OR Manager - November 2019 - 26

Technology
Continued from page 25
One surgeon's experience
pital systems with quality control, inventory
management, and ensuring that
the correct implants are on hand-all
of which can help contain costs and
enhance patient outcomes.11 In this
study, the number of surgical trays was
reduced from 11 to 3, which markedly
reduced OR setup time, resources required,
and overall operating costs.11
Inadvertent bone and soft tissue
injury can occur during TKA procedures.12
Kayani et al compared intraoperative
bone and soft tissue injury
in manual versus RATKA using
the Macroscopic Soft Tissue Injury
(MASTI) classification and found reduced
bone and peri-articular soft tissue
injury in patients undergoing haptic-guided
RATKA. Haptic-guided RATKA
prevented the sawblade from cutting
outside the designated surgical field
and thus limited iatrogenic soft tissue
injury. Previous studies have shown
that minor trauma to soft tissues may
lead to inflammatory responses and
contribute to pain and delayed postoperative
rehabilitation.12
Early clinical outcomes of
haptic-guided RATKA
TKA is a highly successful procedure,
yet 10% to 20% of patients are dissatisfied
with their outcomes.13 Since 2016,
when the haptic-guided total knee application
was launched, data have begun to
show favorable early clinical outcomes.
Early postop results
A prospective, single-surgeon study
by Kayani et al of 40 RATKA patients
and 40 patients who had manual or
conventional jig-based TKA found that
the RATKA group was associated with
less postoperative pain (P<0.001), less
need for analgesics (P<0.001),
less
postoperative blood loss (P<0.001),
less time to achieve straight leg raise
(P<0.001), less time to hospital discharge
(RATKA resulted in a 26% length
26
OR Manager | November 2019
Jeffrey Hodrick, MD, a fellowship
trained orthopedic surgeon with the
Southern Joint Replacement Institute in
Nashville, Tennessee, who has been in
practice for more than 17 years, shares
his thoughts on adopting robotic-assisted
technology for knee procedures.
Dr Jeffrey Hodrick is a paid consultant
of Stryker. The opinions expressed by
Dr Hodrick are those of Dr Hodrick and
not necessarily those of Stryker. Individual
experiences may vary.
Q: What robotic technology do you use,
and for how long have you used it?
A: I currently use the Mako Total
Knee and Partial Knee applications
for every single knee I perform. I have
been using the applications for close
to 2 years in my practice. I honestly
believe the application makes me better,
and I am seeing this in my early
results. [In Dr Hodrick's experience.
Another hospital/site or surgeon's experience
may vary.]
of stay [LOS] reduction), and improved
maximum flexion at discharge.14
A statistically significant shorter LOS
was also reported by Naziri et al in a
comparison of 40 conventional or manual
TKA cases to 40 RATKA cases (1.92
days vs 1.27 days; P<0.0001).
No difference was noted in postoperative
Knee Society Score (KSS) and
complication rates, but better range of
motion was seen with RATKA cases at
90 days.15
Clark and colleagues demonstrated
a statistically significant shorter LOS
(P<0.001), better postoperative range
of motion, and improvement in postoperative
pain with statistically significant
reduced total morphine consumption
(P=0.001) in a comparison of 75 RATKA
patients and 75 patients with computernavigated
TKAs.16
Q: How has robotic technology impacted
you and your patients?
A: Robotic technology has had a profound
impact on the way I approach knee replacement.
Although I was trained and
used a measured resection approach, I
have always thought that the proper technique
exists on a spectrum between that
and gap balancing techniques. The Mako
total knee application allows me to marry
the two techniques by using the CT scangenerated
data and incorporating the soft
tissue tension from the dynamic balancing
portion of the case.
Q: How will robotic technology change
orthopedics?
A: I am not completely sure, but the early
results of robotics for joint replacement are
encouraging. My hope is that as we continue
to learn and understand more about robotics,
we will see a decrease in the percentage
of people who are not totally satisfied with
their knee replacement after 1 year.
1-year postoperative results
Patient satisfaction at 1 year after surgery
was assessed in 150 patients who
underwent manual TKA versus RATKA
in a study by Denehy et al. Patients
were asked to complete the satisfaction
portion of the 2011 KSS, developed
and validated to better characterize the
expectations, satisfaction, and physical
activities of patients undergoing TKA.
Although no difference was seen in
postoperative range of motion between
the two groups, 95% of RATKA patients
reported statistically significant greater
overall satisfaction compared to 75%
of those in the conventional TKA group
(P=0.005). This improved patient satisfaction
with RATKA was attributed to
real-time intraoperative alignment information
and gap balance measurement,
which allowed the surgeon to achieve
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OR Manager - November 2019

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