In a world where innovation has become the norm, the public is constantly seeking the next revolutionary product or service. This trend extends to the medical field when patients, who hear about a new procedure or technique in the media, begin to request the technology for their treatment. While some advancements in technology will ultimately change the way we practice medicine, others – such as robotic and computer assisted hip and knee replacement surgeries – are still in their earliest stages and may not be the answer that patients are looking for. So, what should you tell patients when they ask about a robotic surgery?
Jeffrey P. Rosen, M.D., a board-certified orthopaedic surgeon specializing in hip and knee surgery at Orlando Orthopaedic Center offers his opinion saying, “Despite their theoretical advantages, there is no study completed that proves that they improve clinical outcomes.” He goes on to say that robotic surgeries, specifically for hip and knee replacement surgeries, are still in their infancy and are surely going to be refined as time goes on. For today, he stresses that the skill and judgment of the surgeon are not replaced by the robotics systems yet.
Dr. Rosen has specialized in hip and knee replacement surgery with Orlando Orthopaedic Center since 1985. The Washington D.C. native is a member of the American Medical Association, Orange County Medical Society, American Academy of Orthopaedic Surgeons, Robert P. Kelly Orthopaedic Society and American Association of Hip and Knee Surgeons, where he is a leader in the field.
In his years of experience, Dr. Rosen has seen several “improvements” in technology come and went, and believes that computer assisted, and robotic orthopaedic surgeries will have to undergo further development before they can be performed for the mainstream.
Both types of surgery utilize computers with GPS-like tracking devices to mark the bones and instruments to make the most precise cuts. However, while computer-assisted surgery still relies on the surgeon to make the cuts and implant the devices, robotic surgery uses a robotic arm to perform the bone cuts, “with the surgeon acting almost like an assistant to the robotic device,” says Dr. Rosen.
If performed properly, these procedures can potentially provide greater precision, but they also have their disadvantages. Not only are these surgeries significantly more expensive than routine surgery (computer assisted surgery alone adds about $1,500 to each case, and the robot costs $1 million for the hospital to purchase), but they increase the operating time and thus the risk of infection. Also, some doctors had reported that when the computer overrode the clinical judgment of the surgeon, implants were incorrectly placed.
“Hip and knee surgeons have been doing a very good job for many years in performing hip and knee replacement surgery, and statistically the results before navigation and robotic surgery have been excellent,” says Dr. Rosen. “Newer is not always better, and surgeons need to advise their patients that the ‘latest and greatest,’ as reported in the popular press, may not be in their best interest. Despite the theoretical advantages, there is no real proof so far that computer assisted surgery or robotic orthopaedic surgery improves the outcome.”
When deciding whether or not to perform one of these surgeries, doctors must consider several factors, balancing the advantage of a perfect implant replacement against the increased cost and surgical time, as well as the risks and complications associated with any new type of procedure.
Of course, robotic and computer-assisted surgeries do have the potential for accuracy, and could be helpful in the future.
“Accuracy of implantation is critical to success after total joint surgery,” says Dr. Rosen. “A poorly or incorrectly placed implant will fail or function poorly, leading to pain, weak motion, deformity or revision surgery. Patients benefit from anything that helps to ensure proper implant alignment and placement.”
Dr. Rosen notes that the surgery may prove to be worth its cost over time, however.
“The ongoing compromise continues to be to balance new technology with the expense of that technology. Can we prove a benefit, and how much does it cost? If the robot benefits 90 percent of its patients, then spending $1 million for the equipment is probably worth it,” he says. “If it helps only 1 percent of patients, then probably not.”
Ultimately, according to Dr. Rosen, the future of computer assisted and robotic surgeries is too early to tell.
“Many ‘innovations’ in medicine have come and gone, but many, such as arthroscopic surgery, laparoscopic surgery, and robotic prostate surgery, have proven significant benefit and are now the standard of care,” he says. “We don’t have enough experience with the newest procedures yet to determine their worth.”