Archive Hot Technology 2018

5 Difference-Making Tools for Total Joints

Investing in these innovations could push your program to the next level.

Stefan Kreuzer

Stefan Kreuzer, MD


Automated Arm
AUTOMATED ARM Stefan Kreuzer, MD, says robotic-assisted surgery leads to high-quality and standardized outcomes.

You probably know that outpatient total joint replacement is one of surgery's hottest and fastest growing specialties, but you might not be aware of the following technologies that help surgeons redo hips and knees with more precision than ever. Adding them to your ORs will show surgeons and patients that you're serious about providing state-of-the-art care as the competition for cases intensifies.

1. Robotics

There are currently 2 types of robots in the market: One is a haptic-guided arm that restricts cutting to an exact area and the other involves an autonomous arm that cuts into bone based on the surgeon's preoperative surgical plan.

The autonomous robot is currently used only for hip replacements; however this platform will soon be available after it receives FDA approval for knee arthroplasty. Before the knee replacement operation, the surgeon maps and registers the location of the joint bones to the robotic system by placing a motion sensor near the joint and pressing a button to bring the robotic arm into the surgical field. The arm perfectly mills the bones to the shape of the implant based on the pre-op plan designed by the surgeon. For that reason, automated robots will likely be involved in the development of the next generation of patient-specific implants.

The other type of robotic platform, which is based on haptic guidance, can be used on hips or knees. Surgeons use a similar registration process to align the robotic arm with the joint before pushing the arm through a preprogrammed cutting plane. Optical trackers on the joint and robotic arm are used to synchronize these parts. Every time the surgeon moves, the joint moves in perfect synchrony. But if the surgeon moves too fast, the robot shuts down as a safeguard.

Robotic-assisted surgery doesn't necessarily make joint replacements simpler. Surgeons must virtually plan and map the entire surgery based on pre-op scans of the patient's joint anatomy before they start the actual surgery. Setting up a robotic platform extends the normal time of surgery by 10 to 20 minutes; however, the technology certainly increases the likelihood that surgeons place implants precisely as planned.

It's my belief that robotics will eventually be the great equalizer in joint replacement surgery. Any reasonably gifted community surgeon, even if he does only 20 or 30 joint replacements a year, will be able to incorporate robotics into his practice to achieve outcomes at the highest possible level.

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