Robotic Systems in Orthopedic Surgery
Dr. Kyle Hazelwood discusses new technologies and robotic systems that physicians are using for total knee replacement surgeries.
Featuring:
Kyle Hazelwood, MD
Dr. Hazelwood began practicing at Inland Orthopaedic Surgery & Sports Medicine Clinic in 2017. He is board certified by the American Board of Orthopaedic Surgery and board eligible for subspecialty in Orthopaedic Sports Medicine. He completed a fellowship at the San Diego Arthroscopy and Sports Medicine Fellowship, where he spent time covering the San Diego Chargers and San Diego State University athletic teams. Transcription:
Intro: With a relentless focus on excellence in health care, Pullman Regional presents The Health Podcast.
Deborah Howell: Back in the day, total knee replacement surgeries were huge procedures, which left sizable scars, but we come a long way since then. So what new technologies are physicians using for total knee replacement surgeries in the year 2021? To talk about robotic systems in orthopedic surgery, today we're joined by Dr. Kyle Hazelwood, an orthopedic surgeon at Inland Orthopedic Surgery and Sports Medicine and a vital part of the Pullman Regional Hospital Orthopedic Center of Excellence. Welcome, Dr. Hazelwood.
Dr. Kyle Hazelwood: Thank you very much. Thanks for having me today.
Deborah Howell: So great to have you on. Can you tell us about the new orthopedic equipment you're using and how it creates better outcomes for patients?
Dr. Kyle Hazelwood: Yeah. So we're using a brand new robotic total knee system. It's called the CORI total knee system. It's from the Smith and Nephew. And you can think of it as a two-part system. So the first part is a navigation portion of the procedure. And the second part is really the robotics part of the system. And so what the first part allows us to do, the navigation portion, it really allows us to customize a surgery for each individual patient. So essentially, what we do is take several different data points, starting with alignment in the leg, and we give the computer this information and this feedback. And then the second part of the navigation system, we collect essentially thousands of data points really quickly, and they need to do something called mapping. And so what we're essentially doing is generating a digital model of the knee.
And then, we can really use that model that we've created to customize total knee replacement surgery based off the patient's unique anatomy, bony anatomy and ligament anatomy. So that's kind of the first part of this new equipment. And then the second part is really utilizing the robotics system that works together with the navigation portion of the procedure so we can execute that plan.
And so the robotic arm is essentially a handheld piece of equipment that I control, but really what it does, like I said, is just help us execute the plan that we have designed for each individual patient. And so, for example, if we were using the robotic arm and the surgeon got too close to the MCL ligament, the robot would shut off. And so it really only allows us to execute the surgical plan that we've created.
For the second part of your question, I guess, is how did it create better outcomes? And we need more data to really determine that. To me, when you're talking about outcomes and total knee replacement, there are different things that can mean. And so the one question all of our patients always ask is "How long is this going to last me?" It's a mechanical knee. Like anything mechanical, it wears out over time. And so we always look at studies that look at the survival rates of implants long-term. And so right now, I don't think we have enough data to really say that it lasts longer using this technology. Time will tell. We need to continue to research and study it.
But I will say that there are short-term outcomes that we have looked at and some of the results have been really exciting with this robotic technology. And so there have been a couple of studies now that have showed us that patient satisfaction is a little bit higher using the robotic system, as opposed to the more traditional manual instrumentation. Also a couple newer studies have shown pain outcomes might be better both in patients rating of their pain and also their use of pain medications postoperatively. So those are the recent studies that are really exciting with this new technology.
Deborah Howell: All right. Fingers crossed. And why do we need to invest in this type of technology? Is it the future?
Dr. Kyle Hazelwood: Yeah. I really think it is, Deborah. I think it's really just one more tool we can use as surgeons to try to perform the surgery as accurately as possible for our patients. It has been shown that there's more predictable, more precise alignment when we're using some of this technology.
And so again, kind of going back to the outcomes, in the long-term, is that going to show that total knee replacement lasts longer? We don't know yet. But in theory, if we can make things really accurate, if there are less outliers, in theory, that's going to be better for our patients long-term.
Deborah Howell: Absolutely. All right. CORI, why this piece of equipment versus another?
Dr. Kyle Hazelwood: Well, the CORI system, it's really pretty exciting for me. I'm a little bit biased towards it, but a couple reasons. One, I think it combines the latest technology in both navigation and robotics, like we've kind of talked about. And so it's really the latest iteration. And it has some advantages, I believe, over some of the older generation of those systems. You know, but also from a practicality standpoint, it has a really small footprint and it's really nice for hospitals and surgery centers, et cetera.
