Dr. Raj Yalamanchili shares his insight on the value of robotic surgery for joint replacement and how it works.
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Robotic Surgery for Joint Replacement with Raj Yalamanchili, MD
Featured Speaker:
Dr. Raj Yalamanchili is a fellowship-trained orthopedic surgeon. His practice is focused on knee and hip replacement and preservation. He performs minimally invasive partial and total joint replacement as well as hip and knee arthroscopy. Dr. Yalamanchili is a member of the University of Maryland Joint Network, a group of surgeons known for their advanced expertise and positive outcomes in total hip and knee replacement.
Dr. Yalamanchili also serves as the Director for Joint Replacement at Upper Chesapeake Medical Center. He prefers an individualized approach to all patients as each patient is unique and deserves tailored treatment. He customizes his office visits to address the specific needs and concerns of individual patients in a relaxed atmosphere.
He is one of several orthopaedic surgeons at University of Maryland Upper Chesapeake Medical Center that performs MAKOplasty® Partial Knee Resurfacing and MAKOplasty® Total Hip Replacement. MAKOplasty® is a patient-specific robotic arm procedure that offers a more precise level of accuracy previously unattainable with conventional instrumentation.
Raj Yalamanchili, MD
Featuring Raj Yalamanchili, M.D.Dr. Raj Yalamanchili is a fellowship-trained orthopedic surgeon. His practice is focused on knee and hip replacement and preservation. He performs minimally invasive partial and total joint replacement as well as hip and knee arthroscopy. Dr. Yalamanchili is a member of the University of Maryland Joint Network, a group of surgeons known for their advanced expertise and positive outcomes in total hip and knee replacement.
Dr. Yalamanchili also serves as the Director for Joint Replacement at Upper Chesapeake Medical Center. He prefers an individualized approach to all patients as each patient is unique and deserves tailored treatment. He customizes his office visits to address the specific needs and concerns of individual patients in a relaxed atmosphere.
He is one of several orthopaedic surgeons at University of Maryland Upper Chesapeake Medical Center that performs MAKOplasty® Partial Knee Resurfacing and MAKOplasty® Total Hip Replacement. MAKOplasty® is a patient-specific robotic arm procedure that offers a more precise level of accuracy previously unattainable with conventional instrumentation.
Transcription:
Robotic Surgery for Joint Replacement with Raj Yalamanchili, MD
Caitlin Whyte: Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. I'm your host, Caitlin Whyte. Today, we are talking all about robotic-assisted surgery, how it works, the benefits for patients and some aftercare. Joining us for that conversation is Dr. Raj Yalamanchili, the Director of Joint Replacement. So starting off here, doctor, what is robotic-assisted surgery and when and where is it used?
Raj Yalamanchili, MD: Robotic surgery in orthopedics is used in hip and knee replacements. We are working on using it for other joints as well.
Caitlin Whyte: Now, how does the surgeon prepare for a procedure like this?
Raj Yalamanchili, MD: We did a preoperative CT scan beforehand on the patient and constructed 3D model of the patient's hip or knee. And we plan the surgery out on the computer with regards to where the implant is going to go, how much bone we have to remove, how to orient the implant. The surgeon then at the time of the surgery uses the CT model to remove the correct amount of bone and to put the implants in at the perfect angle
Caitlin Whyte: Is robotic-assisted surgery any more difficult to perform?
Raj Yalamanchili, MD: I don't think it's any more difficult to perform than a regular hip replacement. Just as a regular hip replacement, there's a lot of things that can go wrong. The more hip replacements the surgeon does, the more experienced he is, the more able he's able to sort of figure out what's happening and respond. The same as robotic surgery, the more a surgeon does of them, the more experienced he is, the better he's able to sort of address any issues that arise during the surgery.
Caitlin Whyte: Are there any studies out there supporting the use of robotic-assisted surgery in a hip replacement?
