Robotic Assisted Total Joint Replacement
By: Dr. Kevin Denehy – Total Joint Specialist
Technology is rapidly changing in all aspects of our lives. This evolution can easily be seen in automotive and manufacturing industries, where robotic technology has revolutionized the ability to precisely perform repetitive tasks, thus achieving consistent results and minimizing errors. Likewise, installing counter tops in a kitchen is now done with sophisticated laser measuring devices, ensuring a precise fit down to tenths of a millimeter. Healthcare is also undergoing a similar transition to embrace the most cutting edge technology to improve patient care and surgical outcomes.
Robotic technology was initially introduced into orthopedics in the late 1980’s, but had limited adoption due cumbersome nature, increased operative times, and technical limitations of the systems. In 2000, the FDA approved the da Vinci™ robot, an intuitive surgical robot for laparoscopic surgeries. Since then, it has revolutionized how surgeons in other fields of medicine (general, urologic, and gynecologic) perform their surgeries. For example, in just over 10 years, prostatectomies performed in this country rose from 1% done robotically to 89%. The success in other fields has helped the technology in orthopedics to improve in efficiency, adaptability, and cost reduction. The Mako™ robot was built to help orthopedic surgeons to increase their precision and accuracy during surgery.
Utilizing robotic-assisted total joint replacement, surgeons are now able to plan and execute partial knee, total knee, and total hip replacements matching the patient’s unique anatomy. This technology uses advanced haptic sensors to determine where the patient’s extremity is in space, allowing for intra-operative adjustments to achieve appropriate tensioning of the ligaments around the knee. This results in the total joint replacement being accomplished in a reproducible manner, with precise alignment, and less soft tissue damage.
To patients, these advances lead to many improvements. Recent publications have demonstrated that there is less soft tissue damage when compared to convention total joint replacement. The decrease in soft tissue damage results in decreased post-operative patient pain scores and less narcotic use. This then leads to shorter stays in hospital, faster recovery, and faster return to activities. The technology also allows for exact balancing of ligaments surrounding the joint (down to millimeter increments). Compare that to conventional instrumentation, where surgeons are “eyeballing” the balance, and it becomes clear why the robotic patient’s joint feels more like a normal joint, resulting in a more satisfied outcome. Recent studies have shown 96% of patients to be very satisfied with their robotic assisted total knee replacement, compared to only 75% with conventional instrumentation one year following surgery.
As our population continues to age, total joint replacement volume is predicted to have tremendous growth. This cutting edge technology will provide surgeons the tools to perform accurate and reproducible joint replacement surgeries, improving patient outcomes, and likely decreasing complications and the need for revision surgery.
About Dr. Kevin Denehy:
Dr. Denehy earned his medical degree from Drexel University College of Medicine in 2012. He went on to complete his postgraduate residency training in orthopedic surgery at Hahnemann University Hospital in Philadelphia, PA. He concluded his training with a hip and knee adult reconstruction fellowship at the University of Louisville. He is board eligible by the American Board of Orthopedic Surgery. He is a member of the American Academy of Orthopedic Surgeons, American Association of Hip and Knee Surgeons, and International Congress on Joint Reconstruction.
Dr. Denehy is an expert in minimally invasive hip and knee replacement surgery. He utilizes the direct anterior approach for total hip replacement, allowing for a quicker recovery with less muscle damage. Many of his total knee patients are candidates for a quadriceps-sparing (subvastus) approach that allows for a quicker return to function. When indicated, he also uses a cementless knee replacement, which utilizes the latest technology of 3-D printing to create a surface for your own bone to grow into the implant. With this biological bond, there is less risk of loosening from cement break down, which is a possibility with many other implants.
Dr. Denehy has specialized training in cutting-edge hip arthroscopy techniques, including labral repair and treatment of femoroacetabular impingement. An emerging field in orthopedics, hip arthroscopy allows for repair of structures inside the hip joint through very small portals. This has the potential to delay and possibly prevent progression to arthritis and the requisite hip replacement surgery.
Part of Dr. Denehy’s fellowship training focused on robotic assisted total knee replacement at one of the first centers in the country to perform the procedures. He has performed over 100 robotic-assisted total replacements. Only 25-30 surgeons across the country have performed similar volume. The robotic assisted knee replacement allows for exact sizing, implant positioning, and ligamentous balancing. This results in less muscle damage and soft tissue release, decreased postoperative pain, and improved postoperative function and patient satisfaction.
Dr. Denehy has also had extensive training in complex hip and knee revision surgery, including infection, instability, and early loosening. He has authored numerous papers, and made presentations national meetings on the latest advancements in orthopedics.
To schedule a visit with Dr. Denehy, please contact BGO at (859)-263-5140.