Transcription:
Advances in Joint Replacement Utilizing MAKOplasty

Prakash Chandran (Host): With advances in technology, joint replacement has become less risky and more unique to one specific condition. MAKOplasty is a minimally invasive robotic surgery, that is an option for those suffering from pain in their joints. We're going to talk all about it today with Dr. David Lent, Chief of the Department of Orthopedic Surgery at St. John's Riverside Hospital. This is Riverside Radio HealthCast, the podcast from St. John's Riverside Hospital. My name is Prakash Chandran. So first of all, Dr. Lent, thank you so much for being here today. Truly appreciate your time. Let's get right into it. What exactly is MAKOplasty robotic surgery?

David Lent, MD, FAAOS (Guest): Conservative total knee replacements or hip replacements, relied on the surgeon to open up the hip or the knee and use anatomical landmarks to do the operation. And that has been okay, in the past, but it's very faulty and can lead to not the greatest results. MAKOplasty uses GPS technology in order to ensure that the position of the components is done perfectly.

We do virtual surgery on a computer after making a 3D model of the knee or the hip. And then we bring in a robot that actualizes that model inside the hip or the knee to give a perfect result every single time.

Host: That sounds absolutely incredible. So it's that virtual model that basically is an equivalent of the satellites that then the MAKOplasty robot follows. Right?

Dr. Lent: Absolutely. It's more like, up to now when you wanted to travel somewhere, you, instead of asking your friends for directions on how to get there and writing it down, now you turn on your GPS technology in your car and it gives you all the directions on how to get there based on a satellite guidance. The same thing here is with the knee replacement. We are using "satellite" guidance to ensure that we put the components in the perfect position every single time.

Host: Okay. And why would someone need MAKOplasty robotic surgery versus the traditional one? It sounds like you choose MAKOplasty surgery every time, if you can.

Dr. Lent: In my practice, nobody receives it the old way that conserve - or the conventional way. It's again, just like a instructions. You would never try to go for a long trip and ask a friend for instructions. Now everybody uses their cell phone or their smart device in order to get directions, to go to a certain place. And it can alter it based on traffic patterns. Same thing here in the knee or the hip, every single patient in my practice at St. John's Riverside Hospital will have GPS technology to ensure that the procedure is done expertly with as minimal dissection as required, minimal blood loss in order to ensure the operation. So in quick, we do not do any joint replacement without the robot nowadays.

Host: Wow. And you mentioned the hip and the knee. Are those the main joints that are serviced by a MAKOplasty, or are there others that people should know about?

Dr. Lent: For right now, it's just the hip and the knee. We're able to do full hip replacements and either total or even partial knee replacements utilizing the robot technology.

Host: Got it. And in terms of being a good candidate, it sounds like as long as you need something with regards to the hip or the knee, you're a good candidate for a MAKOplasty robotic surgery.

Dr. Lent: That is exactly correct. The procedure is indicated for people who have very bad arthritis and are incapacitated due to increased pain in both of these locations. And if that is your present situation, then you are a candidate and we do 100% of our patients using robotic surgery.

Host: Okay. Now robotic surgery is sometimes referred to as minimally invasive. Can you just talk at a high level about what this means?

Dr. Lent: Minimally invasive means that we're able to use modern techniques in order to cut and dissect in the hip or the knee less than it was before. The less, and the less dissection that we do, decreases the potential complications, also decreases the pain associated with the procedure and leads to a quicker recovery.

So now using this technology, since the robot can see where the surgeon couldn't possibly see, we need to make the incision much smaller, and yet we have increased accuracy of the procedure. So, with both of those regards, the patients can recover faster, get out of the hospital faster and back to the activities that they enjoy at a much quicker rate.

Host: Yeah, it sounds like it's only upside there. Talk about the scarring. So once that incision is made, even though it's made by a robot, how big is the actual scar?

Dr. Lent: So just to correct you, the incision is made by the surgeon. This is not a robot doing the surgery. This is a surgeon, doing the surgery, the surgeon is making the cuts. The robot just helps direct us to do it in a specific way, but because we have the robot, the length of that incision is half of what it used to be.

The dissection inside the knee is a fraction of what it used to be. We still need to open up the knee or the hip in order to get the components in there and to perform the surgery. But since we don't need to see as much, because the robot can see and the GPS technology can see, that incision and dissection is a fraction of what it used to be.

Host: So I feel like most of the general population, when they hear robotic surgery, they think a robot is doing it. But from what I'm understanding from you, it's kind of like an extension of your hands and it allows you to, for example, see things and be navigated to things that just was not possible before. Is that more or less correct?

Dr. Lent: Yes. I like to say that it's more what we call robotic assisted surgery. It's not robotic surgery. It's not, we bring the robot in and the surgeon disappears and the robot does the whole operation. It's just the opposite. The surgeon is still there. The surgeon is still in control of the operation at all times. And the surgeon is just directed and assisted by a very capable assistant, being the robot.

Host: Well, that's actually a relief to hear, because I definitely have talked to people before that have been apprehensive because they're like, well, I don't want a robot doing my surgery because they don't feel the same things. And they can't make the same types of decisions that a doctor or a surgeon would. But it sounds like you're just leveraging the technology to do better work, but you're still in control.

Dr. Lent: Absolutely. I've come across that as well. Patients that I don't want some robot taking care of me. Let's say something goes wrong. Who's in charge? Well, the surgeon is still very much in charge. It's just an adjuvant, you know, instead of the surgeon just using his hands to figure out what needs to be done. We know what needs to be done by the GPS technology and the robot assists us as the surgeon guides the robot into the appropriate position. But the robot is a good stop. It doesn't let you take too much bone or cut the bone in the wrong way or in the wrong position. It is exacting and allows us to cut the bone exactly to the micro millimeter in the appropriate position.

