The next big step in total knee replacements will be the integration of artificial intelligence and using that to personalize patient care, Philip Huang, DO, said.
Dr. Huang is an orthopedic surgeon with Indianapolis-based OrthoIndy, and he completed Indiana’s first partial knee replacement using Johnson MedTech’s Velys robot.
He spoke with Becker’s about the experience and what’s next for the technology.
Note: This conversation was lightly edited for clarity and length.
Question: Tell me about this first case with Velys for partial knee replacement.
Dr. Philip Huang: The first one was back toward the end of December, and we’ve done about six cases in the last two and a half months. They’ve all been very good experiences overall. The Velys system has existed for knee replacements for four years, and there has not been a partial knee replacement application until the last few months. I was using it for my total knee replacements, and I had knowledge that this application was coming up.
The accuracy and precision that we know for sure is one of the things that is really beneficial in the robotic technology landscape for knee replacement. That is even more critical in a partial knee replacement than it is in a total knee replacement. If you’re only operating on part of the knee and you happen to error or the alignment is a little bit off, you end up affecting the other areas of the knee, which can lead to premature degeneration and sometimes failure of the initial operation, or the whole knee needs to be replaced. The benefits that we know that exist for robotics or technology are even more critical for partial knee replacements, which is why I was very interested in this.
There’s certainly a little bit of a learning curve, just as far as the technology is concerned overall. For this specific procedure, it took about 10 minutes longer for our first few cases. By the fourth or fifth case, we were pretty much time-neutral to what I was doing before.
Q: What’s something that you want to see in future iterations of just partial knee replacement or total knee replacement robots in general?
PH: If you gave me a wish list and said just one thing, I would pick what would be called an “easy button.” There’s a lot of benefits in robotics and knee replacements, but one of the things I think that is most useful and that I hope we’re going to utilize in the coming years is the data, the objective numbers, the digital information and feedback that we get from doing this operation.
Historically, we’ve kind of put all the knees in the same way, and this is one of the things that is kind of a hot topic of knee replacement now. Should we maybe put it in a couple degrees this way or that way depending on the patient’s kind of native alignment?
The more that we do this and the better we can correlate patient outcomes with the data and information, we can really hone that in. Then we can incorporate that into an AI or machine learning to really just hit a button and say, “We know what this is like based on the data that we’ve put in, and what this patient needs,” and this is really the dream.
Q: How do you advise other surgeons to think about these features, costs, etc. and figuring out which robot is the best fit for them?
PH: I think the reason and rationale for any surgeons entertaining this will probably be different. Some people are maybe drawn to the accuracy and the precision that we know historically. Some people might be more interested in some alternative alignment techniques that the robots have. My advice for people that are considering it is to, No. 1, know your personal ideology, your workflow to a knee replacement. What do you believe works? What do you want to achieve with the knee replacement? This landscape is just absolutely exploding as far as the number of available options now, and by making those determinations, I would just go with what you feel like works best for your approach to a knee replacement.
As for costs, that was something that, when these first came out, was really prohibitive for a lot of people. I think that’s one of the things that a lot of the companies have done a better job of is that they have kind of different acquisition pathways now that may help lower the cost overall.
Q: How much do you see AI and machine learning in orthopedic robots in five years down the road?
PH: That’s what excites me the most, and I don’t even know if it’ll be five years. I think in five years it’ll be, the majority of knee replacements will be done robotically. Some of the surveys that we have among surgeon organizations have shown the exponential growth in the utilization of these technologies. But I think the biggest jump will be the integration of artificial intelligence or machine learning platforms and algorithms to be able to really hone in on what works well for each specific patient alignment type. There’s an increasing interest in what we call phenotypes, which are the different types of shapes and alignment of the knee, and I think if we’re able to integrate that into the software it’ll be better for each patient that we care for.
Q: What other healthcare trends that you’ve been paying attention to the most?
PH: Robotics and AI technology is really a hot area due to increasing interest from the surgeon standpoint and probably demand from the patient standpoint. I’m also watching things from a cost-efficiency standpoint. I’m in a private practice setting, so it’s something we’re very aware of. I’ve been in a hospital employed setting before, and I think regardless of what type of practice you may have, the healthcare system really is being increasingly squeezed to provide high quality care at lower lower costs just because of decreasing reimbursements and other insurance-related issues. I’m interested to see how we navigate that challenge moving forward.
