Commentary on robotic assisted TKA
The last forum post I wrote about biologics in orthopedics. Now I have had my first experience with robotic total joints. I have been in orthopedics for 21 years. Initially I did a lot of total knee and hip surgeries with orthopods who were generalists - not fellowship trained total joint surgeons. These docs relied on feel, their knowledge of orthopedics and experience to complete the total joint surgery.
Two weeks ago I worked with one of our younger surgeons and completed a total knee using the MAKO technology. This was a first for me. For those who don't know MAKO Robotic-arm Assisted Sugery uses a robotic arm to assist the surgeon in making exact pre-planned cuts to remove the cartilage and minimal bone.
Initially a patient who is undergoing total knee surgery using the MAKO system, has a pre-operative CT scan to generat e a 3-D model of the patients anatomy. Then intra-operatively , the surgeon uses pin point technology to map out exact cuts the MAKO will assist in making. This requires mapping out multpile sites on the femur and tibia that then compares that to the pre-op CT scan image. The surgeon then uses the MAKO robotic arm to make precise cuts within planned boundaries developed by the preop and intraop mapping of the joint. After the cuts a Triathlon Total Joint implant is used.
I got to thinking after performing two of these MAKO assisted surgeries. I wondered if the advacement in technology was better then the "feel and expertise" of the surgeon. I know studies and debates are there that show that this type of technology improves patient outcomes, decreases need for revision and improves safety. But I wonder what surgeons and providers who have performed these surgeries for years without this technology feel. I know I might open pandora's box but are we relying too much on technology and not enough on "expertise and skill of the surgeon." ?