Robotic-assisted Surgery
Robotic-assisted total and partial knee and hip replacement
At SurgeryShopper.com, you'll find several of our providers that now offer robotic-assisted knee replacement - Learn More about Robotics HERE
In anticipation of the new eligibility for Medicare payment for total and partial knee replacement in the outpatient surgery center setting for 2020, many ASCs are investing in robotic assisted knee replacement systems from a number of manufacturers. This leading edge technology enables our robotic-qualified, board certified, fellowship trained orthopedic surgeons to perform intricate surgical maneuvers beyond the capability of that which they can control with their own hands.
Understanding Surgical Robotics
NAVIO
The NAVIO◊ robotic arm device pictured above can improve the dexterity with large control movements translated into micromotions (measured in millimeters rather than inches or centimeters) that enhance the surgeon’s hand control and decrease surgeon fatigue while improving precision maneuvers when removing the bone on the surface of the knee joint to make way for the prosthetic implant that will be installed. The robot may be operated by controls that are moved synchronously with the surgeon’s hand movements.
Advanced instrumentation is designed to enforce bone resurfacing within the surgeon-defined plan.
Computer assistance is designed to ensure consistent and accurate results.
Robotics-assisted handpiece (above) is designed to enable access through smaller incisions.
Robotic procedures require governmental (Food and Drug Administration (“FDA”) approval for use prior to implementation in surgery. FDA approval is also required as a threshold to eligibility for payment by insurers.
Patient Benefit
The NAVIO robotic surgical system can lower the cost and improve quality and outcomes in several ways:
1. The combination of advanced technology is designed to help your surgeon and may result in more accuracy, leading to better long-term outcomes. That’s because greater precision in installing the prosthetic knee replacement can lead to fewer complications and prosthetic implant revisions and replacements – which in turn lowers patient and insurer costs and risks of complications or failure.
2. Only NAVIO affords the surgeon the opportunity to plan their surgery without a CT scan. The NAVIO surgical system helps your surgeon create a highly individualized plan that is specific to the unique shape and motion of your knee. Traditional planning may require CT scans, a series of images similar to x-rays that shows cross-sections of your knee. Using the NAVIO system, your surgeon creates a 3D representation of the unique shapes and profiles of your knee without the need of a pre-operative CT scan. While other robotic-assisted platforms require CT scans, the NAVIO system works without them, meaning you are not exposed to the potentially harmful radiation experienced with this type of imaging. The elimination of the CT scan saves money for our patients or their insurer and avoids radiation exposure equivalent to 40 chest x-rays.
3. The procedure generally takes less time than knee replacements performed without the robotic assistance. Reduced time for the surgery equates to lower time under general anesthesia, which in turn exposes the patient to less risk of anesthesia-related complication. When a procedure requires less time to complete, additional cases may be scheduled on the same day, which in turn lowers the costs for the facility, which for the ASC means lower costs they can retain as margins or share some of the savings with patients and insurers.
4. NAVIO affords the surgeon a wider selection of prosthetic implants that other systems, for both full and partial replacement. That means if part of your knee is just fine, the surgeons using the other robot will replace the entire knee even if it isn’t medically necessary. When our surgeons use NAVIO Surgical System, they physically remove only the damaged bone, preparing the site for the prosthesis, before placing and adjusting your partial knee implant. Patients who undergo partial knee replacement often report a ‘more normal’ feeling knee, less pain and quicker rehabilitation.3
5. In the ambulatory surgery center setting, lower infection rates and less time in the facility often translate to fewer hospital-acquired infections that can complicate recovery and add avoidable expense to patient and insurer, alike.
6. The benefits of the enhanced precision afforded by the NAVIO◊ surgical system that cause minimal trauma to the patient are undeniable.
Disclaimer
Individual results may vary. There are risks associated with any surgical procedure including NAVIO-enabled Knee Replacement. NAVIO is not for everyone. Children, pregnant women, patients who have mental or neuromuscular disorders that do not allow control of the knee joint, and morbidly obese patients and patients contraindicated for UKR, PFA and TKA should not undergo a NAVIO procedure. Consult your physician for details to determine if NAVIO is right for you.
Important safety notes
Individual results of joint replacement vary. Implants are intended to relieve knee pain and improve function, but may not produce the same feel or function as your original knee. There are potential risks with knee replacement surgery such as loosening, wear and infection that may result in the need for additional surgery. Patients should not perform high impact activities such as running and jumping unless their surgeon tells them that the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if a surgeon’s limitations on activity level are not followed.
1. Collier, Matthew, et al., “Patient, Implant, and Alignment Factors Associated With Revision of Medial Compartment Unicondylar Arthroplasty.”, Jour of Arthro, Vol 21 No 6, Suppl. 2, 2006.
