There’s an analogy Dr. Charles Craven Jr. often uses to help explain how robotic-assisted surgery works. It’s sometimes necessary because of a misconception that the robot is performing surgery. Fortunately, the surgeon is still in the driver’s seat. The robot is riding shotgun.
Craven, an orthopedic surgeon with Novant Health Orthopedics & Sports Medicine - Clemmons, specializes in knee and hip replacements.
“I’m old enough to remember when you needed a folding paper map in your car to get from Point A to Point B,” he’ll say. “That method was fine since we didn’t have another way. But there was no way to know if you were on the most efficient route or about any hazards along the way.”
Since the advent of GPS, paper maps have mostly gone the way of the rotary telephone and the cassette tape.
And since the advent of robotic-assisted surgery, it’s what many surgeons and patients prefer. Fully 99% of the joint replacements Craven and his colleague, Dr. Calvin Maxwell “Max” McCabe, perform are done with robotic guidance.
They operate at Novant Health Clemmons Medical Center, which is next to their clinic and has become a regional destination for robotic-assisted surgery. It offers all the benefits of a small-town hospital while also having high-tech, leading-edge equipment and surgeons well-versed in using it.
Craven calls the robot his “navigation system,” adding, “I still have to drive the car safely, but the robot helps us do what we do more efficiently and more safely.”
We talked to Craven and McCabe about why you should want a robot in the OR if you’re having a hip or knee replacement.
Get back to your daily life, pain free.
As orthopedic surgeons, why do you like using a robot?
McCabe: It’s a very powerful tool for analyzing the deformity and joint stiffness. Before surgery, we use a 3D, CT-based scan that combines X-rays and computer processing for imaging that lets us customize how we approach each knee.Craven: It’s worth noting that robotic surgery uses the same process we’ve always used. A knee replacement still requires the same incision, the same cuts of the bone. The process of placing a new knee in a patient is unchanged, but how we do it — how we assess the joint, how we balance the soft tissues — all of that is enhanced with the robot as our assistant.
It only takes a few minutes to help you stay active for years.
There are said to be lots of advantages to robotic-assisted knee replacement. What are some?
Craven: Quicker recovery; less pain and swelling, thanks to the soft tissue that’s spared; less pain medication, and greater precision for the surgeon.
McCabe: And fewer complications.
Are there any risks associated with the robot?
Craven:There are no additional inherent risks. Any risk involved is minimal and outweighed by the myriad of benefits.
What about the hospital stay and recovery with robotic-assisted surgery?
Not just for knees: Multipurpose robots
Robotic-assisted surgery isn’t exclusively for knees. Patients getting a new hip may also have the benefit of the robot assisting their surgeon.
“The robot can be used for hips, too,” Craven said. “And the indications are expanding. It started with partial knee, and it’s now most commonly used for total knee replacements. It can be used for total hip and hip revisions, but the most popular and widely used application is clearly the total knee. And that includes revision surgery for total knees, which is exciting.”
McCabe: We’ve been moving more and more toward what we call same-day discharge or outpatient surgery. Patients just have an easier time when they can recover at home versus the hospital.
Craven: We've gotten so darn good at discharging joint-replacement patients, robotic and otherwise, that it’s almost always an outpatient procedure. It’s not like robotic surgery makes patients get out of the hospital faster, because they already get out of the hospital quickly. But the benefits, I think, are more apparent in the months that follow surgery. Patients generally have a faster rehab experience with the robot.
We hear about revision surgery when it comes to orthopedic surgery. What is it, and when might it become necessary?
Craven: The joint could loosen, become infected, or there could be an issue with how the implant was placed the first time. Regardless, revisions are our most difficult cases. There can be bone loss, abnormal tissue. In those cases, we appreciate — and so do patients — having the most advanced technology.
About how long might it take for somebody to need revision surgery?
McCabe: If the original implant has worn out, that’s typically 20 or 30 years or more down the road.
I’ve heard from people who delayed knee replacement surgery for one reason or another, and once they finally have the procedure, they all say they wish they’d done it sooner. Is that the refrain you hear from patients?
McCabe: That’s very common and a very gratifying response. Patients tell us they feel like the surgery gave them their lives back.Small hospital, high volume
Novant Health Clemmons Medical Center is a community hospital with a rehab facility onsite, making it especially convenient for orthopedic patients. Yet this (relatively) small hospital does a high volume of robotic-assisted joint replacements. In fact, it’s the largest volume hospital in North Carolina, South Carolina and Georgia for robotic-assisted joint replacements using the Mako robot.
We asked Drs. McCabe and Craven what led to the large volume.
McCabe: It's largely due to our early adoption of the technology. It’s very routine for us now; we’ve been doing it longer than most centers.
Craven: We have a wonderful collaboration in our hospital with a private group of orthopedic surgeons we work side by side with. Collectively, we do in the neighborhood of 1,100 robotic knee replacements a year at Clemmons.
Craven added that he’s proud to work at Clemmons Medical Center. Here’s why:
“The data shows that we’re consistently a top 100 center in the United States, and there are good reasons for that,” he said. “Our return-to-admission rate and our infection rate are all well below national averages. Clemmons is consistently ranked highest for patient satisfaction within the Novant Health system.
“And I think that, in addition to the good work we do in the operating room, it's the culture, the teamwork, the collaboration between a private and a group practice. It’s everything from the person that greets you at the front desk to the nursing staff to the staff in the cafeteria.”
