Robotic-Assisted Joint Replacement Surgery: A Game Changing Technology

Dr. Adam Rothenberg shares information about the robotic-assisted surgery used for joint replacement.
Robotic-Assisted Joint Replacement Surgery: A Game Changing Technology
Featuring:
Adam Rothenberg, MD
Dr. Adam Rothenberg is a fellowship-trained orthopedic surgeon specializing in total hip, total knee and partial knee replacement surgery. With extensive training in robotic-assisted techniques, he focuses on using minimally invasive approaches and patient specific instrumentation to achieve the best results for his patients. 

Learn more about Adam Rothenberg, MD
Transcription:

Melanie Cole (Host):  Welcome to Checkup Chat with EvergreenHealth. I'm Melanie Cole, and I invite you to listen as we explore robotic assisted joint replacement surgery, a game-changing technology. Joining us is Dr. Adam Rothenberg. He's an Orthopedic and Joint Replacement Surgeon at EvergreenHealth Orthopedic and Sports Care.

Dr. Rothenberg, it's a pleasure to have you join us again today. Welcome back. So, joint replacement has been performed in similar ways for decades. So, tell us why robotics? How long have you been using it and what does it even mean to use robotic assisted navigation in joint replacement surgery?

Adam Rothenberg, MD (Guest): Melanie, thanks for having me. And those are two great questions. I'll try to answer them for you and for the patients out there listening. The computer assistance has been around since the 1980s. And what it was, is it's kind of a GPS for your car, that guides surgeons to precisely position the components for hip or knee replacement. Over time from the 1980s and now into 2020s, there's been developments that go from just computer assistance to actually robotic assisted procedures where there's a hand piece, there's a tool that connects to a computer and provides real-time feedback to that surgeon. And that's often tied to a three-dimensional model of your knee or your hip to make sure that we're precisely placing the implants and customizing that position for the patients. These technologies have been improving dramatically over the past few years and there's a number of them available. I've been using them in my practice since finishing my training and during the end of my training in fellowship, which is an Advanced Certification for hip and knee replacements. And those adaptive technologies, by various companies, have been part of my everyday practice as I seek to try to improve the care for total hip and knee replacement patients.

Host: Well, it's certainly an exciting technology. Dr. Rothenberg, tell us what robot you use and why this particular one.

Dr. Rothenberg: I use multiple robots, actually. There are multiple products coming out, but the longest track record of robotic technology is manufactured by Stryker. It's a large company in the United States and across the world that has an adaptive technology called the MAKOplasty. And this was actually developed in the early nineties and eighties and has progressed. The EvergreenHealth has two of these systems and that facilitates total hip, total knee and partial knee replacement surgery. I also use a company's robot called, the CORI System, C-O-R-I. It's manufactured by Smith and Nephew.

The reason why I use these is that I like to find the best technology to match to each patient. They both generate three-dimensional models. They both have pros and cons in terms of which implants they offer. So, if I need an implant to match the patient for their anatomy, I want to be able to switch between the two. And I find that being able to be facile with multiple technologies improves my ability to provide the best care for patients.

Host: How interesting this is. So, do you see that this is being used all around the country now? Is this kind of the game changer? And the new thing that everyone's doing? Are all orthopedic surgeons able to use this kind of technology?

Dr. Rothenberg: Well, it's certainly capturing headlines. The New York Times had two recent headline grabbing articles on their front page about joint replacement. And it's part of the marketing campaigns and pushes. But right now we know that about five to 7% of joint replacements are done with computer assistance, including robotics and non-robotic computer assistance.

So, it's still the minority of surgeons that are able to provide this for their patients. I think part of the growth, or where it's headed is to be expanded, but there is Advanced Certification that's required for these types of procedures. The FDA requires extra training for many of the instruments such as the MAKO, with surgeon to surgeon proctoring and teaching. So, patients aren't able to get these procedures by just every orthopedic surgeon.

Host: So, it takes a lot of training. There's certainly a learning curve and additional certification. So, how does using this technology differ from the way that you had always previously done a joint replacement?

Dr. Rothenberg: Well, it's a game changer for surgery where we think that small changes in a few degrees or a few millimeters can really matter for patient's anatomy and restoring them to the natural feel of their joint. Previously, when total joints were first developed, we had essentially our own eyeballs and our own ability to just kind of measure and custom tools that surgeons kind of made themselves.

And then advancements allowed us to have standardized work tools to be more accurate. But then those just showed that we were within a few degrees. Three, four degrees of accuracy and maybe two millimeters of accuracy on our cuts. And that can mean a real big difference between a knee that feels a little bit unbalanced or less natural than normal or a hip that just kind of, doesn't give you the range of motion that you need.

