It was a year in the making, but the innovative surgeon partners at Oregon Surgical Institute (OSI), a leading west coast ambulatory surgery center (ASC) specializing in orthopedics, took the leap late last year and invested in robotic-assisted technology. The center began using its robot in September to improve the precision of select knee and hip replacement surgeries, enabling better patient outcomes.
“This technology has been around for 9 or 10 years but over the past 2-3 years, it’s caught on like wildfire,” says OSI Surgeon Partner Mark Wagner, M.D. “Robotic technology gives us greater precision with the angles that we cut the bones, how much we actually take off the bone, and with all the ways to perfect the surgery. The robot allows us to maintain an unbelievable amount of accuracy for placement of these (implant) components.”
Dr. Wagner says the technology is used preoperatively to create a plan for the procedure based on a CT scan of the hip or knee. Surgeons can then decide the best components to use for the patient and manipulate them in a 3D environment before the surgery begins to help determine the best course of action. Once surgery begins, the robot helps identify any imbalancing in real time, and guides the procedure using haptic technology to help keep the surgeon within a narrow zone of accuracy.
“Studies have shown, especially for hip replacements, that if you give a surgeon a 20-degree safe zone, some of the best surgeons in the country are only hitting those marks about 50% of the time using nonrobotic technology,” Dr. Wagner explains. “We can achieve 90-100% accuracy when using a robot. The analogy I use with my patients is if we use the old technology for balancing tires on a car, at a low rate of speed you can’t tell the difference but at higher speeds, you start noticing the precision of a wheel that’s balanced perfectly. Our patients today are really demanding those high speeds.”
Improved precision is key, because the number one cause of patient dissatisfaction with knee and hip replacements is imbalancing.
“With the robot, you can tweak intraoperatively to achieve the most perfect ligament balancing for the knee,” Dr. Wagner says. “That helps people walk, it helps them get upstairs with less pain and get back to the activities they want to do. The same is true with hip replacements. We can virtually place our components beforehand, and then with this unbridled degree of accuracy, place them exactly where we want them every time.”
“Investing in the robotic-assisted technology was a significant decision but at OSI, our physician partners are willing to take on financial risk if we believe there is benefit to our patients and our center,” says OSI Surgeon Partner Chris Nanson, M.D. “If we can move from 98% successful surgeries to 99% successful, then robotics is worth it, and we believe this will pay out for us and for our patients in spades.”
Early data support Dr. Nanson’s assertion. Studies show that a navigated hip replacement (which is not a robotic procedure) has lower dislocation rates than a non-navigated hip. Robot-assisted numbers are even better, and more than 100 journal articles suggest computer navigation or robotic technology is consistently better. And, on the horizon, similar technology will be available for ankle replacements, for shoulder replacements and spine surgery, using the same robot with different software and instrumentation.
“Over the long run, we’re trying to increase patient satisfaction rates and lower revision rates, and some of the biggest things that make people unhappy with surgeries is having to go back for a revision, another surgery,” says Dr. Nanson, adding that revision surgery is expensive, and can open the possibility of infection and other morbidities.
Dr. Nanson says OSI’s knee and hip volume has increased over the three months since they began using the robot, sourcing cases that would have gone to the hospital and helping offset the investment.
“It’s already showing profitability, and we’re also getting other surgeons who aren’t physician owners operating here because we have this technology,” Dr. Wagner adds. “We are absolutely thrilled that our partners supported us in this endeavor.”