When you start looking at your options for total knee replacement,
it can be helpful to break the systems down into a few larger cate-
gories. These groups are broad, but most manufacturers have a sys-
tem that falls into one of these sets, says Keith R. Berend, MD, an
orthopedic surgeon with Joint Implant Surgeons, Inc., and CEO and
president of White Fence Surgical Suites in New Albany, Ohio.
• Standard systems. Most surgeons use a conventional system for a
majority of their arthroplasty cases. Standard systems are typically
comprised of several trays of reusable instruments and power tools,
cutting templates and off-the-shelf implants designed to work with a
large range of patients. Within each system, the style of the implant,
sizes, materials and more can vary (see "Which Style Implant to
Choose?" on p. 48). Most standard total knee systems use anywhere
from 7 to 9 large trays per case, though you can work with your ven-
dor to reduce that number. Standard systems are usually more afford-
able, more accessible and give surgeons more options during the pro-
cedure. However, they also can be cumbersome to store and process
in smaller facilities.
• Robotic-assisted systems. These systems use computer naviga-
tion and intelligent instruments to help position and fit the implant dur-
ing surgery. They either use a pre-op CT scan of the patient's knee or
specialized handheld instruments to map out the patient's anatomy and
create a computerized template. This virtual surgical plan then guides
the surgeon as he makes cuts in the bone, eliminating the need for
standard mechanical cutting guides. "Robotic-assisted systems may
help improve accuracy in some cases, but they may not be of value to
high-volume or experienced surgeons, and may also be cumbersome in
the outpatient environment," says Dr. Berend.
• Single-use systems. Surgeons using these systems use disposable
instrumentation and cutting templates to shape the knee and place an
7 4 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J U N E 2 0 1 6
