Robotic Knee and Hip Replacement Marketing Myths

Recently, our health system's cost/outcomes data showed that robotic total knee (RTKA) had greater per case cost than manual (MTKA), with minimal differences in hospital lengths of stay, complications and patient outcomes.

As a fellowship trained member of American Academy of Hip and Knee Surgeons (AAHKS), I have been trained on various robotic and navigation systems. My experience with robotic technology in private practice is similar to the majority of evidence presented at the academy meeting this year. This year's papers again showed increased time and cost without significant return in function and outcomes. Furthermore, there are clear studies linking prolonged surgical time to increase in infection rates, making robotic surgery a risky business for the patient. Recent publication by Tompkins et Al., studied nearly 5000 patients randomized to two groups and saw no difference in revision rates at 10 years. So where does computer navigated technology help?

- Surgeons who perform less than 50 joint surgeries per year have been shown to have better outcomes with computer navigation. The benefit of RTKA and RTHA, decreases with higher volume fellowship trained surgeons.

- Difficult cases with significant destruction of bone from prior surgeries or fractures may benefit from a computer and CT scan/MRI bases planning.

- Partial knee replacements may benefit from computer navigation is some cases where manual alignment is difficult. This is where I use the robot the most.

- Hips performed through the posterior approach, where dislocations and cup mispositioning is far more common.

When it comes to hips, I use low radiation live x-rays to confirm component positioning and leg lengths during a direct anterior approach (DAA). With fluoroscopic DAA, implant position and leg lengths are so close to my pre-operative planning that the additional cost and surgical time spent on computer navigation has not been useful in my practice.

See the link to the above mentioned publication.

https://pubmed.ncbi.nlm.nih.gov/34808279/

Pavel Muradov M.D.

Author

Pavel Muradov Orthopedic Surgeon

You Might Also Enjoy...

Pain Free Injections

Hip pain and knee pain is commonly treated with various orthopedic shots. Patients often have anxiety about getting the shot. At Integrity Orthopedics, we use local anesthetics to numb the joint prior to intra-articular injection, making it pain free.

Physical Therapy Now Available at Integrity Orthopedics

Big news happening at Integrity this week. We're excited to introduce Kristen and Will Classen as our new physical therapists. Their skill set will complete our comprehensive treatment program. Schedule an appointment today by calling 832-755-5766.

Obesity and Osteoarthritis

Severe obesity is associated with increased incidence of osteoarthritis and complications following joint replacement. Unfortunately, 2/3 patients who have severe obesity and arthritis do not perceive their health as compromised. Sounds challenging?

Extension and external rotation stretches to avoid

Hip Precautions

To assure proper recovery and prevent dislocation of the prosthesis, you may be asked to take special precautions when sitting, bending, or sleeping. These precautions depend on approach (anterior vs posterior). They vary from patient to patient.

JJ (Jean-Jacque) Throchon

JJ is a friend who faced the deadliest cancer (same cancer that killed my father) and beat the odds without conventional chemo by changing his lifestyle, what he eats, how he eats and supplements. He started a movement in Europe. I hope it catches on!