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Melanie Cole: Welcome to Right Beside You, a Reed Health podcast. I'm Melanie Cole, and I invite you to listen as we explore Mako robotic total joint replacement. Joining me is Dr. Joel McClurg. He's an orthopedic surgeon with Reed Health. Dr. McClurg, thank you so much for joining us today. Tell us a little bit about you, how you came to Reed Health, and just give us a little background on you.

Joel McClurg: Sure. Thank you. So I came to Reed Health about two years ago. I've been practicing orthopedics for about 18 years now. And over the last eight years, I've been working in robotic Mako total joint replacement.

Melanie Cole: So you're a total hip and knee replacement specialist. How'd you get into the technology side of joint replacement?

Joel McClurg: Yeah, that's a really good question. So, you know, we've been doing total joints the same way for at least the last 40 years, and we had really good outcomes, but we weren't getting any better as the years went by. It's sort of a diminishing returns kind of effect, meaning that, you know, you keep putting more time and energy in and you don't get any better outcomes.

And so we needed sort of something to kind of break that impasse and robotics came out and, you know, robotics has been in all kinds of other industries for a long time, but it finally came to medicine and into orthopedics specifically. And I was really attracted to that technology because I saw that was sort of the path forward to getting better.

And so that's not a very easy thing to do because you take on technology, you have to talk to patients about it, you have to learn about it yourself. But I was just sure that whatever energy and time I was going to spend in doing that, that it was going to be better for the patients in the long run.

Melanie Cole: Well, I'm certain that's true. So tell us what robot do you use and why this particular one. Tell us about it. It's a pretty cool technology.

Joel McClurg: Yeah. So the Mako has probably been around the longest. And it has the most robust data behind it. Meaning, you know, oftentimes when we do studies in the past, we would make decisions and see and look at, say, a hundred patients or so. But what you really want is to see what happens with 10,000 patients or 100,000 patients.

And so, you know, that data has been collected over the last several years in increasing number of patients every year. And so, you know, we've used that one. There's other ones on the market. They do different things and they just don't have the same data, although I think technology and robotics is the future of almost everything in orthopedic surgery.

Melanie Cole: Well, I agree with you and it's really an exciting time to be in orthopedics. So how long has Reed Health had an orthopedic robot?

Joel McClurg: So we got it when I came here. So one of the things I really wanted to do is I had worked on setting up a robotics program where I came from and it was very successful and we got the other surgeons doing it. And so then I came to Reed Health to set up the robotics program.

And robotics is nice. Technology is nice. It's still a person kind of operation, but the really cool thing about robotics is it becomes a catalyst for cultural change, meaning that, you know, you do the same thing for so long, you're getting good outcomes, people are comfortable with the way things are. But there's always a better way to do it.

And when you bring something like robotics in, it kind of energizes everybody, the nurses on the floor, the other physicians, the OR staff, the administration. It's kind of this energy that you bring. And so we've had really great outcomes in the last two years and we've done such better joints than we were doing two years ago.

And part of it that is the Mako technology and how precise the cuts are and less tissue damage, but a big part of it was all the other little changes that we made that went along with the robot that's really made for greater patient care over the last two years.

Melanie Cole: What a great point that you made about the staff and how exciting this is and how it really gets everyone jazzed up. What about you? What's something that surprised you about using robotics in orthopedic surgery?

Joel McClurg: I guess the first thing I noticed is once you get past kind of the learning curve, which is not really that long, so this is not a technology to be used by somebody who's not an expert in the field of hip and knee replacements. So, you know, when these robots first came out, I thought, "Wow, this is great." It's really going to help young surgeons, basically lead them to the right solution for the patient's knee or hip. And we're not there yet. So you better be excellent at what you do. And then the robot is just sort of a tool to help you get a more precise solution to that patient's knee or hip. So that part kind of surprised me.

And then how quickly the learning curve, kind of, was over. Like within five cases, it's a totally different flow of how you do the surgery. So I'd done the surgery for, you know, at that point, I guess 10 years of my career, the free hand way, the way we've always done it. And within five cases, it was just totally intuitive for doing it the robotic way. Even though it was a completely different workflow and different retractors and everything, in the end, the essence is still the same it's to get the cuts done on the bone, so that when you put the implants in, the soft tissue around the knee is perfectly balanced.

And I'd say, especially on the partial knee replacement side, so when we only replaced one of the three compartments. The first one I did with the robot was better than the last one I did free hand. There's just no comparison between the free hand technique and the precision of the robotic technique.

Melanie Cole: That's really amazing. So doctor, you have an interesting story to tell. It's an F-16 jet fighter story. Tell us about that. I'm looking forward to this.

Joel McClurg: Yeah. So I came up with that a while ago, sort of, I like analogies, I like visual analogies. And you know, it goes back to that whole thing about you have to be a good surgeon first, and then you can use technology. And so this is not a technology where it kind of leads you along the way. So just because you can drive or fly a single engine plane, it doesn't mean you can fly an F16 jet fighter. And that's what the analogy is, which is the old way of doing it gives you some ideas about lift and propulsion and landing. But you need to take your game up a whole different level to fly an F16 than to fly a single prop plane. And that's what the robot is. It's still just a tool for flying, just like a plane is a tool for flying. But the technology and the understanding that's necessary to make that happen is totally different at the robotic level.

