Scott Webb (Host): Joint replacements are very common today. And thanks to the Rosa Robotic System, surgeons like my guest today are able to get us back on our feet and moving much sooner. And I'm joined today by Dr. Kenneth Rauschenbach. He's an Orthopedic Surgeon at Montefiore St. Luke's Cornwall.

 This is Doc Talk presented by Montefiore St. Luke's Cornwall, I'm Scott Webb. Doctor, thanks so much for your time today. We're going to talk about robotic navigation and joint replacement surgery, and lots of cool stuff. As we get rolling here though, who's a good candidate for joint replacement surgery?

Kenneth Rauschenbach, DO: Well, joint replacement's pretty much the number one surgery in all of medicine right now, whether it be a hip and knee, which are the most common, and then followed by shoulder replacement. Anyone who develops significant and severe changes which limit their activities of daily living, simple walking, et cetera. The replacement is the last of the options for these patients when nothing else has worked, including anti-inflammatory medications, some therapy and activity modification, and even injections of a couple different types. Once they failed all of those options, the next step would be a joint replacement.

Host: Yeah. I always love hearing, I've heard this from other surgeons that, you know, surgery's kind of a last resort. Yeah, I'm a surgeon and I like doing surgery, but we try a bunch of other stuff first. But if we find ourselves, you know, as a, as you say, sort of the last resort, okay, here we are, you need a new hip, you need a new knee, and what you're using there, the Rosa Robot System, a robotic system. I'd like to just have you generally just tell us a little bit more about that. Maybe when robotic systems came into be, like Da Vinci and Rosa and maybe some of the benefits basically for patients, for surgeons, the surgical team, what can patients expect, versus the old school kind of open surgeries.

Kenneth Rauschenbach, DO: Joint replacement is, you know, predicated on getting everything positioned and aligned. Unfortunately, just like any other mechanical device, they don't last forever. Typically, in 2023, a knee replacement, it lasts anywhere from 15 to 25 years on average depending on activity. The key component to doing the joint replacement and getting the longevity out of it, is to balance and align the knee as perfectly as possible.

What the robot systems do, is allow us to have, you know, essentially onsite three dimensional control of the actual patient's knee, so that we can make subtle adjustments to balance those more perfectly compared to our previous jigs that we used. So even a millimeter here or a degree there can make a significant difference on the longevity of the joint.

 The joint replacement replacement robots have been around about 10 to 15 years. There's a number of different companies. The Rosa Robot is the one I use, although, they're all effective in allowing you to have this real time ability to make subtle adjustments, to balance the knees as perfectly as possible, thus giving us the best chance of increased longevity.

Host: Yeah, and just to clarify for listeners, sometimes when folks hear that, uh, robots are involved, they sort of picture, I don't know, something out of sci-fi where the robots are doing the surgery and the surgeons are just kind of standing nearby. But that's not really what it is. Right? You know, you are performing the surgery, the surgeon does the surgery, but to use the robots to be really precise. Right?

Kenneth Rauschenbach, DO: Correct. That feeling where the robot's moving me over and making the cuts and doing what the surgeon usually does is a misnomer of course. So the, the robot is there. We use a special set of arrays that we apply to the patient's body and to the bone, and it allows us to take some points and essentially do a three dimensional mapping of the joint. After we make the adjustments to make it the balance of the knee in both the flexion and extension planes, we can make these subtle arrangements. The robot then brings in the cutting block and holds it precisely in a position that we've preset it for. We then do the cuts all ourselves, just like we did before.

It just gives us that little bit of adjustment that the jigs don't have that fine tuning to do. Once we use the cutting blocks, we then proceed to make all our cuts using the robot. And that again, you know, verifies the cut to make sure they're exactly what we planned out so that we can get the best possible result.

Host: Yeah. And as you say, you know those little millimeters, which, you know, maybe are sort of insignificant in daily life, when it comes to replacement surgery, really important, and especially as you mentioned for the longevity of the replacements. Let's talk about some of the other benefits for patients, whether that's smaller scars, faster recovery, back on their feet sooner, whatever it might be. I'd like to have you sort of talk about some of the benefits.