Raj Yalamanchili, MD: That's a good question. Right now, the way hip replacement is done, the surgeon is essentially eyeballing the patient, eyeballing the implant size, eyeballing how much bone he has to cut off. And frequently, we were operating through a small hole. And in the best of hands, a Harvard study has found out that the Harvard surgeons doing hip replacements, they were able to put the hip socket in at the perfect angle about 50% of the time. Now, these guys have black belts in orthopedics. So if those guys are putting it in at 50% of the time at the perfect angle, then, you know, the rest of us are probably around the same or probably a little less in terms of accuracy. That doesn't mean that the 50% of the patients did badly. It's just that, you know, we aim for perfection in orthopedics, and these guys are putting in at 50%.
Now, studies with the robot, with this Mako robot we have in terms of putting the hip socket in have shown about an 87% accuracy in putting the hip socket. The same with a partial knee replacement, when you look at the Swedish and Austrian registries, there is a redo surgery rate of about 4% in two years on partial knee replacements. With the robotic partial knee replacement, the rate's about 0.4%. So a big difference from 0.4 to about 4% in redo surgery rates.
Caitlin Whyte: Absolutely. So with these enhanced statistics, how does that affect the surgeon's role? Is the surgeon still in control during surgery?
Raj Yalamanchili, MD: Great question. My patients are afraid that I'm in the surgeon's lounge, drinking coffee, watching the news, while the robots are hacking away. That's not the case. I'm in the room. I hold a knife. I do the surgery. You can sort of imagine the robot as a tool to help me get the perfect alignment. So you can hang a picture up on the wall, you know, have your partner stand behind and say, "Honey, is that level?" And sort of leave the picture alone. Or you can put a bubble level on and make sure the picture is perfectly leveled to the ground.
So by using the robot, you know, my hands are on the drill, my hands are on the saw. We are aiming for perfection in terms of how much bone we remove, where the implants go. And our hope is that by doing this, we minimize some of the complications of hip replacement surgeries, such as dislocation, leg length inequality, bursitis and premature wear.
And just like the tires on your car, if they're perfectly aligned, hopefully get you a full 60,000 miles out of it. So those studies have not been out yet because this technology's about 10 years old, I think. I've been using it for about six years. So we haven't really done long-term studies saying, you know, 20 years from now, is there a big difference? But we are hoping that, you know, these things go in perfectly that the hip lasts you longer.
Caitlin Whyte: Well, let's look into some post-procedure and aftercare now. How does a joint that's replaced using robotic-assisted surgery compare to a more traditional joint replacement in terms of how long it lasts?
Raj Yalamanchili, MD: Good question. You know, when you get your tires changed on your car, you can just put the tire on and leave it, or you can take it to the alignment shop and have it perfectly aligned.
We're hoping that if the hip replacement or the tires are perfectly aligned, we're seeking to maximize the life, hopefully more than 20 years. We know the hips and knees we've put in about 20 years ago manually had been lasting 20 years. We know from studies that we're hitting the safe zone of cup placement about 50% of the time if done manually. With the robot, that safe zone is accomplished close to 90% of the time. So again, we're hoping for longer life. Exactly how much longer than a manual hip? I can't say because the data is not out there, but hopefully more than 20 years.
Caitlin Whyte: And what are some other benefits for the patients for choosing this route of surgery?
Raj Yalamanchili, MD: So hip replacement is a beautiful surgery. It can be done through an anterior approach, posterior approach, antelateral approach. With a good surgeon, 99% of the patients do great. The problem is about 1% of the time, people have problems with leg length differences, dislocation, and these are challenging problems to fix.
These problems are more prevalent in people with cartilage problems where their ligaments are a little looser than normal, or if they have back arthritis or a spine surgery where their back is stiffer than normal and the hip has to compensate. So with the robot, we are trying to essentially make this take care of those 1% of people and hopefully by putting in the cup in the perfect position and using the perfect size, we minimize those complications of leg length inequality, dislocation and hip pain.
Caitlin Whyte: And what about rehab? What is needed after a robotic surgery for hip replacement?
Raj Yalamanchili, MD: Typically, my hip replacement patients need a physical therapist, they go through some precautions and sort of stretching exercises, and I teach them some stretching exercise at home. They don't really need a lot of physical therapy. The physical therapy for knee replacements for the partial knee is about the same as a manual partial knee replacement. They need about four to six weeks of physical therapy after the surgery.
Caitlin Whyte: And how about returning to activities? Can patients just jump right back into their old ways after a hip replacement?
