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

• uglas

las A. D Denn nnis is, M , M.D.

Adjun junct ct Prof

• fes

essor

• r, Dept.
• t. of Bio

iomed edical al Engine neer ering ng Univ iversity ty of Tenne nnessee Assista tant nt Clin linical al Prof

• fes

essor

• r, Dept.
• t. of Orthop

thopedic c Surgery Univ iversity ty of Color lorado

• Heal

alth th Scien ence ces Cente nter Clini linical cal Dir irec ecto tor Roc

• cky Mtn. Muscul

culos

• skel

elet etal al Resear arch h Laborator

• ry

Denver er, Color

• rad

ado

DISCLOSU DISCLOSURE RE

Consu

• nsult

ltant nt : Dep epuy uy Royalties: s:

• Depuy /

puy / Innome Innomed / / Wol Wolte ters K s Kluw uwer

Lab Labor

• ratory Rese

esearch Sup uppo port

• Depuy

puy

• Por
• rte

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

• mpu

pute ter N r Navigatio igation & & Robo

• botics

cs C Can I an Impr prove e Accu curacy racy Of Compo

• mponen

ent P Placem emen ent

Majority

jority Of The he Data S ta Shows

• ws N

No Impr provem emen ent I t In F Func unctio tional al Outco comes es O Or Surv rviv ivor

• rship !

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

• t Be Enoug

e Enough Room

• om For

For Y Your

• ur

Rout

• utin

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
• om S

Set-up up

• Drapi

ping R g Robo bot

• Moving R

ng Robo

• bot I

Int nto Posi

• sition
• Hand

ndpi piece A Assembl bly To R To Robot

TKA TIME TKA TIME: P PREOP + + INTR INTRAOP

Inse

serting g & R Remov

• ving

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

• ne

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

• m CAS:

: Sur urge geon E

• n Error
• rs 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

• st 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

• Denni

nnis, JOA A 2013 013

• 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 AS S Super erior

• Schnu

hnurr, In Int Ortho thop 201 2012

• Hoffart, JBJS Br 2012

012

CAS CAS VS VS NO NO CAS CAS

54

54 Bil Bilateral T l TKA KA

2 Fellow

• wshi

ship T p Traine ned d Arthr hrop

• plasty S

Surgeons

• ns

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

• mpar

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

• rrelati

tion

• n 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

• rt 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

• ne Safely
• Most D

t Data ta Pertain tains T To U

• 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

• re T

e The R Roboti tic P c Proc

• cedur

ure e Beco ecomes es T Time N e Neut utral ? l ??

• Total OR
• tal OR R

Room

• om Occup

Occupatio ion T n Time

• Sk

Skin in → Ski kin Tim Time

How

• w A

About

• ut 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

• tt.
• t. M

MD

“Total

• tal 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

• vided 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

• stly

y Te Technol nology

• gy

Can

n Impr Improv

• ved P

d Precisi sion

• n 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

• ves

Long Long-Te Term C Clini nical Outc Outcome

• mes

s

Enc

ncour

• urage S

Sur urge geon n Use Users To s To Col

• llect

t & & Ana nalyze yze D Data ta To To Prove

• ve 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