Orthopedic surgeons are more regularly using robotic technology to achieve highly accurate and precisely placed partial knee replacements, and now ambulatory surgery centers are beginning to implement the technology.
In a webinar, Jess Lonner, MD, of Rothman Institute in Philadelphia, discussed the trend toward robotic technology in ASCs and the use of Blue Belt Technologies' Navio® Surgical System.
A Duke University study found as many as 90 percent of patients indicated for knee replacement surgery avoid treatment. Patients often decline surgery because they are fearful of pain associated with a total knee replacement, duration of recovery, activity limitations, financial issues, lost work time and poor outcomes.
A large percentage of patients have arthritis in only one compartment of the knee; only 6 percent of patients have arthritis in all three compartments. "There is a continuum of interventions we can consider when evaluating our patients coming in for treatments for arthritis," said Dr. Lonner. One of those options includes partial knee replacement surgery.
The benefits of partial knee replacement over total knee replacement are:
• Accelerated recovery
• Less pain
• Less blood loss
• Less postoperative morbidity
• More normal feeling knee
• Greater patient satisfaction
"Patient satisfaction is what determines success after knee replacement surgery," says Dr. Lonner. With partial knee replacement procedures, around 94 percent of patients are satisfied, compared with 75 percent to 81 percent of the total knee replacement patients.
But not all patients are good candidates for partial knee replacements. The pattern of arthritis, patient selection, component design and polyethylene quality all factor into the surgeon's decision to perform partial knee replacements.
"Five to 10 years ago, there was skepticism about the role of robotic technology, but now there is broader adoption of the semi-autonomous systems. The indications are expanding as well, and will continue to grow over the next decade as new companies enter the market," said Dr. Lonner.
Blue Belt Technologies' Navio system:
• Eliminates the need for CT-scans
• Uses a handheld robotic instrument
• Has intraoperative registration, mapping, planning
• Incorporates intraoperative gap balancing
• Utilizes two robotic control mode — burr speed/exposure control
Over 30 percent of the Navio systems installed are utilized in outpatient surgery centers.
"We found tremendous success in accuracy with both the first and second generation systems," said Dr. Lonner. However, the Navio system is more cost-friendly.
To prove the cost-effectiveness, Dr. Lonner and his colleagues examined 200 select cases with 50 percent done in the surgery center; the rest were done at the hospital, and all patients were discharged home. The average cost of care at the hospital inpatient was $16,495; the hospital outpatient was $13,295 and the ASC was $9,969. With the new Navio technology, the surgery center can break-even and realize a return on investment after 60 cases.
As of 2013, there were 15 percent of unicompartmental knee arthroplasties in the United States performed with robotic assistance. The expectation is that those numbers will grow over the next five to 10 years. A poll taken among orthopedic surgeons — most were non-robotic users — suggested the surgeons expected over the next five years around 30 percent of partial knee replacements will include the use of robotic technology; in 10 years that number raises to 37 percent.
"The observations that many of us have had with robotics is that they dramatically improve the precision of surgery in terms of the compartment alignment, conservative bone resection and functional outcomes," said Dr. Lonner. "What we've seen with nearly 1,000 cases is the polyethylene issues are far smaller than if we look at tens of thousands conventionally-performed uni-knee arthroplasties. That is significant in reducing reoperations farther down the road."
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