There are several components of it. There's a camera and a monitor. But the main computer is really small. It's about the size of an X-Box. And then the robotic arm, in some of the older generations are really big and bulky and hard to store. The robotic arm is a little handheld device and it's perhaps just maybe twice the size of an electric toothbrush, so it's really small. It makes it easy for places to store. And like I said, the technology is just so new. It works so well. It really makes things kind of streamlined
Deborah Howell: It seems like you're really excited to have this new technology, are you?
Dr. Kyle Hazelwood: Yeah, I really am. You know, and it's mostly just for my patients' sake and I think I practice in a community that I think is really informed and savvy, and it's exciting to bring something new to offer to our patients. And maybe they don't have to go necessarily to the big city like Seattle or something to have this type of surgery. We can offer it to them here. And if this tool helps us be a little bit more accurate and perhaps, like we talked about, have a little less pain after surgery and patients are more satisfied, that really makes me pretty excited to have this.
Deborah Howell: I get that completely. How is this going to change how you perform total knee replacement procedures?
Dr. Kyle Hazelwood: Well, it's a little bit different workflow than the way we were doing it before. So it does kind of change the workflow in the operating room. You know, from a patient standpoint, I would say one of the biggest things, it's actually way more convenient for them. Because some of the ways or even the way I was doing this surgery before, we had to get special imaging ahead of time. And it was something we were doing again with the system we were using, trying to make things more accurate for our patients. But we really are able to gather all the data in the operating room, and so there's no special imaging. Perhaps our patients, you know, if they're wanting to have surgery sooner rather than later, there's a little less delay. And so I think that's the biggest thing it'll change from a patient perspective, just, you know, again, cutting down on preoperative studies and making things a little bit more efficient.
Deborah Howell: I just love how you advocate for your patients. It's wonderful to hear. How is the CORI different than what's in most ORs?
Dr. Kyle Hazelwood: Yeah, that's a good question. You know, CORI has been out for less than a year, but certainly there are multiple places using it across our state. I think that it's really a mix of what's in ORs. I think that there's some ORs using navigation systems, some ORs using robotics and some ORs still using more of the traditional manual instrumentation. I don't think any of those are really wrong. It's just really what is right for each patient and surgeon. But again, this is just kind of the newest iteration of navigation and robotics. And so, it hasn't been out very long. It's not super common yet, but I think it will be in the future like we talked about.
Deborah Howell: Especially since it's so easy to store and so precise and it just sounds wonderful. I wish my mother had had that. She had three different knee replacements in her life because they just kept wearing out. It was, you know, old style.
Dr. Kyle Hazelwood: Yeah, you know, and that can happen, right? And I think the future of knee replacement, that's the ultimate goal, is that it lasts as long as possible. Patients are satisfied. They have one surgery, not multiple surgeries. And so all sort of this new technology, I think, you know, this CORI system included and other technologies. That's the whole goal, is really to make things efficient as possible, last as long as possible and increase satisfaction as much as possible.
Deborah Howell: Absolutely. Is there anything else you want people to know about this topic?
Dr. Kyle Hazelwood: Well, I think we've kind of covered the highlights. I would like to say that this surgery is new technology. It really takes a team of people. And in my group here in orthopedics, my staff has been wonderful about kind of adopting this and being able to explain it to patients. I have an assistant who's been in orthopedics for 25 years and he's been through probably every iteration of navigation systems and early robotics. And it's really nice to have that support. And just within our hospital here, where we're doing this at Pullman Regional Hospital, you have to have nurses and therapists kind of buy in and support this and they have. And my surgery staff is awesome and I have a few ortho techs who've really taken an interest in this and learned this new technology.
And that's what I think you have to have. You have to have a big team of people to support you anytime you take on something new like this, and we have such a great team there. It's been awesome.
And then, the other thing too is you have to have, I think, a hospital administration who supports this. We have our hospital CEO and surgery director here who really supported this once I told them we should look into this and, you know, and the community has to get behind it. So it takes a big group of people to make something like this happen. I'm so fortunate to have the team that I do.
Deborah Howell: A map, a team and a community. That's what it's all about. And because we're talking about patient outcomes and it really affects, you know, quality of life forever.
Dr. Kyle Hazelwood: Absolutely.
Deborah Howell: Dr. Hazelwood, we so appreciate your time and for everything you do. Thanks so much for being with us today.
