Top Docs 2016: Robotic Tools That Treat Arthritis Earlier Can Ease Knee Pain

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Matthew Hummel, MD, orthopaedic surgeon,
Commonwealth Orthopaedic Centers

—As told to Lisa Murtha

“The robotic arm is just a simple tool to make a procedure that’s been done for some time even better. It’s been around for about eight or nine years. I’ve been using it about a year; we were the first in Kentucky to use it. It’s FDA-approved for both hips and knees. Right now it’s used for partial knee replacements.

In the past, for younger, more active people who had isolated arthritis in just one portion of the knee, we would do partial knee replacement resurfacing. It was a very technically demanding surgery that often had a higher failure rate, sometimes upwards of 20 percent. [The robot] has taken the failure rates down to 1 percent. So it’s improved it quite a bit.

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Illustration by Sam Falconer

[With] previous technology, like the da Vinci for general surgeons, you sit at a controller away from the patient and move it independently. This RIO Robotic Arm Interactive System is a tool that I maneuver, trigger on and off. It’s no different from using a hand-held saw, except for the level of technology involved. It’s a super-smart saw. It provides me with a level of precision and accuracy that I don’t think was affordable any other way.

During surgery, where I make my cuts, there is always that option for individual error. [Now, with the robot], once I open the patient up, I map their anatomy out so it matches my plan on the CT scan. I will cut in exactly that same plane I’ve planned. If I go one millimeter outside that zone, it stops.

People say: ‘It takes the control away from the surgeon.’ It does not. It takes away the unknown. For example if there’s a bone cyst, and I’ve got to move two degrees this way, I can go in real time and change my plans. I can run it through simulations on a CT scan and see how the knee responds. Once I think the simulation looks the best, I can cut that angle. So it does provide more freedom to try to match your anatomy better.

Arthritis is a spectrum. When you get the earlier arthritises, you use non-surgical treatments. In the past, when people got that mid-range arthritis, surgeons would say: ‘Let’s buy time until you’re ready for the full knee replacement.’ Now we can treat that earlier stage of arthritis before we let it advance, and hopefully restore quality of life for that patient. You’re never going to be 21 again, but it will get you better than what you are now.”

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