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Reproducible results
Of the robot's many advantages, its greatest might be the ability to achieve
reproducible results and all but eliminate variation in patient outcomes. In
"Robots in Orthopaedic Surgery: Past, Present, and Future," William L. Bargar,
MD, of the Sutter Joint Replacement Center, University of California–Davis
School of Medicine in Sacramento, Calif., says, "Just as the industrial revolution
standardized production methods and controlled quality, so can the use of
robotics allow the surgeon to obtain accuracy and reproducibility to control
quality and eliminate variation of outcomes."
Dr. Ortiguera offers to use the robotic arm on every knee replacement patient,
but finds it's especially helpful to achieve reproducible implant positions from
one partial knee replacement to the next.
"There's a higher failure rate in partial replacements than in full replacements,
in large part because the results are very dependent on proper implant place-
ment and proper knee alignment," says Dr. Ortiguera. "It's very important for us
to balance the soft tissues of the ligament that support the knee and we have a
hard time doing that without robotic technology."
Dr. Ortiguera has been using the robot for partial knees since 2010. A couple
months ago, Mayo Jacksonville added robot-assisted total knee arthroplasties.
In the first 5 weeks, he's done about 20.
The robot adds about 15% to 20% more time to a knee arthroplasty, according
to Dr. Ortiguera, much of it spent on inserting pins in the tibia and femur to
transmit data back to the computer in order to determine optimal alignment of
the implant, based on how the joint moves. "It will slow you down a bit, but
you're providing a better product to the patient," he says.
Unmatched accuracy is your reward for longer cases. Studies have shown that
robotic arm assistance is more accurate than manual techniques. Take bone
milling, for example. A robot is 4 times more accurate in preparing the bone
than a surgeon sawing the bone surfaces by hand.
"If I asked you to saw a straight line on a piece of wood by hand and com-
