Written by: Anay R. Patel, MD
Knee replacement surgery is one of the most effective and reliable operations in the history modern medicine. By removing damaged joints and replacing them with small pieces of metal and plastic, surgeons can restore patients to full activities including tennis, golf, pickleball, dancing, and hunting. This is truly one of the best operations that medicine has to offer.
That being said, even with modern techniques approximately 20% of patients are unhappy with their knee replacement result. A large part of this is because more than 75% of knee replacements are done by orthopaedic surgeons who do less than 25-50 knee replacements a year, or less than 1 a week. A knee replacement is a routine operation but it is by no means a simple thing. The nuances of each patient and their particular anatomy are often unappreciated. This 20 percent can be cut in half by surgeons who are fellowship trained in knee replacements and by surgeons who do more than 150-200 knee replacements a year. A fellowship trained surgeon is someone who did an extra year of training on top of their 5 years of orthopaedic surgery training and specifically in the area of knee replacement. These surgeons, combined with their dedicated specialty practice to knee replacement often have a success rate of 90-95% percent, instead of less than 80% by non specialized low-volume surgeons.
Robotic surgery is a new frontier in modern knee replacement. A robotic arm, which is still controlled by the surgeon, allows for more precise planning of the surgery and more accurate cutting of the bone. For a surgery that was often planned in 2-4 millimeter terms, a robot can cut to an accuracy of less than half a millimeter. This promising technology allows the surgeon to plan a knee replacement closer to patient’s native anatomy and hopefully aim for a knee that feels more natural while also allowing for a quicker recovery. How is this done? Imagine you are driving along a road through the mountains. The road is a compromise between laying down the road itself, and at times, perhaps having to make a tunnel through a mountain or build a bridge over water. There’s a balance of where the road needs to go and what the land allows. Traditional knee replacement often requires us to bring the patient to the knee replacement, or bring the earth to the highway. This means more damage to the earth, or in this case, more trauma to your knee. Robotic knee surgery allows us, by adjusting for millimeters and degrees, find a more natural balance of the road and the earth. By moving less earth, digging fewer tunnels, and building fewer bridges, we can do less work on the earth, or the patient themselves and bring the implant to the patient rather than bringing the patient to the implant. By placing less stress on the patient’s knee we can allow for less pain, less inflammation, and hopefully, a faster recovery with a knee that feels more natural.
Unfortunately because this technology is so promising and exciting, there is also a lot of misinformation regarding the merits of this procedure. A recent study showed that patient’s prefer a less experienced surgeon using a robot over a more experienced surgeon not using a robot. It’s critical to remember that a robot is a tool to assist a surgeon, not a substitute for the surgeon themselves. Data indicates that lower volume surgeons do not have as much success as high volume surgeons. Joint arthroplasty fellowship surgeons have better outcomes than non-fellowship trained surgeons. Robots can be a powerful tool in the hands of an experienced surgeon, but they cannot substitute or compensate for a surgeon who isn’t well experienced with knee replacement or isn’t a specialist in this procedure. Much like a GPS could get you lost if you don’t know where you are going, it’s important your surgeon is aided by robotic technology, not reliant on it. Technology is meant to enhance a surgeon’s ability, not replace them. Furthermore the data is clear that high volume surgeons are more successful AND that high volume hospitals are more successful. Finally, dedicated orthopaedic surgery specialty hospitals tend to have lower complication rates including lower infection rates and lower readmission rates than nonspeciality hospitals.
At Texas Orthopaedic Hospital, home of the Fondren Orthopedic Group, our joint replacement specialists are highly specialized in knee and hip replacement. We are the highest volume hospital for hip and knee replacement in Texas and one of the largest in the world. We perform over 4000 knee, hip, and shoulder replacements a year in our dedicated orthopaedic specialty hospital. Of our knee replacement surgeons who use robotic surgery, we are all fellowship trained knee replacement surgeons that do more than 200-300 knee replacements a year with thousands of surgeries of experience. Our experience and specialization is our strength while our commitment to data collection and improving our processes allows us to give the next patient the best surgery possible. We combine a commitment of specialization with the latest technologies to get you back to your life. Welcome to the Joint Replacement Division at Fondren Orthopedic Group.