Melanie Cole: Well, I'm sure that's true. What a great analogy. So how many surgeons are using robotics at Reed Hospital and Healthcare Services?

Joel McClurg: So all four of our surgeons now are using it. And that's kind of what happened where I came from, which is, you know, we adopted the technology for total hip replacements and partial knee replacements. And we had eight surgeons there that eventually picked up the technology.

And so that's kind of what happens. It's not one of those kinds of technologies where you use it for some patients and not others. You either believe in the technology and the results or you don't. But I would say is there's no industry where you can look at and say, 'Well, they got into technology whether it's robot or any other technology, and they got back out again."

And so our surgeons, once they got comfortable with the technical side of doing hip and knee replacements with the robot, and they were experienced total joint surgeons, they bought completely into it because of the results, because the literature says that these patients have less narcotics, shorter length of stay, less blood loss, less tissue trauma, less physical therapy. And those results are becoming very clear in the literature. And so everybody at Reed Health has converted over to the use of the robot.

Melanie Cole: So tell us a little bit about how your results have been. You've touched on it a little bit through this podcast. But most importantly, how have patients responded to the use of technology in their replacement?

Joel McClurg: Right. And that's a big thing, you know, it's like you buy a car and they tell you it'll go so fast and corner so much. Well, you still have to know how to drive that car. And so it's not just one of those, "Well, in specialized hands and in only these situations. And if we use it on just on this group of patients, we get these really good results." It's not like that. This technology, if you commit to, it has excellent outcomes for the patients.

And since the time we came, we collect data on everything now. So we look at length of hospital stay and you know what patients get in terms of narcotics after surgery. And anything you can think about, we look at whether they return to the OR, whether they have a wound problem, whether they're happy with their surgery. We track all that data. And so we have that data from before we started the robotics until after the robotics and everything is better. Blood loss is less. Length of stay was two and a half days. And now, it's less than a day. Fewer complications. No transfusions. The data is just so very clear.

And like I said, part of it is the robotics and the technology, but a lot of it was the buy-in and energy that it brings with the staff. Everybody's committed to taking better care of the patients. And so you combine robotic technology and that energy and synergism of people wanting to buy in and believe in something bigger than themselves and then you get great outcomes. And so we've got those great outcomes and we can prove it because we collect all that data on every single patient.

Melanie Cole: So before we wrap up, Dr. McClurg, because this is really absolutely fascinating what you're able to do. What do you see happening in the future? What's the future of robotic joint replacements? What's something you're really excited about that's coming up?

Joel McClurg: Yeah, that's a good question because it never ends. So I've been on this quest for 18 years to produce the perfect total hip or knee replacement. And I mean, we're getting closer and then robotics is kind of the way that's going to get us there. But we change things all the time, mostly little things now, but one of the really big things that's on the horizon is the use of implants that give us data from the patient.

So when we do this operation, we put a metal femur in the thighbone and a metal tibial base plate in, and then we put a piece of plastic between them. And in the very near future, we're going to have those plastic implants have things embedded inside the plastic that tell us things about the patient, how many steps they've taken in any given day, what's the temperature of the implant, different kinds of pressure sensors. So we're actually gonna get the real-time data from the knee once it's implanted inside the patient.

And that helps us with individual patients. You know, we can say, "Hey, look. We looked at the data Your knee is talking to us. And it tells us that you're only taking 200 steps a day, and we want you to take 2000 or 20,000 steps." But also things like the temperature, if we see that the temperature is going up inside the plastic, that could be a warning that the patient has wear or infection or those sorts of things.

And so these knees are going to be giving us data in real-time in the future that helps us do even better in diagnosing the patients that have problems, and we're seeing how much they're moving and those sorts of things. So the technology is going to continue to advance as time goes by.

We do total hips, total knees, and partial knees now. There's going to be a total shoulder application that's going to be coming out. And that's just the tip of the iceberg. There is all kinds of uses of robotic technology in orthopedics

Melanie Cole: The technology never ceases to amaze me, Dr. McClurg. So one piece of advice that you could give patients experiencing joint pain, what would it be? What would you tell them? What do you tell them every single day?

Joel McClurg: I do. I tell them pick the right surgeon. So a robot is a tool and if you have an energized surgeon and she wants to do great work by you, the robot is just a tool that she will use, that I'll use. But you need to be comfortable with your surgeon and understand their reputation. And that'd be the most important thing. If you pick the right person, everything else will fall into place for you.

Melanie Cole: What an informative, interesting episode this was. Thank you so much, Dr. McClurg, for joining us today and telling us about robotics in total joint replacement. Patients can contact Dr. Joel McClurg by calling (765) 962-4444 to schedule an appointment or for more information. You can also visit ReedHealth.org to get connected with one of our providers. That concludes this episode of Right Beside You, a Reed Health podcast. Please remember to subscribe, rate and review this podcast and all the other Reed Health podcasts. I'm Melanie Cole.