What the robotics allows us to eliminate those variables and provide the most accurate potential cuts and positioning of the implants as possible. And it has real time feedback. So, when I'm in the surgery, I'm looking at a computer screen that shows me where the tools are going to go, where the implants are going to go, and I can adjust them on the fly to make sure that if something is different about that patient's anatomy than expected, that I can adjust and accommodate that during the surgery and not after the fact.

Host: So, thank you for telling us how this differs for the surgeon and even for the patient. What about recovery? What about what the patient feels or sees? Is there any difference there? Tell us some of the advantages and even possible disadvantages of using robotic technology for joint replacement.

Dr. Rothenberg: Sure. Well, let me start with the disadvantages. There's not a lot of them, but it's important that patients know that. With the technologies they usually require according to the techniques, additional small incisions for temporary placement of pins. Those pins allow cameras to track the patient's anatomy during real time. And they're usually not too intrusive or large, but patients do notice them. So, I make sure to talk to the patients before the surgery so they understand that. Also we do often need a specialized image. So, either a special CT protocol or specialized x-ray or MRI to generate these plans. That can be additional time and a burden to the patients.

And we have to explain to them that we need that information to generate the precise plan, a three-dimensional model for us to be able to do the procedure. But with those small disadvantages, the advantages are that with that three-dimensional plan, we can eliminate multiple needs for repeating our work throughout the procedure. We actually have boundaries that prevent the sharper tools that remove bone from damaging the tissues around the knee or the hip. And that reduces the risk of damaging nerves, blood vessels, or ligaments, which can be devastating to patients, even in the rare instance that it occurs in regular joint replacement.

We also allow them to keep more of their natural bone and ligaments with these procedures. And so patients feel, the knees and the hips feel more natural. They have less pain from the procedure, and they're usually able to recover faster. Many of my patients go home the same day. They don't need to stay in the hospital. And those that stay in the hospital almost always leave the next day. In terms of their overall experience, besides the noticeable, additional incisions, it's really the same experience for them. So, when they go to sleep, we take good care of them. And when they wake up, they've got a natural feeling hip or knee replacement.

Host: Now I want give you an interesting question, Dr. Rothenberg. What's something that has surprised you about using robotics in orthopedic surgery, as it's relatively new and very exciting. And the future looks really bright for these technologies. What's something that's really given you pause, surprised you, delighted you?

Dr. Rothenberg: That's a great question. The real time modeling of the hip and knee on the screen, what it confirms is that no single patient is alike. When we go through training, we talk about how anatomy works and we make assumptions and we use those assumptions to guide how we are replacing the joints to try to make them feel more natural. And in my studies, we realized that we were kind of falsely lumping people in the middle and that everyone has a unique alignment. Everyone has a unique anatomy and balance. And some people are knock-kneed and some people are bow-legged, and we don't want to throw that away and change the anatomy for that patient just because we made a false assumption.

So, the robotic technology gives us real time ability to see those anatomic variables, to change how we're doing the surgery in real time and make sure that, that patient gets the most natural replacement of what they're used to feeling their whole life. Because if I'm, going to see a patient who's 65 and I change the way that their knee or hip feels, it's not going to feel natural, even if the pain is gone. So, I've been super surprised by this technology and it's been a game changer for me and trying to help patients live their best life.

Host: Very cool. Dr. Rothenberg, as we wrap up, what's a piece of advice you'd give patients that are experiencing joint pain? What questions would you like them to ask about robotic joint replacement?

Dr. Rothenberg: Well, when they seek out a surgeon or a partner, they need to have a collaborative experience with that surgeon and really feel that that surgeon has their best interest in mind and can offer them most advanced technologies to match their anatomy. And so I just ask them to talk to them about their experience, what exposure they have to newer technologies and what their philosophy is about joint replacement. These are things that orthopedic surgeons and joint replacement surgeons all should be thinking about and should be able to share with their patients so that both the patient and the surgeon are on the same page.

Host: Excellent episode, Dr. Rothenberg as always. You're such a great guest. Please join us again and update us as things are so exciting in your field. Thank you again. And that concludes this episode of Checkup Chat with EvergreenHealth. Please visit our website at evergreenhealth.com/orthosportsmedicine for more information, and to get connected with one of our providers. Please remember to download, subscribe, rate, and review this podcast and all the other EvergreenHealth podcasts. For more health tips and updates, follow us on your social channels. I'm Melanie Cole.