Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
Issue link: http://outpatientsurgery.uberflip.com/i/1283756
or rotate the implant placement just a degree or two for the perfect fit. The system can be used for both partial and total knee replacements. One of the key benefits of a haptic system is that the robot has boundaries that prevent you from sawing outside of the bone area, points out Dr. Flanagan. "Even if you try to push it into a ligament or soft tissue, it will stop it," he says. While haptic systems still require surgeons to do some of the manual labor, a new robotic system removes them entirely from the cutting process. These systems still use a 3D model created by pre-op scans of the patient's joint, but instead of the surgeon operating the robotic arm, the active robotic system makes the cuts to the bone while the surgeon stands by with a hand-held controller, says Dr. Kissin. Because the technology is so new, this robot can cur- rently be used only for total knee replacements. "The main difference is that you're removing the potential for human error," says Dr. Kissin, who was the first in the nation to perform surgery with the robot this year. "Surgeons still set up cases similar to how they would with a haptic system. However, when it's time to cut, the robot will go in and do it." Better cuts for more patients The benefits of the robotic assistance are clear — increased accuracy could lead to higher patient sat- isfaction with knee replacement outcomes. Some reports suggest up to 20% of patients are dissatisfied with their knee replacements, and robotic assistance could help reduce that number. Though robotic assis- tance is so new that there isn't yet a significant amount of data to back up claims of improved outcomes, Dr. Kissin notes that it makes sense that a technology ensuring accurate cuts and placement of implants would enhance outcomes. He notes that a study con- ducted at his hospital showed patients who received robotically replaced knees had implants placed within two millimeters of the pre-op surgical plan. Plus, some experts theorize robots could move more cases to same-day set- tings, because it's believed the technology results in shorter recovery times and happier patients. "At the end of the surgery, we can extend the knee and the robot will tell us how many degrees the implant might be off, which helps us to make adjustments," says Dr. Flanagan. "If a fully straight leg is zero degrees, but the robot is telling us that it's actually at minus-five degrees, then we know the joint might be misaligned. A matter of a few degrees isn't something you can see with the human eye, but the robot lets us double-check our work." The robot also lets surgeons attempt more com- plicated knee replacement methods. Dr. Flanagan notes that robotic assistance has allowed surgeons to perform more press-fit knees, which are per- formed without bone cement or glue. This is anoth- er potential way to boost patient outcomes. "The theory is that by doing press-fit knees, the bone will attach itself to the metal implant components and fuse as one piece, which may make the implant less likely to loosen over time," he says. "They're easier to put in when you have a robotically cut knee. Essentially, the implants haven't changed, but how we put them in is better." With the guarantee that the cuts and placement will be almost perfect, it's hard to imagine a patient who wouldn't benefit from a robotic knee replace- ment. Typically, it depends on the joint itself. "Someone who has a severe deformity that causes it to be out of the parameters set by the robot's bound- 1 6 • S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E • S E P T E M B E R 2 0 2 0 SPOT CHECK Robotic assistance lets surgeons place implants within millimeters of pre-op measurements and confirm the joint is properly aligned. Northern Westchester Hospital