RO ROBO BOT IN IN TK TKA: A: KEEP IT EEP IT CONVENTIONAL - PowerPoint PPT Presentation

RO ROBO BOT IN IN TK TKA: A: KEEP IT EEP IT CONVENTIONAL NVENTIONAL. IT . IT HAS HAS WOR WORKE KED FOR D FOR YEARS Doug ouglas las A. D Denn nnis is, M , M.D. Adjun junct ct Prof ofes essor or, Dept. t. of Bio iomed edical al Engine neer ering ng Univ iversity ty of Tenne nnessee Assista tant nt Clin linical al Prof ofes essor or, Dept. t. of Orthop thopedic c Surgery Univ iversity ty of Color lorado o Heal alth th Scien ence ces Cente nter Clini linical cal Dir irec ecto tor Roc ocky Mtn. Muscul culos oskel elet etal al Resear arch h Laborator ory Denver er, Color orad ado

DISCLOSU DISCLOSURE RE  Consu onsult ltant nt : Dep epuy uy  Royalties: s: • Depuy / puy / Innome Innomed / / Wol Wolte ters K s Kluw uwer  Lab Labor oratory Rese esearch Sup uppo port • Depuy puy • Por orte ter A Adve dventi ntist Hospi st Hospita tal  Ow Owners rship In Inte tere rest: Jo Joint t Vue ue

THIS THIS I I KNOW !! KNOW !!  Use Of Com ompu pute ter N r Navigatio igation & & Robo obotics cs C Can I an Impr prove e Accu curacy racy Of Compo omponen ent P Placem emen ent  Majority jority Of The he Data S ta Shows ows N No Impr provem emen ent I t In F Func unctio tional al Outco comes es O Or Surv rviv ivor orship ! hip !!

LET LET’S EXAM EXAMINE NE WHAT WHAT IS INV IS INVOLVED D TO PER TO PERFORM M ROB ROBOTIC TKA C TKA

CONGESTED TED O OR ENVIR VIRONM ONMENT ENT ↑ AIR IRFLOW OW D DISR SRUPTI TION ? ON ??

CONGESTED TED O OR ENVIR VIRONM ONMENT ENT  May N Not ot Be Enoug e Enough Room oom For For Y Your our Rout outin ine A e Ass ssis istan ants ts  Ma May R Require A A Self- Retr tracti action S n Syste tem

TKA TIME TKA TIME: P PREOP + + INTR INTRAOP  ↑ Preo Preop Pl Plannin ing T Time  ↑ Intrao traop Time • Room oom S Set-up up • Drapi ping R g Robo bot • Moving R ng Robo obot I Int nto Posi osition • Hand ndpi piece A Assembl bly To R To Robot

TKA TIME TKA TIME: P PREOP + + INTR INTRAOP  Inse serting g & R Remov oving g Reg egis istratio ion Pi Pins (4) (4) • Late P te Pin H Hole e Fractu cture R re Risk??  Bone R e Registrati tration ( (40 Points ts)  Sa Sawb wblad lade R Reg egis istratio ion : : Twice wice • Femo moral Blade de • Ti Tibi bial Blade

TKA TIME TKA TIME: P PREOP + + INTR INTRAOP  Movi Moving R Robotic A Arm In & In & Out O t Of Opera erativ ive e Field ield • Must Must B Be D Don one Care arefu fully lly • Inju jury ry To Su Surgic ical Sta l Staff ff • Steril Sterilit ity  Intrao traop Adj djust stments • In & In & Out Out • ↑ OR OR Ti Time

PRECI PRECISION / / ACCURACY ACCURACY  Still ill Re Requires ires Surg rgeo eon Re Regis istratio ration  Le Learned Fr d From om CAS: : Sur urge geon E on Error ors Oc s Occur ur  “ GARBAGE IN E IN = = GAR ARBAGE O E OUT” UT”

DOES DOES IT IT MAKE MAKE A A DIFFER FFERENCE I ENCE IN C CLINI INICAL L OUT UTCOMES ? OMES ??

CAS CAS VS VS NO NO CAS CAS Most Show ost Show I Improved ed A Alig lignmen ent B t But ut No Clini nical cal D Differ erenc ences es No C Clin inical ical D Differ feren ence ce CAS AS S Super erior • Denni nnis, JOA A 2013 013 • Schnu hnurr, In Int Ortho thop 201 2012 • • Hoffart, JBJS Br 2012 012 • • Venk nkate atesan, J Knee ee Surg 201 2013 • • Hoppe pe, Act Acta Ortho thop 201 2012 • Kim, JBJ • BJS Am Am 20 2012 • Burne nett tt, CORR RR 2013 013 • Har arvie, JOA OA 201 2012