And that is really one of the huge differences instead of the surgeon, as good as we are, we cannot have the precision within the micro millimeter level, but the robot can be that precise and can really improve the precision and the location of the components and really gives a, an improved result at the end of the day.

Host: Yeah, it's truly amazing. Let's talk about the procedure itself. Talk a little bit about the prep that is required before the procedure. What happens during the procedure, how long it takes and then the recovery afterwards.

Dr. Lent: All right. Fantastic. So before that operation, in order to allow the robot to work, we need to get a roadmap. Again, I keep coming back to that analogy of a car and directions. The, your GPS technology has a map in its brain. We need to give the robot a map. So we will, before the operation, send the patient for a CAT scan and make a 3D model of the knee on the computer. And even before the patient shows up to the hospital, the surgeon is actually operating on the patient virtually, putting the components in the appropriate position, putting and assigning the appropriate size components where they need to go. So that, all that prep work is done before the patient comes into the surgery.

Then we actualize that surgery and do the surgery. The surgery takes between an hour and a half, used to take much longer and have more blood loss and more complications. But because of the robot, the surgery is much smaller, much quicker. And then the patient is admitted overnight and goes home the next day. Many of our patients are now even leaving that day of the surgery because the amount of pain that they're under and the dissection is so much less than we can even safely allow them to go home the day of the procedure. But at the very longest patients stay overnight and go home the next day.

In the past, patients needed to go to rehabilitation and be admitted there for a week, 10 days or longer. Now patients, 99% of our patients go home to their home, sleep in their bed, along with their family and get some physical therapy as an outpatient or in their home. So it has helped transform this procedure from beginning to end throughout and really patients are loving the procedure and benefiting from this most amazing technology.

Host: Yeah, that just sounds incredible. It improves every piece of it, including the recovery time. Tell me, I have just one clarifying question. I imagine that after that CAT scan or 3D model of the knee is complete, the time between the scan and the surgery has to be relatively quick because things could change. Is that correct?

Dr. Lent: That's very astute of you my friend, but it doesn't have to be that quick. It can be within three months, but generally we do it within a week of the procedure. But you're right, should the surgery need to be canceled and delayed, we may need to get a new CAT scan at a later date to ensure that nothing has changed in the interim.

Host: Okay. And so after the procedure, how long does the implant last itself?

Dr. Lent: So whether you do it robotically or not robotically, there is a life expectancy of these components. But at this point they're well over 20 years, some even closing in on 30 years, but we don't truly even know because the components that we see now were inserted over 20, 25 years ago.

And the, the studies coming out showing that those components are lasting 20 years or more. Now we're putting in even better components. And now we have the addition of them being put in perfectly using the robot. So we expect those components to last 30 plus years, hopefully for the rest of the life of the patient.

Host: So I think one thing that we've done a good job of in this conversation is convincing people about all of the upside around getting a MAKOplasty robotic procedure. But the big question that's probably looming in people's mind, is it covered by insurance? Is that something you could speak to?

Dr. Lent: Yes, I can speak to that. You know, initially when the technology came out, it was not covered by insurance. At this period of time, there is no insurance that does not cover it. They have the insurance companies themselves have seen the benefit for them on their bottom line as well, because since the components are put in, so, so expertly and precisely, the length of time patients stay in the hospital, the complications that patients have are reduced by a very large margin. So, it is cost-effective to use the robot. So even though the technology is slightly more expensive than a regular surgery, in the long run, it saves the insurance company a lot of money. So they are all on board now with robotic surgery and approve it across the board.

Host: You know, if someone is listening to this and they are considering getting one of these replacements done. Talk to us a little bit about the landscape of joint replacement and why it's so important to get a MAKOplasty versus the traditional procedure that still might be available today.

Dr. Lent: In my mind, there is no room to do it conventionally. There are very good surgeons out there that are still using old technology and get very good results. And I can't speak disparagingly on any of them. All I can tell you is that the ones that haven't used it do not know what they're missing and their patient, they don't know what they're missing with their patients. The robotic technology is far and above. And initially when I started doing the surgery 12 years ago, it was more experimental. It has now been proven by over a million components being put in showing the definite benefits to the patient. And it is expanding rapidly in the country and around the world. And I suspect with over the next decade, there'll be very few people doing it without the robot. And I do not do any patient that way, and I don't recommend that any patient get it the old the old conventional way.

Host: Makes sense to me, Dr. Lent. Anything else you wanted to share with our audience before we close here today?

Dr. Lent: I feel that St John's Riverside has been the leading institution, despite it being a small community hospital. We had this technology for the past decade. We have done more than any other hospital in the region and we have it down really to a good program where the patients do extremely well and are extremely satisfied and there is no other institution in the region that does it as well as we do it. And we're just the leader and our patient satisfaction is proof to that effect.

Host: Well wonderful. Dr. Lent, truly informative conversation. Amazing to hear the future that we live in today with MAKOplasty robotic surgery. Thank you so much for your time.

Dr. Lent: You're very welcome.

Host: That was Dr. David Lent, Chief of the Department of Orthopedic Surgery at St. John's Riverside Hospital.

For a physician that performs MAKOplasty surgery, please call our physician referral service at 914-964-4DOC. Or email us at findadoc@riversidehealth.org.

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