Dr. Kyle Hazelwood: Thanks for having me.
Deborah Howell: For more information as well as more podcast episodes, visit PullmanRegional.org. This has been The Health Podcast from Pullman Regional. I'm your host, Deborah Howell. Thanks for listening and have yourself a terrific day.
Intro: With a relentless focus on excellence in health care, Pullman Regional presents The Health Podcast.
Deborah Howell: Back in the day, total knee replacement surgeries were huge procedures, which left sizable scars, but we come a long way since then. So what new technologies are physicians using for total knee replacement surgeries in the year 2021? To talk about robotic systems in orthopedic surgery, today we're joined by Dr. Kyle Hazelwood, an orthopedic surgeon at Inland Orthopedic Surgery and Sports Medicine and a vital part of the Pullman Regional Hospital Orthopedic Center of Excellence. Welcome, Dr. Hazelwood.
Dr. Kyle Hazelwood: Thank you very much. Thanks for having me today.
Deborah Howell: So great to have you on. Can you tell us about the new orthopedic equipment you're using and how it creates better outcomes for patients?
Dr. Kyle Hazelwood: Yeah. So we're using a brand new robotic total knee system. It's called the CORI total knee system. It's from the Smith and Nephew. And you can think of it as a two-part system. So the first part is a navigation portion of the procedure. And the second part is really the robotics part of the system. And so what the first part allows us to do, the navigation portion, it really allows us to customize a surgery for each individual patient. So essentially, what we do is take several different data points, starting with alignment in the leg, and we give the computer this information and this feedback. And then the second part of the navigation system, we collect essentially thousands of data points really quickly, and they need to do something called mapping. And so what we're essentially doing is generating a digital model of the knee.
And then, we can really use that model that we've created to customize total knee replacement surgery based off the patient's unique anatomy, bony anatomy and ligament anatomy. So that's kind of the first part of this new equipment. And then the second part is really utilizing the robotics system that works together with the navigation portion of the procedure so we can execute that plan.
And so the robotic arm is essentially a handheld piece of equipment that I control, but really what it does, like I said, is just help us execute the plan that we have designed for each individual patient. And so, for example, if we were using the robotic arm and the surgeon got too close to the MCL ligament, the robot would shut off. And so it really only allows us to execute the surgical plan that we've created.
For the second part of your question, I guess, is how did it create better outcomes? And we need more data to really determine that. To me, when you're talking about outcomes and total knee replacement, there are different things that can mean. And so the one question all of our patients always ask is "How long is this going to last me?" It's a mechanical knee. Like anything mechanical, it wears out over time. And so we always look at studies that look at the survival rates of implants long-term. And so right now, I don't think we have enough data to really say that it lasts longer using this technology. Time will tell. We need to continue to research and study it.
But I will say that there are short-term outcomes that we have looked at and some of the results have been really exciting with this robotic technology. And so there have been a couple of studies now that have showed us that patient satisfaction is a little bit higher using the robotic system, as opposed to the more traditional manual instrumentation. Also a couple newer studies have shown pain outcomes might be better both in patients rating of their pain and also their use of pain medications postoperatively. So those are the recent studies that are really exciting with this new technology.
Deborah Howell: All right. Fingers crossed. And why do we need to invest in this type of technology? Is it the future?
Dr. Kyle Hazelwood: Yeah. I really think it is, Deborah. I think it's really just one more tool we can use as surgeons to try to perform the surgery as accurately as possible for our patients. It has been shown that there's more predictable, more precise alignment when we're using some of this technology.
And so again, kind of going back to the outcomes, in the long-term, is that going to show that total knee replacement lasts longer? We don't know yet. But in theory, if we can make things really accurate, if there are less outliers, in theory, that's going to be better for our patients long-term.
Deborah Howell: Absolutely. All right. CORI, why this piece of equipment versus another?
Dr. Kyle Hazelwood: Well, the CORI system, it's really pretty exciting for me. I'm a little bit biased towards it, but a couple reasons. One, I think it combines the latest technology in both navigation and robotics, like we've kind of talked about. And so it's really the latest iteration. And it has some advantages, I believe, over some of the older generation of those systems. You know, but also from a practicality standpoint, it has a really small footprint and it's really nice for hospitals and surgery centers, et cetera.
