Trends in Robotic Joint Replacement: New Markets, Flexible Pricing and AI

Surgical robots are becoming more affordable for ASCs... just in time to meet patient demand.

As the patents for the da Vinci surgical robot systems began to expire after 25 years, numerous companies have entered the market with systems priced to make robotic surgery more accessible to independently owned ASCs.

The robotics market is especially hot in orthopedics, with several manufacturers selling robots to assist with joint replacements. Robotic joint replacement supports orthopedic surgeons with a three-dimensional view for preoperative planning, intraoperative precision for implant positioning and the ability to make more refined cuts that can reduce post-op pain and healing time.

Surgeons and patients alike are taking note of these advantages and more frequently opting for a robotic-assisted approach, especially for hip and knee replacements. The numbers don’t lie: According to one study, there was an 84% increase in robotic-assisted knee replacements between 2018 and 2021. Another study predicted that one in four total hip replacement surgeries in the U.S. will be performed with robotic assistance next year.

Creating the right environment for success while making the finances work requires homework before you bring a robot in. Interested facilities should work directly with robot manufacturers and possess a clear understanding of the needs within your market.

Following are recommendations from three orthopedic surgeons and an ASC administrator working in two vastly different markets: Fairbanks, Alaska and Newport, Calif.

Bringing an orthopedic robot to the far north

At Surgery Center of Fairbanks in central Alaska, orthopedic surgeons Mark Wade, MD, and Neal Everson, DO, lead the largest outpatient surgical practice in the region. Their facility offers a range of procedures, including general surgeries as well as more specialized procedures such as total knee and total hip total replacements. The facility houses MRI and CT services along with the comprehensive physical therapy options needed to make an outpatient total joints surgery program succeed.

The only thing missing was a robot.

“People considering a total joint replacement want to make sure they find the right surgeon, the right facility and the right surgical approach to avoid complications and get to their best outcome.”
Mark Wade, MD

Demand for robotic joint replacements had been forcing many potential patients in the community to drive at least five hours for their surgeries. This worried Drs. Wade and Everson, not only because some prospective patients wouldn’t make the trip, but because the patients who did faced potential complications associated with travel after surgery, such as blood clots from not being mobile immediately after their care.

“We know our outpatient joint replacement offers so many benefits for patients in their hometown to ambulate earlier, recover at home and be close to their surgeons and physical therapists,” says Dr. Wade. However, their patients were having to weigh these post-op benefits with the intraoperative benefits of robotic joint replacements, including more precision with placing a tailored joint, that Surgery Center of Fairbanks wasn’t offering.

The center solved this dilemma by working with a manufacturer to lease one of its refurbished robots. This gave the ASC a full year to test the waters in its market, and the response was positive. “We think the demand in our community for robot-assisted joint replacement will be enough to eventually purchase our own robot,” says Dr. Everson. “Just a few years ago, a robot was out of reach cost-wise for such a small market. It’s exciting to see this changing.”

Transforming the episode of care in Southern California

More than 3,000 miles south in Newport Beach, Calif., a much larger and more competitive market is also responding to patient demand for robotic-assisted joint replacements. It’s where James B. Chen, MD, recently brought his expertise to DISC Sports & Spine Center — an outpatient facility known for treating athletes and highly active people. In December, Dr. Chen joined DISC and the robotic joint replacement system he uses for hundreds of surgeries each year soon followed.

Dr. Chen has experience across multiple total joint robotic platforms. The system he uses today integrates robotic technology with data-backed pre- and post-op tracking and virtual patient support through an app that connects him with his patients through each phase of care.

From the moment a patient enters Dr. Chen’s clinic, they are automatically enrolled in an app that works from their smart watch to track their movement and overall health stats. This data is transmitted to Dr. Chen to help him understand things like a patient’s presurgical gait that he can use for his preoperative planning. A virtual assistant in the app also gives the patient preoperative education and training on physical therapy before the procedure.

During surgery, the robot itself provides data on the patient’s unique anatomy such as ligament balance. The precision of the robot assists Dr. Chen in planning a specific surgery around patient nuances such as age, deformity, bone quality and what a patient hopes to achieve with the new joint. “It’s actually changed my practice to be able to use the robot as a tool to execute my plan in a more accurate fashion,” he says.

He also offers a smart implant for interested and eligible patients that collects and transmits kinetic movement data such as gait, range of motion and overall postoperative movement. After surgery, the postoperative movement data and AI-based predictive analytics the robotic system provides allow Dr. Chen to track the trajectory of a patient’s recovery. “If a patient is falling below where they need to be, I can know this right away and work with them to tailor their physical therapy or make other recommendations,” he says. The virtual assistant in the app also communicates with the patient to provide an extra guide for recovery.

What patients want to know

OPEN HOUSE Hosting your community to demonstrate a robotics system helps to ease patients’ minds after they learn that surgeons still perform the procedures.

One common thread driving robotic surgery success in these two very different markets is patient demand. Along with a growing body of literature on the benefits of robotic-assisted joint replacement, centers with orthopedic robots are publicizing the technology’s merits.

“People considering a total joint replacement want to make sure they find the right surgeon, the right facility and the right surgical approach to avoid complications and get to their best outcome,” says Dr. Wade. While patients are very interested in robotic joint replacement, Dr. Everson notes that they have many questions — largely centered around how the surgeon uses the robot.

To help its community get answers, Surgery Center of Fairbanks recently hosted an open house to introduce its robot and show how it works. “It was packed with double the numbers we were expecting — 60 or more past, present and future patients,” says Dr. Everson.

Drs. Wade and Everson hosted a Q&A at the open house that allowed participants to use the robot to cut simulated bone and presented a live demonstration. “We wanted to show them the robot isn’t doing the surgery. It’s assisting us to make precise measurements and adjust on the fly as needed to customize each joint,” says Dr. Everson.

Where AI is taking robotic joint surgery

Dr. Chen also connects with patients to explain how robotic-assisted surgery supports better planning and precision and how the robotic technology collects highly reliable data that help him steer a patient’s course of care. “As more data are collected, subcategories of individuals can continue to be better defined,” he says.

While this predictive nature of robotic data analytics is in its early stages, AI algorithms are evolving and, as more patient outcome data are collected, Dr. Chen’s hope is to work toward a goal where surgical plans tailored to patients’ specific profiles will optimize outcomes.

Even after surgery, these predictions, along with individual patient data continually collected through the smart implants he uses, can help Dr. Chen care for his patients long-term. “If one of my patients develops sudden knee pain even years after surgery, I will be able to read their data to determine a cause early in order to guide intervention,” he says. OSM