Raj Yalamanchili, MD: Patients can return to most of what they were doing before. For the first six weeks or so, there are certain precautions they have to follow to minimize dislocations and to allow healing to take place. I have patients who climb trees for a living, cut down trees for living. I have patients who bike hundreds of miles for exercise and for fun after the hip replacement. So it is possible to live a very active life with a hip replacement.
Caitlin Whyte: And how would I know if I'm a candidate for the robotic-assisted joint replacement option?
Raj Yalamanchili, MD: Anyone is a candidate for a robotic-assisted joint replacement. It is just that we don't have a lot of these robots in the country. It's an expensive piece of machinery. And there's only a few centers in the country, who've been doing this for a while and who've done a couple of hundred of these. So what I said before that a hip replacement or a knee replacement in experienced hands is a great surgery, whether you do it manually or robotically and certain subset of patients have these complications about 1%. And we're trying to minimize that and lower that number and go for perfection.
Caitlin Whyte: Well, just a great show, full of so much information. I'm so glad you could join us today, doctor. Find more shows just like this one at umms.org/podcast. And thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.
Robotic Surgery for Joint Replacement with Raj Yalamanchili, MD
Caitlin Whyte: Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. I'm your host, Caitlin Whyte. Today, we are talking all about robotic-assisted surgery, how it works, the benefits for patients and some aftercare. Joining us for that conversation is Dr. Raj Yalamanchili, the Director of Joint Replacement. So starting off here, doctor, what is robotic-assisted surgery and when and where is it used?
Raj Yalamanchili, MD: Robotic surgery in orthopedics is used in hip and knee replacements. We are working on using it for other joints as well.
Caitlin Whyte: Now, how does the surgeon prepare for a procedure like this?
Raj Yalamanchili, MD: We did a preoperative CT scan beforehand on the patient and constructed 3D model of the patient's hip or knee. And we plan the surgery out on the computer with regards to where the implant is going to go, how much bone we have to remove, how to orient the implant. The surgeon then at the time of the surgery uses the CT model to remove the correct amount of bone and to put the implants in at the perfect angle
Caitlin Whyte: Is robotic-assisted surgery any more difficult to perform?
Raj Yalamanchili, MD: I don't think it's any more difficult to perform than a regular hip replacement. Just as a regular hip replacement, there's a lot of things that can go wrong. The more hip replacements the surgeon does, the more experienced he is, the more able he's able to sort of figure out what's happening and respond. The same as robotic surgery, the more a surgeon does of them, the more experienced he is, the better he's able to sort of address any issues that arise during the surgery.
Caitlin Whyte: Are there any studies out there supporting the use of robotic-assisted surgery in a hip replacement?
Raj Yalamanchili, MD: That's a good question. Right now, the way hip replacement is done, the surgeon is essentially eyeballing the patient, eyeballing the implant size, eyeballing how much bone he has to cut off. And frequently, we were operating through a small hole. And in the best of hands, a Harvard study has found out that the Harvard surgeons doing hip replacements, they were able to put the hip socket in at the perfect angle about 50% of the time. Now, these guys have black belts in orthopedics. So if those guys are putting it in at 50% of the time at the perfect angle, then, you know, the rest of us are probably around the same or probably a little less in terms of accuracy. That doesn't mean that the 50% of the patients did badly. It's just that, you know, we aim for perfection in orthopedics, and these guys are putting in at 50%.
Now, studies with the robot, with this Mako robot we have in terms of putting the hip socket in have shown about an 87% accuracy in putting the hip socket. The same with a partial knee replacement, when you look at the Swedish and Austrian registries, there is a redo surgery rate of about 4% in two years on partial knee replacements. With the robotic partial knee replacement, the rate's about 0.4%. So a big difference from 0.4 to about 4% in redo surgery rates.
Caitlin Whyte: Absolutely. So with these enhanced statistics, how does that affect the surgeon's role? Is the surgeon still in control during surgery?