Kenneth Rauschenbach, DO: Yeah, the, the biggest benefit, like I said, would be hopefully for the longevity and our allowing us to make these, you know, more subtle cuts. But it all allows us to make smaller incisions, allows us to maneuver around the, the important structures in the knee, in a manner that allows us to make the incision small.

Of course, you have to be able to get the components in, so you'll still have a significant incision. But, the robot actually gives us these little advantages during the process. It also allows us not to enter the medullary canals. The typical previous jigs that we used for many, many years, which were very effective by the way, opened up the canals of the femur and the tibia, which led to more bleeding.

So less blood loss, better balancing of the joint spaces, smaller incisions are all just bonuses to using the robot. We've also seen a significant improvement in postoperative outcome and range of motion because of the precise balancing. So people are getting a few more degrees of motion, and their rehab is a little bit quicker, a little bit faster. So it, it provides many benefits.

Host: Yeah. I'm wondering do you find that patients, you know, cause it usually, it seems to be you get to a certain age, one knee starts to go, then the other knee starts to go. Do you find that patients, once they've had successful outcomes with one knee replacement, that they come back in for the other knee or the other hip, whatever it might be. Do you find you get, uh, some repeat business just because the Rosa and your expertise and the team and everything is just so successful.

Kenneth Rauschenbach, DO: Absolutely. Unfortunately, arthritis is an equal opportunity offender, I like to say. So all the joints are affected. Sometimes they're varying degrees because of, you know, previous injuries or other things. So typically, you know, we don't just do one knee. Some people get lucky enough to have that, but unfortunately, a lot of times the knees are affected, the, the hips are affected.

So, and you know, the Rosa has allowed us to get a quick, easy rehab, people do well, and then they're not so afraid of that second knee. And it definitely has that advantage that this has improved the rehabilitation process, which typically was a six to eight week process. And I found using a robot, it has accelerated that process up to a month.

And then if the other knee is bad, we literally go right on to the other one and get them both done. Um, so, and then, people having them at an earlier age as well because our longevity is improving and the bad part of an younger person having a joint replacement is, you know, the second time we have to do it is much more difficult than the first and there's bone loss.

So, by improving that longevity, it really makes a big difference going forward.

Host: Yeah, it definitely does. And you know, you mentioned arthritis. So osteoarthritis is just an equal opportunity offender. Right? And I am a victim of osteoarthritis, as many people are. Is there anything we can do, Doctor to sort of slow the progression of osteoarthritis? Or is it just sort of a rite of passage, a rite of aging?

Kenneth Rauschenbach, DO: It's multifactorial. So everybody in the world is going to get arthritis, just like the wheels on our car. They, the treads wear out after that 40, 50, 60,000 miles and you know, if you run over a bump, you know that tire wears out quicker. So if you have an injury when you're a younger person, this could lead to an earlier arthritic condition in say a particular joint, a knee, hip, an ankle, et cetera.

What we can do, you know, there are supplements we can take to help prevent the progression, but keeping our bodies in good shape, the muscles strong. Keeping our weight down cause all of these small components play a big role on our weight-bearing joints, ie our knees and our hips. If we can keep a healthy lifestyle, keep the muscles strong, keep toned up, keep our body weight down; all of these things will be beneficial. Going to see your physician earlier and getting ahead of these things so it doesn't progress to the point where the first day you get in there, you need a knee replacement. We have injections that can help the joint, something called visco supplementation. We have over the counter vitamins, glucosamine and chondroitin, as well as the you know, anti-inflammatory nutraceuticals like turmeric are, can be beneficial.

Host: Yeah, well this has been perfect today. You know, it's sort of like once a kid, always a kid. So I love doing these and I love learning about lasers and robots and science and technology and you know, how it benefits surgeons and patients and everybody. So good stuff today. Thanks so much. You stay well.

Kenneth Rauschenbach, DO: You have a great day, sir.

Host: And visit montefioreslc.org for more information about our orthopedic services

And if you found this podcast to be helpful, please be sure to share it on your social channels and be sure to check out all the other Doc Talk episodes. This has been Doc Talk, the podcast from Montefiore St. Luke's Cornwall Hospital. I'm Scott Webb. Stay well.