Recently, San Francisco Surgery Center became the first ambulatory surgery center to offer MAKOplasty, a new robotic system that assists in partial joint replacement. Kevin R. Stone, MD, of The Stone Clinic in San Francisco, and John H. Velyvis, MD, of the Coon Joint Institute in St. Helena, California, performed the procedure, which was successful and allowed the patient to walk out of the recovery room within two hours of the surgery. "Given the benefits, I think robotic implantation will become the standard of orthopedic care in the future," says Dr. Stone. He and San Francisco Surgery Center administrator Jeff Wong discuss the procedure and what it takes to bring MAKOplasty into an ASC.
MAKOplasy is a robotic system that assists in partial joint replacement. The device has been successful in performing partial knee and hip replacements, and development is underway on software that would allow the surgeons to use MAKOplasty during shoulder and total knee surgery. Surgeons use the computer software to preplan surgeries based on three-dimensional images of each patient's individual anatomy, and then use the MAKOplasty robotic arm during the surgery for increased precision. The system won't allow surgeons to cut beyond the preplanned perimeters, but surgeons are able to adjust the preplanned program during surgery if necessary.
"The most important feature is the extreme accuracy of using a robotic device to put in the components," says Dr. Stone. "In the past, we would use cutting jigs as guides, and while most of the time we could put them in accurately, the positioning wasn't always perfect. Our ability to adjust the component position in every plane was limited. With the computerized robotic guidance, you can put the device in extremely accurately and adjust for the variation in the patient's anatomy before cutting any bone."
Dr. Stone says that while unicompartmental implants sometimes do well, when they fail early, it's often due to misalignment. By using the robotic technology, he can expect the unicompartmental implants to have a longer lifespan because of the increased accuracy.
1. Purchasing the system. Acquiring the financing for the equipment was the most challenging aspect of bringing MAKOplasty to the surgery center, says Mr. Wong. "We had to work closely with MAKO and our lenders to purchase the equipment," he says. One of the driving forces behind this decision was the increasing baby boomer population who will need hip and knee replacements in the future. The equipment was expensive, but San Francisco Surgery Center decided to invest more on the front end with the potential to increase revenue and quality of care on the back end.
"We are big proponents of technology because we see it as adding value instead of cost," says Mr. Wong. "If we can bring a traditional hospital procedure to the outpatient setting, we'll have a greater patient volume."
2. Educating the OR team. MAKOplasty provides education for the surgeon and OR team on how to use the robotic technology. The training is time consuming, but learning to use the technology appropriately could benefit the surgery center in the long run. MAKOplasty also provides hospitals and surgery centers with a systems technician to assist with any mechanical issues or questions during the procedure. "The technician is like a co-pilot in the surgery room, helping to run the equipment and instructing on best practices," says Mr. Wong.
3. Performing the procedure. MAKOplasty has been performed in hospitals for years as an outpatient procedure. There are several factors that allow patients to recover quicker from this minimally invasive procedure, including the small incision and increased accuracy of implant placement, which is made possible by the preplanning program. From a procedure standpoint, transitioning MAKOplasty to a surgery center setting was relatively easy.
"To perform the procedure in a surgery center, it first took preparation of the OR team in learning how to use the robot," says Dr. Stone. "It also took an accurate surgery through a small incision."
4. Benefits of outpatient joint arthroplasty. Performing minimally invasive joint arthroplasty in an outpatient setting is beneficial because the patients don't have expensive hospital stays when the procedure is performed in an outpatient surgery center and patients can begin rehabilitating their joints quicker. "The minimally invasive MAKOplasty may be less painful and less extensive than other procedures," says Mr. Wong. "It doesn't require an overnight hospital stay, and patients can start rehabilitation the next day after surgery."
Surgeons can also be more secure about the success of their surgery. "You have the confidence of knowing that the implant is placed accurately before you even leave the OR," says Dr. Stone.
5. Lowering the cost of care. Bringing MAKOplasty to the surgery center eliminates the high hospital costs. "This will revolutionize patient care for joint arthroplasty, as well as economics because it will be generally less expensive to perform this procedure in an outpatient setting than in a hospital," says Dr. Stone. The increased accuracy from using the robotic technology also lowers the rate of revision surgeries. "Nothing is more expensive than a failed implantation for the surgeon, hospital or surgery center and the patient, so diminishing the error rate is always cost effective," Dr. Stone says.
