Weighing in on robotics
Orthopedic surgeon Kevin Stone, MD, of the Stone Clinic in San
Francisco, Calif., has been using robotics to perform partial knee
replacements for the past 3 years. "I had been doing them without the
robot for 25 years, but the accuracy was never quite high enough to
place the implant perfectly every time," he says. "The robotic device
provides a much higher level of confidence."
A computerized model of the joint's anatomy is built from a pre-op
CT scan of the knee. The computer then plans the accurate placement
of the implant by adjusting its position, rotation and alignment. On the
day of surgery, surgeons place pins containing arrays in the femur and
tibia that tell the robot where the knee is in space and match it to the
computer model. "We're then able to place a burr that removes only
the worn part of the knee we're resurfacing and place the implant in
that spot," explains Dr. Stone.
Orthopedic surgeon and joint replacement specialist Sharat
Kusuma, MD, MBA, recognizes the benefits offered by robotics and
believes the technology can be a game-changer for low-volume sur-
geons. The current surgical consultant and former director of adult
reconstruction at the Grant Medical Center in Columbus, Ohio, has
colleagues who knew they weren't skilled at partial knees, but
wanted to offer patients a needed service and improved outcomes.
They got robotics programs up and running and became prolific.
"That's the story you want to hear," says Dr. Kusuma. "You don't
want to hear about the hospital that invested in robotics just to
market the technology to patients. That's healthcare dollars not
well spent."
Robotics is expensive and may not be cost effective, especially for
high-volume, skilled surgeons, says Dr. Kusuma. He says robotics pro-
vides improved accuracy for surgeons, but there's nothing about the
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