Scott Webb (Host): When many of us picture robots, we might conjure images from Star Wars. And though the Mako robot at Emerson Health doesn't look like movie robots, it helps surgeons, like my guest today to perform hip and knee replacement surgeries with great precision and patient outcomes. And I'm joined today by Dr. Matthew Sloan. He's an Orthopedic Surgeon and Director of Robotics Orthopedic Surgery at Emerson Health.

 This is the Health Works Here podcast from Emerson Health. I'm Scott Webb.

Dr. Sloan, thanks so much for your time today. I was mentioning that I've done a bunch of podcasts on the da Vinci robot and I do love robots cause I think once you're 10 you're always 10 years old. Right? So we're, today we're going to talk about the Mako robot. So first, as we get rolling here, what is robotic assisted surgery and why is this particular robot called Mako?

Dr. Matthew Sloan: Robotic assisted surgery is, in my purposes, a joint replacement surgery of the hip and knee that's assisted by a robotic device. The robot isn't like robots from cartoons. It doesn't really resemble a person, which a lot of my patients think it might. And, it's not performing the surgery by itself.

It's pretty much a really fancy tool that we use to perform the surgery and it helps keep us on track with our plan from before the surgery and putting the implants exactly where we want to put them. And, the reason they call Mako, Mako is because it looks, I guess, in some ways, like a, a Mako shark. It's gray and sleek looking. I'm not sure the exact idea in the marketing behind Mako itself.

Host: Yeah, and I assume I know the answer to this question but I'm assuming that robotic assisted surgery has many benefits and it's certainly safe, right?

Dr. Matthew Sloan: The benefit of a robotic assisted surgery is that we have a plan, just like you have a blueprint for a house when you're building one, and the plan that we have, we're putting in place as precisely as possible. So there's been a number of studies on robotic assisted surgeries, and all of them agree that the implants go in more precisely than if you don't use robotic assistance.

Does it make a difference in the long run? Robotics has only been around for about 12 years and so we don't know at 30 years is it going to improve the outcomes. But we know that patients tend to recover quicker, have less pain, and we're putting the implants exactly where we want to. I can't imagine a world where you're putting implants in less precisely and getting a better outcome. And the main downside to robotics is really that there is a little bit increase in the cost of the procedure, but in my mind, the long term benefits of putting in the implants exactly where you want them outweighs any costs.

Host: Yeah, I see what you mean. Right. When we think about the outcomes 20, 30 years from now, we'll find out for sure. But as you say, doing it sort of the old school way without robots can't possibly lead to better outcomes. It just, it would be counterintuitive for it to turn out that way. So, who's a good candidate for Mako surgery?

Dr. Matthew Sloan: Anyone who's a candidate for a joint replacement is a good candidate for robotic assisted surgery, and I, do pretty much every surgery using robotics unless it's a revision type surgery. So if you're a candidate for a hip or knee replacement because of arthritis and symptoms that limit your activities on a day-to-day basis, then you're a candidate for robotic assisted surgery. It's not a dramatically different surgery, it's just a surgery that's done more precisely.

Host: Yeah, you mentioned arthritis and of course, like me, like many people, I have the osteoarthritis, uh, pretty much everywhere, but especially in my knees. So generally, who are you performing the surgery on? Is it people with, uh, sort of like me, like chronic type things like osteoarthritis or is it a combination of that and maybe some acute injuries and sort of everywhere in between?

Dr. Matthew Sloan: The most common patient who has joint replacement is someone with osteoarthritis. There's some other inflammatory conditions like rheumatoid arthritis, psoriatic arthritis, or post-traumatic arthritis, meaning they had a prior injury in the hip or the knee that caused them to develop arthritis.

And most folks who have joint replacements are somewhere in their fifties, sixties, or seventies. And then increasingly there's more patients who are having surgeries in their eighties just because the recoveries are improving. And people in their eighties or even nineties are tolerating the surgeries. And there's also patients in their thirties and forties who have these procedures that for whatever reason they had advanced disease in their hip or knee. Those are the patients that we really try to hold off on doing a surgical intervention as long as possible just because you want to do one surgery that's going to get them through the rest of their life if possible.

Host: Yeah, I see what you mean. Right. We don't know exactly what the shelf life or the, you know, uh, expiration date is on some of these things yet. So if someone in their thirties or forties could maybe do, what are we talking, like some physical therapy, different types of things like that, other interventions before you get to surgery, you try to go that way, right?

Dr. Matthew Sloan: Any patient I meet, I usually look at the x-ray and I say, you are or you are not a good candidate for joint replacement. If you're a good candidate for joint replacement, it doesn't mean that you need to have it right away. It just means that it's a treatment option for you if your symptoms get bad enough and that that doesn't really change depending on the age.

We just would be a little more aggressive in trying a lot of the nonsurgical options for younger patients. So exactly what you're saying. Physical therapy, anti-inflammatories, avoiding painful activities and different types of injections like steroid injections or gel injections or some of these things. Whatever we could do to try to stave off having a surgery at a young age.

Host: All right. So, Doctor, when we are in a position where we've tried some other things, tried the other interventions and surgery's our best option or the last option, however you want to put it, what do we need to know? What do we need to think about as prospective surgical patients here when we're hiring an orthopedic surgeon, when we're thinking about robotic surgery, what types of things should be on our minds?