2. Hernigou, Ph, Deschamps, G., “Alignment Influences Wear in the Knee after Medial Unicompartmental Arthroplasty.”, Clin Orthop Relat Res., Volume 423, June 2004, pp 161-165
3. Hall et al., “Unicompartmental Knee Arthroplasty (Alias Uni-Knee): An Overview with Nursing Implications,” Orthopaedic Nursing, 2004; 23(3): 163-171.
4. American Academy of Orthopaedic Surgeons website, accessed March 7, 2017: http://orthoinfo.aaos.org/topic.cfm?topic=A00389
The information listed on this site is for informational and educational purposes and is not meant as medical advice. Every patient’s case is unique and each patient should follow his or her doctor’s specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation.
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MAKO
The Mako System offers three unique steps:
- enhanced planning,
- dynamic joint balancing, and
- robotic-arm assisted bone preparation.
The Mako does require a pre-operative CT scan which exposes the patient to the equivalent of about 40 chest x-rays (and more peri-operative expense).
In the Partial Knee and Total Hip applications, this system has been shown to facilitate more accurate positioning to plan1,2 and has shown enhanced patient reported outcomes.3-5 The Mako Total Knee application was designed based on the clinically successful Mako Partial Knee and Total Hip applications with the goal of minimizing surgical complications by enabling surgeons to have a more predictable surgical experience. In a laboratory study, Mako Total Knee Technology demonstrated accurate placement of implants to a personalized surgical plan6 as well as soft tissue protection around the ligaments of the knee.7 As early clinical outcomes are being generated, patients receiving a TKA with the Mako System, have shown reduced pain and increased satisfaction when compared to a manual cohort at six months.8
Patient Benefit
The MAKO robotic surgical system can lower the cost and improve quality and outcomes in several ways:
1. Similar to NAVIO, the MAKO combines advanced technology designed to help your surgeon perform partial and full knee replacement and also hip replacement and may result in more accuracy, leading to better long-term outcomes. That’s because greater precision in installing the prosthetic knee replacement can lead to fewer complications and prosthetic implant revisions and replacements – which in turn lowers patient and insurer costs and risks of complications or failure.
2. Short surgical times have been reported with the Mako Partial Knee application. In two studies, Coon et al. have reported tourniquet times of 30.7 minutes for medial PKA and 35.5 minutes for lateral PKA.9-10 Mako-assisted surgery allows for shorter time under general anesthesia, which in turn exposes the patient to less risk of anesthesia-related complication. When a procedure requires less time to complete, additional cases may be scheduled on the same day, which in turn lowers the costs for the facility, which for the ASC means lower costs they can retain as margins or share some of the savings with patients and insurers. This may or may not explain differences in pricing when the MAKO system is used. The MAKO system costs facilities considerably more than the NAVIO system to purchase, which could explain some portion of higher costs to patient and insurers.
4. In the ambulatory surgery center setting, lower infection rates and less time in the facility often translate to fewer hospital-acquired infections that can complicate recovery and add avoidable expense to patient and insurer, alike.
Disclaimer
Individual results may vary. There are risks associated with any surgical procedure. Robotic surgical systems for knee and hip replacement are not for everyone. Children, pregnant women, patients who have mental or neuromuscular disorders that do not allow control of the knee joint, and morbidly obese patients and patients contraindicated for UKR, PFA and TKA should not undergo a robotic procedure. Consult your physician for details to determine if a robotic-assisted knee or hip replacement is right for you.
Important safety notes
Individual results of joint replacement vary. Implants are intended to relieve knee pain and improve function, but may not produce the same feel or function as your original knee. There are potential risks with knee replacement surgery such as loosening, wear and infection that may result in the need for additional surgery. Patients should not perform high impact activities such as running and jumping unless their surgeon tells them that the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if a surgeon’s limitations on activity level are not followed.
- Bell SW; Anthony I; Jones B; MacLean A; Rowe P; Blyth M. Improved accuracy of component positioning with robotic-assisted unicompartmental knee arthroplasty: data from a prospective, randomized controlled study. J Bone and Joint Surg. 2016; 98: 627-35.
- Elson L, Dounchis J, Illgen R, Marchand R, et al. Precision of acetabular cup placement in robotic integrated total hip arthoplasty. Hip Int 2015; 25(6): 531-536
- L Kleeblad, T Borus, T Coon, J Dounchis, J Nguyen, A Pearle. Midterm Survivorship and Patient Satisfaction of Robotic-Arm Assisted Medial Unicompartmental Knee Arthroplasty: A Multicenter Study. The Journal of Arthroplasty, January 2018: 1-8.
