Building an orthopedics ASC robotics program: Benefits, considerations & where technology is headed

Orthopedic surgeons Joseph Burkhardt, MD, of Great Lakes Bone & Joint Center in Battle Creek, Mich., and Sridhar Durbhakula, MD, of OrthoBethesda in Bethesda, Md., discuss the Navio Surgical System, a robotics-assisted technology for partial knee surgery, and where outpatient procedures are headed in the future.

Q: What made you consider a robotics program at your ASC?

Dr. Burkhardt: I think it’s a tool to improve accuracy and implant placement that is much more reproducible than traditional instrumentation. It allows surgeons to take structures into consideration beyond what you previously could.

Dr. Durbhakula: The trend in joint replacement is leaning toward outpatient procedures for patients who are good candidates. The reasons for this trend include a lower chance of infection, faster recovery, one-on-one nursing and better postoperative care in the surgery center. It’s better for the patient care experience, and the patients are able to heal comfortably from home.

In the surgery center, I’m looking for technology that makes the surgery safer and more efficient. I’m also looking for technology that makes procedures reproducible and won’t add cost to the system, but will have benefit and patient value. The Navio technology fits into these goals.

Q: What are some of the benefits of robotic techniques vs traditional techniques?

SD: With robotic techniques we have computerized feedback to know our implants are in better condition. There is less bleeding and pain. The technology behind computer-assisted surgery helps in the long-term recovery and results.

JB: The short term recovery is improved and the patients feel better and return to independence quicker. Overall alignment and matching between tibial and femoral components seems to be much more accurate than traditional instrumentation.

Q: Why did you choose the Navio Surgical System over comparative technologies?

SD: The Navio system has an open platform, so it’s not specific to one implant vendor. I might use one implant and my colleague can use another. We can use whatever technology will be best for the patient.

Additionally, other robotic technologies for joint replacements require preoperative imaging. That adds radiation to the patient and is costly for the overall episode of care. This step is not required with the Navio system.

JB: It’s versatile and can be used with many different manufacturers’ implants. It’s also a compact machine which makes it easy to work with.. The ASC staff can easily move it from one room to another. It makes a lot of economic sense with regard to the cost, as some of the competitive robotic systems are significantly more expensive..

Q: Were there major hurdles incorporating the technology into your center?

SD: The transition was rather seamless. I saw the technology and I knew it would help with the flow of surgery. It’s also more efficient and there is less prep time. The vendor did a great job with labs and teaching individual team members about their responsibilities with the robotics-assisted technology. It was easy for us to assimilate.

Q: As techniques advance, do you anticipate more partial knee replacements being performed in an outpatient setting?

DS: Most patients who are candidates for partial knee replacement will prefer it with the robotics-assisted technology at an outpatient center. We are going to see more patients who opt for this type of surgery over the next few years because of advances like the Navio system. My hope is that Navio is a pioneer for the surgery center model for outpatient joint replacements.

Outpatient partial knee replacements are here to stay; we just have to figure out which technologies make sense and add value. We have to figure out which technologies are worth pursuing and which are not.

JB: I already do about 95 percent of my knees in the outpatient setting. The Navio system is a better mousetrap; it provides more information for implantation so the patient will end up with a better functional outcome. The initial goal with partial knee replacement was pain relief, but now we can look at pain relief and improved function.

Q: Do you believe robotics are or will become more widely adopted in ASC setting?

DS: About 5 percent to 10 percent of joint replacements now are done in the outpatient setting. There are estimates that number will grow 100 percent to 400 percent over the next few years as more people will need joint replacements and insurance companies could mandate the outpatient setting.

We have to prove that robotic technology helps achieve surgeries with good outcomes. Then we need to increase public awareness about the technology and what it can do. That’s what my group hopes to do over the next few months--perform surgeries, collect outcomes and then let the public know robotics-assisted procedures are an option here. That will help drive volume and patients will understand it’s a better option than others on the market.

Q: How did the results match up to your expectations?

DS: We have some initial data on patient outcomes early on, but it will take a few years before we have meaningful five-year data. We’re using established implants, but the robotic technology is a better way to put them in. The patients go home with less pain and overall a better experience.

Q: How many procedures will you need to do in order to see a return on your investment?

DS: If you can do between three and five procedures per month, you’ll see the return on investment. You can be selective about the outpatient criteria and make sure you’re bringing in the right patients to justify using the technology.

Q: What were some of the key factors for getting all of the stakeholders on board?

JB: I experienced less push back than I thought I would. This is a technology patients see as beneficial and they seek you out for their procedures. Patients understand and like the concept of Navio’s ability. It can drive volume that way.


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