Amanda Wilde (Host): This podcast is for informational purposes only and is not intended to be used as personalized medical advice. 

Over time, there's wear and stress on your joints, and whether it's a result of injury or age, knee pain can be debilitating. Next, we will talk with orthopedic surgeon Dr. Smith Meads and focus in on when robotic surgery fits the treatment plan.

This is Be Well with Skagit Regional Health. I'm Amanda Wilde. Dr. Meads, good to meet you. Thank you so much for being here.

Smith Meads, DO: Thank you for having me on.

Host: Well, starting generally, when a patient comes into your office with knee pain, how do you assess what treatment options are available?

Smith Meads, DO: Well, the first thing we start with is getting X-Rays of their knees to see how far along the arthritis has progressed. So depending on if they're really mild with early stages of arthritis or, maybe their pain isn't all that bad, but even the stages of X-Ray have progressed pretty far; we're going to always try some non-operative things first, like weight control, healthy diet, healthy living, even moving on to things like anti-inflammatory medications. Then there's some different injection options that we talk about. All of this leads up to eventually the point where the arthritis is bad enough that they need to have their knee replaced. And then we start talking about surgical intervention to replace their knee.

Host: It's really common, as I know more and more folks, basically over 60 or 65, there are many getting knee replacements at this point. Is it more common than it used to be?

Smith Meads, DO: Well, certainly it is in large part because our population continues to age as the baby boomer population has been moving into elderly ages, we've been seeing a huge increase in the number of total joints being done in the country.

Host: And then we see this increase also in technology. Can you explain a little bit about the difference between traditional knee replacement surgery and the robotic-assisted system?

Smith Meads, DO: Well, I think the easiest way to understand this is to think of going from an analog system to a digital system. So in a normal or traditional knee replacement, we have to cut the knee to fit a specific replacement size, and to do that, I have to check and balance with different aspects of the anatomy, and I do that with my eyes and hands, And, we're taught and go over this in-depth and learn this ad nauseum during our residency.

What has happened with robotics and what we call computer navigation, is we can take those same anatomic points, but we can put them into a digital system that can show us exactly the numbers that we have been filling now over the years. And so now it goes, like I said, from an analog to a digital system.

Host: So, it's going to be more accurate and precise as well?

Smith Meads, DO: That's the goal of this is to limit the chances where human error can make a difference. And so the idea here is we will end up with more precise cuts on the bones and more accurate tension on the soft tissues.

Host: And are there any other benefits we're missing from using a robotic-assisted system?

Smith Meads, DO: Well, I think one of the benefits that has really been shown is just that we are able to catch people's interest. And it actually, has made people a little bit more, I think, willing to move towards knee replacement as they hear about a robot being used.

Host: Oh, so there's more trust in a robotic system because I was going to say it's more accurate, isn't it, to say robotic system rather than a robot?

Smith Meads, DO: Yeah, it is. So the term is robotic-assisted total knee replacement. And that is the more accurate way of stating it.

Host: And why do you think people are more open to having the robotic-assisted surgery? I think for me, I would say the first thing I would wonder is, hey, is my recovery time going to be less and is this going to be less invasive and therefore, less time in the hospital and less time getting over the treatment.

Smith Meads, DO: Unfortunately, those particular things are not yet changed. The length of time of recovery, the invasive nature of the surgery, all of that has remained the same. And realistically, probably not going to change because we have to extract and re-implant parts that are decent size. And so, what this does is it allows us to be more accurate and precise at the same time with what we're doing.

Host: Have you observed any differences in patient outcomes?

Smith Meads, DO: The difference that I've noticed isn't so much the outcome of the pain that they're having or the ability to get up and walk. The main difference that we're seeing is that we no longer have the outliers that don't do quite as well. And so that's where we're limiting is, the, if you think of a bell curve of people having anything done, and the majority are going to fit within a certain percentage. And we're getting that tighter. That's what we're able to accomplish with it.

Host: Just wondering too, I seem to read around that more young people are having knee issues than before and I'm wondering if these sort of knee issues that you see that are helped by knee replacements, are on the rise.

Smith Meads, DO: It is, in large part, because of the size of people in the country, with obesity being more prevalent, that's making younger people, and instead of only sixties and seventies getting their knees replaced, we're seeing even forties, fifties, certainly in the early sixties.

Host: So there's where a lifestyle change could really prevent this issue.

Smith Meads, DO: Absolutely.

Host: Anything else we can do to prevent the need for knee replacement, whether it comes earlier or later in life?

Smith Meads, DO: Nothing that's been very well proven in data. So for the most part, we focus on healthy dieting, healthy living. And from there, there's not much we can do. The major component to arthritis developing is genetic, not necessarily a specific gene that has been mapped out, but just that if there's a family history of it, you're more likely to have it. And then with the different types of jobs or wear and tear scenarios that someone might put their knee through, they're more likely to develop it.

Host: As you've seen medical technology move forward, how do you see the role of robotic- assisted surgery or systems evolving in the future?

Smith Meads, DO: I think it's going to become mainstream. Right now, it's still more common that we're doing a traditional knee replacement. And I think as we continue to hone in the technology to where we understand better what the robot is capable of doing, then we're going to be able to implement it more and more. I don't think it will ever replace the need of a surgeon, because there are aspects of this where you have to be able to make changes on the fly, which robots often cannot do.

Host: Yeah, and so this is really the robot is a valuable tool that can make the difference because you can change on a dime.

Smith Meads, DO: Right. Exactly.

Host: And surgeons always have to just kind of fly in there and deal with conditions.

Smith Meads, DO: Absolutely. And one of the things too, is while our anatomy is very, very closely the same from one person to the next; there are slight differences and those slight differences sometimes can mean quite a bit.

Host: Right. So really, you can individualize further with the robot. Thank you so much for this explanation of robot-assisted surgery in total knee replacement. Fascinating.

Smith Meads, DO: Yeah. Happy to do this.

Host: That was Orthopedic Surgeon Dr. Smith Meads. Visit SkagitRegionalHealth.org to learn more. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for other topics of interest to you. This is Be Well with Skagit Regional Health. Thanks for listening.