- Blyth MJ, Anthony I, Rowe P, Banger MS, MacLean A, Jones B. Robotic-arm assisted versus conventional unicompartmental knee arthoplasty: Exploratory secondary analysis of a randomized controlled trial. Bone and Joint Research. 2017 Nov 16 (11):631-9.
- Bukowski B.R, Chughtai M, Anderson P. et al. Improved functional outcomes with robotic compared with manual total hip arthoplasty. Surg Technol Int. 2016 Oct.
- Hampp EL, Scholl LY, Prieto M, Chang TC, Abbasi A, Bhowmik-Stoker M, Otto JK, Jacofsky DJ, Mont MA. Robotic-arm assisted total knee arthroplasty demonstrated greater accuracy to plan compared to manual technique. Orthopaedic Research Society 2017 Annual Meeting, San Diego, CA. Poster No. 2412. March 20-22, 2017.
- Khlopas A, Chughtai M, Hampp EL, Scholl LY, Prieto M, Chang TC, Abbasi A, Bhowmik-Stoker M, Otto JK, Jacofsky DJ, Mont MA. Robotic-arm assisted total knee arthroplasty demonstrated soft tissue protection. Surg Technol Int. 2017 Jul 11;30. [Epub ahead of print]
- Marchand RC, Sodhi N, Khlopas A, Sultan AA, Harwin SF, Malkani AL, Mont MM. Patient satisfaction outcomes after robotic-arm assisted total knee arthroplasty: a short-term evaluation. J Knee Surg. 2017 Nov;30(9):849-853
- Coon T, Shi S, DeBattista J. Clinical and functional outcomes of robotic-arm assisted medial unicompartmental knee arthroplasty. . European Knee Society 2017 Annual Meeting. London, England. Poster No. P59. April 19-21, 2017.
- Coon T, Shi S, DeBattista J, Bhowmik-Stoker M. Clinical and functional outcomes of robotic-arm assisted unicompartmental and bicompartmental knee arthroplasty. European Knee Society 2017 Annual Meeting. London, England. Poster No. P60. April 19-21, 2017
OMNIBot™
Similar to the NAVIO and the MAKO, the OMNIBot™ System is a robotic-assisted system used by surgeons to accurately plan and perform total knee replacement.
Like MAKO, OMNIBot™ also requires a CT-scan prior to surgery for planning purposes adding cost and radiation exposure unlike the NAVIO. OMNIBotics surgery uses a patented Bone Morphing™ technology that quickly builds its version of a 3D virtual model of your knee during surgery.
Unlike NAVIO and MAKO, the OMNIBot™ system is only approved for use in a full knee replacement surgery. If only part of your knee is damaged and requires replacement, if all your surgeon has available is an OMNIBot™, you may be scheduled for a full replacement. You may wish to ask this very direct and delicate question in such a way that you get your answer without offending the surgeon as a challenge. Your surgeon could elect to do a partial knee replacement without the use of the robotic assistance.
Compared with MAKO, the OMNIBot™ system is not approved to hip replacement procedures.
Patient Benefit
One of the most important factors for a successful total knee replacement is to ensure the ligaments and other soft tissues have equal tensions on both sides of the knee. If the ligaments are tighter on one side, they can cause pain and even reduce the length of time the implant lasts.1
To solve this tightness issue, often surgeons make tiny incisions in the tight ligaments to try and make them the same tension as the looser ligaments on the other side. Unfortunately, these small incisions are imprecise, and may lead to additional swelling and pain.
OMNIBotics is the only knee procedure that has a robotic instrument, the BalanceBot™ to help your surgeon assess and balance your knee. This device is designed to reduce the need for these additional incisions in your ligaments.
Disclaimer
Individual results may vary. There are risks associated with any surgical procedure. Robotic surgical systems for knee and hip replacement are not for everyone. Children, pregnant women, patients who have mental or neuromuscular disorders that do not allow control of the knee joint, and morbidly obese patients and patients contraindicated for TKA should not undergo a robotic procedure. Consult your physician for details to determine if a robotic-assisted knee or hip replacement is right for you.
Important safety notes
Individual results of joint replacement vary. Implants are intended to relieve knee pain and improve function, but may not produce the same feel or function as your original knee. There are potential risks with knee replacement surgery such as loosening, wear and infection that may result in the need for additional surgery. Patients should not perform high impact activities such as running and jumping unless their surgeon tells them that the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if a surgeon’s limitations on activity level are not followed.
- Babazadeh et al. The relevance of ligament balancing in total knee arthroplasty: how important is it? A systematic review of the literature.Orthop Rev (Pavia). 2009
