HSN deploys surgical robot for knee operations
July 21, 2021
SUDBURY, Ont. – A new robotic tool is allowing surgeons at Health Sciences North to better tailor knee replacements to their patients’ needs, while also reducing the amount of discomfort they experience afterwards. The ROSA Knee device, manufactured by Zimmer Biomet, has been in place at the hospital for a few weeks now, and is one of just three to be employed in all of Canada.
“This is just a game-changer,” said orthopedic surgeon Kevan Saidi (pictured). “It’s really exciting.”
The robot doesn’t do any of the actual incisions or saw cuts involved in a surgery, he explained, nor does it look like the sort of droid that might appear in a sci-fi movie.
“It’s just an arm and a couple of monitors,” Dr. Saidi told the Sudbury Star. “It’s more computer-assisted surgery, where it collects information, and then we use a saw to cut through a guide at the end of the arm. So, we’re still doing the whole surgery; all the robot does is let you place your guide more precisely, and because it’s fixed it doesn’t move or wobble at all.”
A few patients have expressed a bit of anxiety about going under the knife with a robot involved – and if they really don’t want the automated help, the HSN surgeons won’t force it on them – but most have been fine with it and the results so far have been encouraging.
“It’s hard to make broad statements because I’ve only done 10 with the robot so far, but I’ve been surprised with how easy it is and it matches up with what I think it should do,” said Dr. Saidi. “If you are a lousy surgeon, it’s not going to make you a great surgeon, but if you are a good surgeon, it helps you to be better.”
Dr. Saidi said doing a knee replacement the old-fashioned way involves “a lot of art,” but the ROSA device allows for more precision.
“Before if I wanted to change something one degree or one millimetre, I would just eyeball it, and it could be one, two or even three millimetres, depending on how everything went,” he said. “With the robot I can say I want to change this one degree or one millimetre, and I can actually do it. The error of the robot is less than a millimetre.”
The technology is also helping surgeons implement a new approach to knee replacements in which the goal is to restore the alignment a patient had before getting arthritis, rather than try to make their posture conform to an ideal.
“We were taught in our training that we were going to make everyone almost perfectly straight, or if not a little bit knock-kneed, but what’s happened in the last five years or so is there’s more of a patient-specific, kinematic approach,” said Saidi. “Because most people aren’t actually perfectly straight or knock-kneed; most are actually a bit bow-legged.”
The ROSA unit helps surgeons by providing “real-time information,” he said, which they can use to customize a replacement to the patient’s body type, while also making it less invasive.
Surgeons at Health Sciences North use artificial bones to master the use of a new robotic device that can help tailor and expedite knee replacements.
“At the end of it, what happens is there is way less surgery for the patient and we don’t have to do all these big soft-tissue releases that we used to have to do,” he said. “As a result, they don’t have the same pain.”
In the past, about 25 percent of patients would still be using a cane six weeks after an operation, said Dr. Saidi, whereas with the new approach, “it’s only five to 10 percent.”
The ROSA system isn’t absolutely required to make a knee repair fit a person’s pre-arthritic bearing, but it makes it much easier to achieve.
“Putting someone similar to what they used to be is a transition in technique and ideology, and the robot lets you execute it to within one or two degrees, or less than a millimetre,” said Saidi.
The robotic system carries a hefty price tag – about $1 million US per unit – but HSN has an arrangement to pay on a per-case basis and overall should break even or even come out on top, said Dr. Saidi, as there are savings to be reaped in faster surgeries and having fewer instruments to sterilize.
The robot is only being used for knee replacements right now, although a version is also being developed for hip and shoulder procedures, he noted.
Six of the 10 orthopedic surgeons currently working at HSN specialize in knee surgeries and most of those have now been trained and certified to use the ROSA.
While the robotic device may seem futuristic and impersonal, it’s really not that much different from other types of technology that people are now using in their daily lives.
“Before you’d go for a drive and use your map, and you might get lost a bit along the way, but eventually you got to the right place,” said Dr. Saidi. “This ROSA is kind of like GPS, where you say I want to go here, and then it even ups it a notch, where you can save some time and get there faster. It’s like the Waze (a navigation app) of surgery.”