Robotic technology & hip arthoplasties: Will precision outweigh the cost?

Mary Rechtoris -   Print  |

Hip arthroscopy and robotic procedures are becoming increasingly popular in today's orthopedic market. Researchers are devising new and innovative ways to reduce recovery time. Robotic surgery has been a hot topic; some surgeons are finding success with the technology, but robotic systems are expensive and others wonder whether the ends justify the means.

Benjamin Domb, MD, is a renowned Chicago-based orthopedic surgeon and founder of the American Hip Institute. Dr. Domb specializes in sports medicine and hip arthroscopy, and has been conducting studies assessing the accuracy of component positioning in total hip arthroplasties.


Dr. Domb was prompted to conduct his research after learning about a 2000 study by Harvard surgeons. The Harvard study revealed nearly half of the components in 2,000 hip replacements were inaccurately placed.


Dr. Domb and six separate surgeons performed nearly 2,000 total hip arthoplasties over more than four years to learn how to improve accuracy in hip arthoplasties. They found the robotic arm produced the most consistent results.


"As we've conducted and published research on the robotic-arm technique, it has gained traction and acceptance," states Dr. Domb. "In hip surgery, the two major frontiers are arthroscopic and robotic surgery. Both will be adopted gradually, but there are technical hurdles and a large learning curve for both."


Robotic technology and other minimally invasive procedures provide a wealth of benefits including a shorter recovery time for patients. Hip arthroplasties involve a small incision — about two to three inches, allowing surgeons to avoid cutting through the hip muscle. Robotic technology also shortens recovery time by providing surgeons enhanced vision without opening the small incision.


Dr. Domb and his colleagues found a three-fold increase in accuracy with the robotic-arm. Despite the proven accuracy of this technique, many hospitals and other healthcare facilities simply do not have the means or cannot justify spending large sums of money on this technology.


Dr. Domb says, "The data has proven the potential for improved accuracy with robotic technology — the main issue is cost. Our analysis on cost-effectiveness has yet to be done on robotics, but  it is expensive. The robotic system costs in the neighborhood of $1 million. Of course, there is an additional expense in the surgeon taking a great deal of time to train and develop skills to use robotic technology. Orthopedic surgeons spend a year in fellowship at our institution learning hip arthroscopy and robotics, but it is not feasible for most practicing surgeons to spend a year in training in the middle of their careers."


In addition to cost, time is one of the barriers associated with robotic technology with many orthopedic surgeons simply not having enough time in a day to learn how to properly use the technology. Surgeons are already crunched for time trying to manage their centers, spend time with patients and complying with data collection regulations posed by the government. Ultimately, surgeons have to allot sufficient time to learn the necessary skills to utilize robotic technology.


Dr. Domb is the director of Chicago Comprehensive Hip Fellowship through the American Hip Institute. He trains orthopedic surgeons for one year on performing hip arthroscopy and robotic procedures.


"Surgeons come out of our program confident and well-trained," he states. "We will see a proliferation that follows the training curve. As graduates of the American Hip Institute fellowship come out of training, they will utilize robotic technology, and teach it to others."


The question remains as to whether more surgeons will adopt robotic technology. Many healthcare facilities have to weigh the benefit of precision against the overwhelming costs of robotic technology. A vast number of studies are confirming that minimally invasive techniques provide the best outcome for appropriately-indicated patients.


With the evolving healthcare market becoming increasingly focused on patient-outcomes and satisfaction scores, robotic technology may become a necessity for healthcare facilities to stay afloat. As patients become aware of the accuracy of these minimally invasive techniques, they may seek facilities offering the innovative techniques. In the future, healthcare facilities may feel pressure to adopt the technology to stay competitive in the orthopedic market. The precision may soon outweigh the costs.


More articles on practice management:
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