Learn more about San Francisco Surgery Center.
Learn more about The Stone Clinic.
Read Articles Related to Knee Surgery:
10 Points on Personalized Knee Replacements
Developing the Future: Biologic Knee Replacement
Beyond Traditional Surgery: Options for Knee Surgery With Better Outcomes
How it works
MAKOplasy is a robotic system that assists in partial joint replacement. The device has been successful in performing partial knee and hip replacements, and development is underway on software that would allow the surgeons to use MAKOplasty during shoulder and total knee surgery. Surgeons use the computer software to preplan surgeries based on three-dimensional images of each patient's individual anatomy, and then use the MAKOplasty robotic arm during the surgery for increased precision. The system won't allow surgeons to cut beyond the preplanned perimeters, but surgeons are able to adjust the preplanned program during surgery if necessary.
"The most important feature is the extreme accuracy of using a robotic device to put in the components," says Dr. Stone. "In the past, we would use cutting jigs as guides, and while most of the time we could put them in accurately, the positioning wasn't always perfect. Our ability to adjust the component position in every plane was limited. With the computerized robotic guidance, you can put the device in extremely accurately and adjust for the variation in the patient's anatomy before cutting any bone."
Dr. Stone says that while unicompartmental implants sometimes do well, when they fail early, it's often due to misalignment. By using the robotic technology, he can expect the unicompartmental implants to have a longer lifespan because of the increased accuracy.
MAKOplasty in an ASC
1. Purchasing the system. Acquiring the financing for the equipment was the most challenging aspect of bringing MAKOplasty to the surgery center, says Mr. Wong. "We had to work closely with MAKO and our lenders to purchase the equipment," he says. One of the driving forces behind this decision was the increasing baby boomer population who will need hip and knee replacements in the future. The equipment was expensive, but San Francisco Surgery Center decided to invest more on the front end with the potential to increase revenue and quality of care on the back end.
"We are big proponents of technology because we see it as adding value instead of cost," says Mr. Wong. "If we can bring a traditional hospital procedure to the outpatient setting, we'll have a greater patient volume."
2. Educating the OR team. MAKOplasty provides education for the surgeon and OR team on how to use the robotic technology. The training is time consuming, but learning to use the technology appropriately could benefit the surgery center in the long run. MAKOplasty also provides hospitals and surgery centers with a systems technician to assist with any mechanical issues or questions during the procedure. "The technician is like a co-pilot in the surgery room, helping to run the equipment and instructing on best practices," says Mr. Wong.
3. Performing the procedure. MAKOplasty has been performed in hospitals for years as an outpatient procedure. There are several factors that allow patients to recover quicker from this minimally invasive procedure, including the small incision and increased accuracy of implant placement, which is made possible by the preplanning program. From a procedure standpoint, transitioning MAKOplasty to a surgery center setting was relatively easy.
"To perform the procedure in a surgery center, it first took preparation of the OR team in learning how to use the robot," says Dr. Stone. "It also took an accurate surgery through a small incision."
4. Benefits of outpatient joint arthroplasty. Performing minimally invasive joint arthroplasty in an outpatient setting is beneficial because the patients don't have expensive hospital stays when the procedure is performed in an outpatient surgery center and patients can begin rehabilitating their joints quicker. "The minimally invasive MAKOplasty may be less painful and less extensive than other procedures," says Mr. Wong. "It doesn't require an overnight hospital stay, and patients can start rehabilitation the next day after surgery."
Surgeons can also be more secure about the success of their surgery. "You have the confidence of knowing that the implant is placed accurately before you even leave the OR," says Dr. Stone.
5. Lowering the cost of care. Bringing MAKOplasty to the surgery center eliminates the high hospital costs. "This will revolutionize patient care for joint arthroplasty, as well as economics because it will be generally less expensive to perform this procedure in an outpatient setting than in a hospital," says Dr. Stone. The increased accuracy from using the robotic technology also lowers the rate of revision surgeries. "Nothing is more expensive than a failed implantation for the surgeon, hospital or surgery center and the patient, so diminishing the error rate is always cost effective," Dr. Stone says.
Learn more about San Francisco Surgery Center.
Learn more about The Stone Clinic.
Read Articles Related to Knee Surgery:
10 Points on Personalized Knee Replacements
Developing the Future: Biologic Knee Replacement
Beyond Traditional Surgery: Options for Knee Surgery With Better Outcomes