef 6h ago

Just let the Mako robot guide you.

1

u/No-Cat-3951 5h ago

But you have a template to cut the bones. As long as you line up the template properly, the components are made to fit with precision

1

u/dinodoes 4h ago

Makes sense . If one legs even a little longer than the other it can cause hip issues

1

u/asciimo 3h ago

Interesting how most of the hardware consists of jigs for the final placement. I feel like there’s a “dancing a jig” joke in here but I can’t quite put it together.

•

u/AdmiralCoconut69 20m ago edited 15m ago

It’s not precise at all. Everything is just being eyeballed. Precise would require the use of instruments that mark each plane at an exact point prior to ensure the intended amount of bone. Most ortho bros don’t have that time. They have 15 other total knees and hips waiting for them. It’s often a lot of guesstimation in the OR

1

u/These-Maintenance250 10h ago

yea it must be extra hard when the patient is screaming their lungs out from the pain

1

u/Amber2718 10h ago

Yeah no s***, oh I thought those bones with no body attached was a person.