Becker's ASC Review

34 Executive Briefing: Robotic Knee Surgery in ASCs Sponsored by: F remont, Calif.-based Arthur Ting, MD, was first introduced to robotic technology for knee surgery at an ambulatory sur- gery center. As an experienced sports medicine physician who underwent a fellowship at Kerlan-Jobe Orthopaedic Clinic in Los Angles, Dr.Ting was interested in learning more about how robotic technology could help him perform more precise knee re- placement procedures. No other orthopedic device company allows real time virtual trial- ing and robotic tooling. The robotic technology was an easy fit for the surgery center because there was a total joint replacement program at the center already. "The robotic technology makes do- ing the knee replacements more reproducible and more precise," says Dr. Ting. "However, it was a process for me to incorporate the technology into my practice. There is a definite learning curve, but as a joint surgeon it allowed me to learn." Clinical improvement Jess Lonner, MD, an orthopedic surgeon at Rothman Institute and Jefferson Surgical Center at the Navy Yard, and his colleagues compared partial knee replacements with the Navio system to conventional surgical techniques and showed the use of robotics can improve bone preparation precision prosthesis alignment and soft tissue balance in partial knee replacements. Taken together, these factors improve outcomes and durability. The initial cadaveric study included 25 knees to show the preci- sion of bone preparation using the Navio system. A further clinical study including the initial 70 cases performed at the center with the Navio system found the alignment was within one degree of the preoperative plan in 92 percent of the cases. There were no instances of inadvertent soft tissue complications. These procedures were performed in the surgery center — some days performing five partial knee replacements in addition to a few arthroscopic surgery cases at the ASC and the patients were discharged home after an average of three hours in the PACU. There were no hospital readmissions. Learning the technology Dr. Ting performed his first 35 robotically-assisted knee surgeries with an expert surgeon in the technology; then he felt confident doing the procedure on his own. He found the experienced sur- geon's mentorship invaluable as he paved the way for bringing robotics into his surgery center and realized clinical advantages for his patients. When he first began using the technology, Dr, Ting was amazed at how perfect the X-rays looked with regards to alignment and implant placement preciseness. Surgeons take images of the pa- tient's anatomy and plan the procedure based on those images. Then, the robotic system guides their procedure through the pa- tient's anatomy. "You've already committed to your cuts and you now trailing im- plants using standard instrumentation," he says. "The experience of watching the technology and being able to observe how accu- rately one was able to balance the knees introaoperatively prior to cutting was exciting. Being able to do the procedure virtually and make adjustments to the procedure experientially with computer technology makes the procedure more accurate when we perform in on the patient." Cost-effective robot One of the huge drawbacks to acquiring new technology — even technology that shows clinical benefit — is cost. ASCs operate on a tight margin and new technologies, including the robot, come at an expense. However, more device companies now are develop- ing platforms to meet the ASC's unique needs. "The big advantage of the Navio system over other devices is the cost allows surgeons to introduce it introduce it into their ASCs," says Dr. Ting. "It's about one-fifth the cost of other robotic sys- tems, so that's been a significant advantage for us." Dr. Ting can use the Navio system on all his patients — even Medi- care patients — and finds the technology cost-effective. The machine is also mobile, so he can take it from one operating room to another — or one facility — without experiencing a huge financial burden. "The mobility and overall cost of the Navio makes it much more practical in the outpatient setting," he says. "And there is no differ- ence between Medicare of private insurance Navio system cost per case. We are able to use it with every patient whether the pa- tient is contracted or non-contracted, Medicare or non-Medicare; that's been huge." It took about 30 cases for Dr. Ting's center to break even finan- cially. The break even point is dependent on the profile of the 5 Core Concepts on Robotic Partial Knee Surgery in ASCs By Laura Dyrda

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