Raj Yalamanchili, MD: Great question. My patients are afraid that I'm in the surgeon's lounge, drinking coffee, watching the news, while the robots are hacking away. That's not the case. I'm in the room. I hold a knife. I do the surgery. You can sort of imagine the robot as a tool to help me get the perfect alignment. So you can hang a picture up on the wall, you know, have your partner stand behind and say, "Honey, is that level?" And sort of leave the picture alone. Or you can put a bubble level on and make sure the picture is perfectly leveled to the ground.
So by using the robot, you know, my hands are on the drill, my hands are on the saw. We are aiming for perfection in terms of how much bone we remove, where the implants go. And our hope is that by doing this, we minimize some of the complications of hip replacement surgeries, such as dislocation, leg length inequality, bursitis and premature wear.
And just like the tires on your car, if they're perfectly aligned, hopefully get you a full 60,000 miles out of it. So those studies have not been out yet because this technology's about 10 years old, I think. I've been using it for about six years. So we haven't really done long-term studies saying, you know, 20 years from now, is there a big difference? But we are hoping that, you know, these things go in perfectly that the hip lasts you longer.
Caitlin Whyte: Well, let's look into some post-procedure and aftercare now. How does a joint that's replaced using robotic-assisted surgery compare to a more traditional joint replacement in terms of how long it lasts?
Raj Yalamanchili, MD: Good question. You know, when you get your tires changed on your car, you can just put the tire on and leave it, or you can take it to the alignment shop and have it perfectly aligned.
We're hoping that if the hip replacement or the tires are perfectly aligned, we're seeking to maximize the life, hopefully more than 20 years. We know the hips and knees we've put in about 20 years ago manually had been lasting 20 years. We know from studies that we're hitting the safe zone of cup placement about 50% of the time if done manually. With the robot, that safe zone is accomplished close to 90% of the time. So again, we're hoping for longer life. Exactly how much longer than a manual hip? I can't say because the data is not out there, but hopefully more than 20 years.
Caitlin Whyte: And what are some other benefits for the patients for choosing this route of surgery?
Raj Yalamanchili, MD: So hip replacement is a beautiful surgery. It can be done through an anterior approach, posterior approach, antelateral approach. With a good surgeon, 99% of the patients do great. The problem is about 1% of the time, people have problems with leg length differences, dislocation, and these are challenging problems to fix.
These problems are more prevalent in people with cartilage problems where their ligaments are a little looser than normal, or if they have back arthritis or a spine surgery where their back is stiffer than normal and the hip has to compensate. So with the robot, we are trying to essentially make this take care of those 1% of people and hopefully by putting in the cup in the perfect position and using the perfect size, we minimize those complications of leg length inequality, dislocation and hip pain.
Caitlin Whyte: And what about rehab? What is needed after a robotic surgery for hip replacement?
Raj Yalamanchili, MD: Typically, my hip replacement patients need a physical therapist, they go through some precautions and sort of stretching exercises, and I teach them some stretching exercise at home. They don't really need a lot of physical therapy. The physical therapy for knee replacements for the partial knee is about the same as a manual partial knee replacement. They need about four to six weeks of physical therapy after the surgery.
Caitlin Whyte: And how about returning to activities? Can patients just jump right back into their old ways after a hip replacement?
Raj Yalamanchili, MD: Patients can return to most of what they were doing before. For the first six weeks or so, there are certain precautions they have to follow to minimize dislocations and to allow healing to take place. I have patients who climb trees for a living, cut down trees for living. I have patients who bike hundreds of miles for exercise and for fun after the hip replacement. So it is possible to live a very active life with a hip replacement.
Caitlin Whyte: And how would I know if I'm a candidate for the robotic-assisted joint replacement option?
Raj Yalamanchili, MD: Anyone is a candidate for a robotic-assisted joint replacement. It is just that we don't have a lot of these robots in the country. It's an expensive piece of machinery. And there's only a few centers in the country, who've been doing this for a while and who've done a couple of hundred of these. So what I said before that a hip replacement or a knee replacement in experienced hands is a great surgery, whether you do it manually or robotically and certain subset of patients have these complications about 1%. And we're trying to minimize that and lower that number and go for perfection.
Caitlin Whyte: Well, just a great show, full of so much information. I'm so glad you could join us today, doctor. Find more shows just like this one at umms.org/podcast. And thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.