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move, make sure you're ready to negotiate. "The first price a vendor tells you is
not the real price," says Dr. Khabie.
He adds that you can't forget about the additional expenses associated with
the technology: software upgrades, annual maintenance and per-case costs. Dr.
Nonweiler says the systems typically require surgeons to use brand-specific
implants, so consider asking your vendors for a volume discount, especially if
purchasing the robot means more of your surgeons will be converting to using
the technology — and the manufacturer's implants.
You could also try getting creative with partner facilities, says Dr. Khabie. For
example, a hospital could move the robot between its inpatient ORs and outpa-
tient department as needed. That type of arrangement is definitely possible with
the newer, compact platforms, says Dr. Khabie. "If a hospital wants to share it
with one of its outpatient surgery centers," he adds, "it can easily be loaded into
a van or moved back and forth for procedures."
Not only does the technology offer a "competitive edge," says Dr. Khabie,
but it also helps surgeons perform more partial knee replacements, which
studies show patients prefer to total knees. "Before I had access to the robot,
I wasn't doing any partial knee replacements, because of the challenges asso-
ciated with getting the knee positioned correctly and removing the right
bone," he explains. "There was always a fear that the implant would fail and
I'd need to perform a total replacement anyway. Patients with disease in only
one part of the knee who have previously been advised to have a total knee
replacement done can now get a partial."
Continued advancement
Although the robots are currently designed for unicompart-mental knee replace-
ments and total hips, manufacturers are working to expand application of the
technology for other types of surgeries, including ankle, shoulder and spine proce-
dures.
The use of orthopedic robots will expand and they will become smarter and
