robot, but to ask third-party payers or Medicare to foot the bill is ludi-
crous when we have lots of public health problems that need more
resources dedicated to them. We need to invest in surgeons who get
poor outcomes by giving them robotics. But those surgeons often
operate in low-volume hospitals that can't afford the technology. It's a
paradoxical situation.
How important is proper patient selection in joint replacement?
Outpatient surgery is enabled by superior surgical technique and
excellent perioperative management, which includes proper pain con-
trol. Proper patient selection is a huge knowledge gap among orthope-
dic surgeons. You're going to get poor outcomes if you don't pick the
right patients — even if you work with a robot and St. Peter comes
down from heaven to assist.
Where do partial knee replacements fit in?
Even though approximately one-third of patients who need knee
replacements would benefit from a partial joint replacement, only
about 5% get it done, mostly because surgeons get paid less money for
partial knees than they do for total knees. If you become a niche
provider of partial knee replacements, you'll have a 6-month-long
waiting list.
OSM
Dr. Kusuma (skk2002ga@gmail.com) is a surgical consultant and former
director of adult reconstruction at the Grant Medical Center in Columbus,
Ohio.
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