Dr. Matthew Sloan: The questions I think any educated patient should be asking their surgeon is one do they perform the procedure frequently? Because we know surgeons who perform joint replacement surgeries more often are going to be better at it, just from the practice. So in general, it's good to be seeing a surgeon who does a lot of joint replacement. After that, the things that I like what we've been talking about today, robotic assistance, I think it makes sure that your surgeon is able to perform the surgery in a reproducible way that limits any outliers. Because even if you go over the risks of a surgery and you know that you may have some sort of risk of complication at 1% rate. You don't want to be that 1% outlier. So all these things that we can do with robotics and having a plan ahead of surgery are going to minimize the risk of having complications. And then you want to just make sure that your expectations match with what your surgeon's expectations are.

So, everyone likes to think that surgery is going to be something that's a really quick recovery, and you flip the switch and you're doing better the next day and your knee or your hip doesn't hurt and doesn't cause you any problems, and you're a new person. But the reality of the situation is, we're going to make you better. That's the goal of the surgery. But in order to do that, you have to have a bad problem to start with. So if you're not having symptoms that bother you on a daily basis, you're probably not a great candidate for joint replacement because we don't have something that we can make much better. So, all those things are important to having a good outcome.

Host: Yeah. The last thing I think I want to hear when I, uh, sit down with a prospective surgeon and is, you know, I've, I've always wanted to try one of these robots, always wanted to see, see how one of these robots works. Yeah. I definitely want to be in the hands of someone like yourself who's performed hundreds, of these surgeries and is a real expert of course.

And makes me wonder what you're hearing anecdotally or otherwise from patients, not just about, you know, the sort of quantifiable outcomes, in terms of how you all measure success, but what are you actually hearing from patients like postop or when they're back in your office for a checkup? Like what kinds of things are they saying? Are they saying like, this was the best decision I ever made in my life? I'm assuming so.

Dr. Matthew Sloan: Yeah. One of the things that I've been pretty amazed with since we instituted our robotics program here. So I, trained on robotics when I was in training, and then when I came to Emerson, I wanted to bring Mako and a robotic system to the joint replacement that we were performing.

And so before that, we had about six months without robotics. And um, I think that, patients really do well with these surgeries, hip and knee replacements, no matter how you do them. You know, some people have called hip replacement the surgery of the century for the 19 hundreds just because patients tend to do better.

But I, I really have been surprised at how much quicker patients recover, especially with the knee replacements using robotics and part of it is that there's something on the robotics called haptics, which prevents us as surgeons from going even a half millimeter further beyond the bone into soft tissue where you could cause some sort of trauma that might take a little bit longer to recover from.

 Something that's beyond what we can do just holding the tools by hand, and those sorts of haptics, I, I really think are the difference between doing these things by hand and doing them with robotic assistance. And, when the patients come for their two week checkups, there's less swelling. They're up and walking around. The knee itself, when I test, it feels better. The patients are reporting better motion at an, an earlier time point. Those sorts of things really didn't think would be so dramatic, but I really have seen kind of in this robotically performed group of patients that, they really are showing up pretty early.

Host: Yeah, it's pretty amazing. I'm in my fifties and I worked with a guy, you know, 40 years ago who, uh, had had hip replacement surgery. And he showed me his scar, which back then the scar ran, I'm pretty sure like just below his armpit, all the way down to his kneecap. I mean, it went all the way down his side. It was really hard to look at. And I've seen people since then who've had the robotic assisted surgeries be the, you know, knee, but especially the hip replacement. And it's just absolutely startling how much smaller the scars are. The faster recovery time. I mean, there's just so many benefits, right?

Dr. Matthew Sloan: Yeah, absolutely. One of the big things that comes along with it is the changes that we've had in, anesthesia and discharge protocols. So most people are able to go home the same day as their surgery. And if they're not going home the same day, usually everyone is home by the next afternoon.

 But yeah, the recovery is quick. The incisions are smaller than they used to be. People are having their surgeries done under spinal just with a little bit of sedation. So, that they're not awake for the procedure, but they don't need a tube down their throat and they're not getting groggy and nauseous after the surgery. So everything has kind of been enhanced over the past few decades.

Host: Yeah, that's my favorite part about hosting these is just learning about the innovations and advances in medicine and science and technology, and of course, you know, robots and lasers and, you know, so many cool things. Just want to give you a chance, doctor as we wrap up here, just to tell listeners what you love about what you do. You know, you sound like you're really passionate and compassionate. What do you love about what you do there at Emerson?

Dr. Matthew Sloan: I love the people we work with, the staff. I think almost universally, when patients come back, they're always blown away by the quality of people that they meet throughout the whole process. From our staff at Orthopedic Affiliates, to the folks that they see in the recovery room, the pre-op room at Emerson Hospital. And it's always nice getting feedback about their interactions with everyone. And then, you know, seeing people back early on and just getting them through their early recovery and then seeing them back a year or two later and they can't remember which hip or knee they had replaced. That's always a big win for me and always a great feeling.

Host: Well it's been great to get to know you today, learn more about the Mako robotic assisted system, always great to learn about science and technology and everything going on at Emerson Health. So thanks so much for your time. You stay well.

Dr. Matthew Sloan: Great. Thanks so much for having me.

Host: And visit emerson health.org/orthopedics for more information or to make an appointment. And thanks for listening to Emerson's Health Works Here podcast. I'm Scott Webb. And make sure to catch the next episode by subscribing to the Health Works Here Podcast on Apple, Google, Spotify, or wherever podcasts can be heard.