There are several components of it. There's a camera and a monitor. But the main computer is really small. It's about the size of an X-Box. And then the robotic arm, in some of the older generations are really big and bulky and hard to store. The robotic arm is a little handheld device and it's perhaps just maybe twice the size of an electric toothbrush, so it's really small. It makes it easy for places to store. And like I said, the technology is just so new. It works so well. It really makes things kind of streamlined
Deborah Howell: It seems like you're really excited to have this new technology, are you?
Dr. Kyle Hazelwood: Yeah, I really am. You know, and it's mostly just for my patients' sake and I think I practice in a community that I think is really informed and savvy, and it's exciting to bring something new to offer to our patients. And maybe they don't have to go necessarily to the big city like Seattle or something to have this type of surgery. We can offer it to them here. And if this tool helps us be a little bit more accurate and perhaps, like we talked about, have a little less pain after surgery and patients are more satisfied, that really makes me pretty excited to have this.
Deborah Howell: I get that completely. How is this going to change how you perform total knee replacement procedures?
Dr. Kyle Hazelwood: Well, it's a little bit different workflow than the way we were doing it before. So it does kind of change the workflow in the operating room. You know, from a patient standpoint, I would say one of the biggest things, it's actually way more convenient for them. Because some of the ways or even the way I was doing this surgery before, we had to get special imaging ahead of time. And it was something we were doing again with the system we were using, trying to make things more accurate for our patients. But we really are able to gather all the data in the operating room, and so there's no special imaging. Perhaps our patients, you know, if they're wanting to have surgery sooner rather than later, there's a little less delay. And so I think that's the biggest thing it'll change from a patient perspective, just, you know, again, cutting down on preoperative studies and making things a little bit more efficient.
Deborah Howell: I just love how you advocate for your patients. It's wonderful to hear. How is the CORI different than what's in most ORs?
Dr. Kyle Hazelwood: Yeah, that's a good question. You know, CORI has been out for less than a year, but certainly there are multiple places using it across our state. I think that it's really a mix of what's in ORs. I think that there's some ORs using navigation systems, some ORs using robotics and some ORs still using more of the traditional manual instrumentation. I don't think any of those are really wrong. It's just really what is right for each patient and surgeon. But again, this is just kind of the newest iteration of navigation and robotics. And so, it hasn't been out very long. It's not super common yet, but I think it will be in the future like we talked about.
Deborah Howell: Especially since it's so easy to store and so precise and it just sounds wonderful. I wish my mother had had that. She had three different knee replacements in her life because they just kept wearing out. It was, you know, old style.
Dr. Kyle Hazelwood: Yeah, you know, and that can happen, right? And I think the future of knee replacement, that's the ultimate goal, is that it lasts as long as possible. Patients are satisfied. They have one surgery, not multiple surgeries. And so all sort of this new technology, I think, you know, this CORI system included and other technologies. That's the whole goal, is really to make things efficient as possible, last as long as possible and increase satisfaction as much as possible.
Deborah Howell: Absolutely. Is there anything else you want people to know about this topic?
Dr. Kyle Hazelwood: Well, I think we've kind of covered the highlights. I would like to say that this surgery is new technology. It really takes a team of people. And in my group here in orthopedics, my staff has been wonderful about kind of adopting this and being able to explain it to patients. I have an assistant who's been in orthopedics for 25 years and he's been through probably every iteration of navigation systems and early robotics. And it's really nice to have that support. And just within our hospital here, where we're doing this at Pullman Regional Hospital, you have to have nurses and therapists kind of buy in and support this and they have. And my surgery staff is awesome and I have a few ortho techs who've really taken an interest in this and learned this new technology.
And that's what I think you have to have. You have to have a big team of people to support you anytime you take on something new like this, and we have such a great team there. It's been awesome.
And then, the other thing too is you have to have, I think, a hospital administration who supports this. We have our hospital CEO and surgery director here who really supported this once I told them we should look into this and, you know, and the community has to get behind it. So it takes a big group of people to make something like this happen. I'm so fortunate to have the team that I do.
Deborah Howell: A map, a team and a community. That's what it's all about. And because we're talking about patient outcomes and it really affects, you know, quality of life forever.
Dr. Kyle Hazelwood: Absolutely.
Deborah Howell: Dr. Hazelwood, we so appreciate your time and for everything you do. Thanks so much for being with us today.
Dr. Kyle Hazelwood: Thanks for having me.
Deborah Howell: For more information as well as more podcast episodes, visit PullmanRegional.org. This has been The Health Podcast from Pullman Regional. I'm your host, Deborah Howell. Thanks for listening and have yourself a terrific day.