CAS CAS VS VS NO NO CAS CAS  54 54 Bil Bilateral T l TKA KA  2 Fellow owshi ship T p Traine ned d Arthr hrop oplasty S Surgeons ons  CAS / / No C No CAS  Mean an F F/U: 2. 2.5 5 Year ears  No C Clin inica ical l Differen rences ces • KSS SS / ROM OM  Fewer A Alignm nment nt Out Outliers In C s In CAS Gr Group Dennis, Kindsfater, et al, JOA 2013

TKA A ALIGN GNMEN MENT  398 T 98 TKA R A Rev evie iewed @ @ 15 Y Year ears  Com ompar ared ed A Alig lignmen ent V t Vs Sur s Surviv ival  “A Postoperative Mechanical Axis of 0° ± 3° Did Not Improve The Fifteen- Year Implant Survival Rate” IS THE ROBOT WORTH IT ?? Parratte tte, , Pagnano ano, e et al, JB JBJS 2 2010

TKA A ALIGN GNMEN MENT  Ga Gait La t Lab A b Ana nalysi ysis s Of Of 35 TK TKA • 17 Ne Neutr utral A Alignme gnment nt • 9 Va Varus us & & 4 Va Valgus gus Alignme gnment nt  No No Cor orrelati tion on Betw tween n TK TKA A Alignme gnment & nt & Dyna ynami mic K Kne nee Loa Loadi ding D ng Dur uring ng Ga Gait  IS IS THE THE PRECIS ISION ON A ROB OBOT MA OT MAY OFFE Y OFFER OF OF ANY NY VA VALUE LUE IN IN CLINIC LINICAL L OUTC OUTCOME OME ? ?? Riv iviere, , Parratte tte, e et t al, l, K Knee 2 nee 201 017

ME MEANINGFU FUL CLI L CLINICA CAL L DA DATA  THER THERE ISN ISN’T ANY !! ANY !! • Minim imal al S Short ort Term R rm Repo port rts • Small N l Num umbers bers Of Patien ents • Docu cumen ent t It C Can B an Be D Done one Safely • Most D t Data ta Pertain tains T To U o UKA • Similar R lar Results ults With T ith TKA ? ??

ROBOT ROBOT COS COST $$$$ $$$$$  Health lthcar care C e Cris isis is  > $1,000, 000,000 000  Doe Does It It Fit With Fit With Bundl Bundling ng  How How Many Many Hos Hospitals Can Can Afford Afford It It ??

ROBOT ROBOT COS COST $$$$ $$$$$  Requ Requires A A Preo reop CT CT Sca can • Incr Increased Cos Cost • Patien tient R t Radiation iation

QUESTIONS I ESTIONS I HAVE  WHAT AT I IS S THE LEARN E LEARNING C CURV RVE ? ??  Ho How Ma w Many Ca Cases A Are R Required Befor ore T e The R Roboti tic P c Proc ocedur ure e Beco ecomes es T Time N e Neut utral ? l ?? • Total OR otal OR R Room oom Occup Occupatio ion T n Time • Sk Skin in → Ski kin Tim Time  How ow A About out For For The Sur he Surgeo eon W n Who ho Ha Has Ne Never Us Used A A Robot B Before ?? ??

QUESTIONS I ESTIONS I HAVE  Richar hard D d D. Scot ott. t. M MD  “Total otal K Knee A ee Arth throplas plasty ty I Is A Sof Soft Tiss Tissue O Ope peration”  IS IS THE RO THE ROBO BOT BETT BETTER TH THAN CO CONV NVENTIONAL SO SOFT TISS FT TISSUE E BALA LANC NCING ING T TECHNIQ NIQUES ? ??

QUESTIONS I ESTIONS I HAVE  A Marketing P eting Progr gram I am Is Prov ovided T ided To The H Hospital pital  ARE H HOSPITA ITALS P PURCHASING SING TO IMPR PROVE P VE PATIENT C TIENT CARE & E & CL CLINICAL O OUTC UTCOMES MES OR R TO TO INC NCREA EASE SE P PATIENT TIENT VOLUM LUME ? ??

SUM SUMMARY: ARY: ROBO ROBOTIC T TKA KA  Ne New & & Costl ostly y Te Technol nology ogy  Can n Impr Improv oved P d Precisi sion on Of Of Alignme gnment nt Bene nefit Long t Long Te Term S m Sur urvi vivor vorshi ship p ??  No No Clini nical D Data ta To To Show how It It Impr Improve oves Long Long-Te Term C Clini nical Outc Outcome omes s  Enc ncour ourage S Sur urge geon n Use Users To s To Col ollect t & & Ana nalyze yze D Data ta To To Prove ove Clini nical Superio riorit rity  Not Not Ye Yet R t Ready y For For Wi Wide despr spread Use Use ! !!

THAN THANK K YOU YOU