Mr. Roboto

Baxter Health Invests in New Technology

At a time when many smaller and rural hospitals are facing existential issues and uncertain futures, Baxter Health continues to invest in medical technology to stay current in the marketplace. The most recent example of this is the installation of the CORI Surgical System, a medical device that allows orthopaedic surgeons to perform their work with a higher degree of accuracy.

“I would say this technology puts us in line with all of the leading total joint replacement centers in the country and is a device that some larger hospitals don’t have,” said Dr. Edwin Roeder, board-certified orthopaedic surgeon with Baxter Health Bone & Joint Clinic. Roeder came to Mountain Home last fall after practicing at hospitals in Missouri for 25 years.

“Baxter Health has moved up to the level of what the most proficient medical centers are doing. I think it’s an investment that shows a real commitment to the community to bring the most state-of-the-art techniques for knee replacement to Mountain Home.”

The new system is designed specifically for knee replacement surgeries and assists the surgeon in planning the placement of an artificial knee that allows for subtle differences in a patient’s anatomy.

“With the robotic knee, you’re able to go out and put a knee in that’s precisely balanced for that patient’s ligaments,” Roeder said. “You can put a knee in based on the patient’s anatomy regardless of where it is in that bell-shaped curve that we used to call ‘normal.’ As a result, you get a better-balanced knee with full motion and better stability.”

The robot represents the latest chapter in knee replacements. Introduced in 1968, the surgery has seen dramatic improvements in technique, materials and technology, making total knee replacements one of the most successful procedures in medicine. According to the American Academy of Orthopaedic Surgeons, more than 700,000 total knee replacements are performed in the United States each year, most commonly due to injury, arthritis or general wear and tear of the knee over time.

Robotic surgical devices entered the realm of total knee replacement in the early 2000s and have steadily improved since then. The technology helps the surgeon be more precise in the necessary bone cuts that must be made to place the prosthetic knee in proper anatomic alignment.

Dr. Thomas Knox, a board-certified orthopaedic surgeon who recently joined Baxter Health Bone & Joint Clinic, was previously in private orthopaedic practice since 1983 which has given him a front-row seat to the evolution of surgical procedures and technology.

“A company called Mako came out with the first robotic knee system, and it was designed for putting partial knee replacements in,” Knox said. “That system evolved, it became popular and it was eventually acquired by the company Stryker. They developed it further to accomplish knee replacements. That particular system required you to do preoperative imaging such as an MRI scan or a CT scan, and that information was downloaded to the factory where they came up with an operative plan that they then downloaded onto the robot that you executed.”

Knox said the CORI system differentiated itself by providing an imaging component to the system that eliminated the need for prior imaging, saving time and cost.

“Two years ago, I went to Memphis and did an anatomic cadaver lab utilizing (CORI) with an expert in the field,” Knox said. “I came away from that totally impressed by the fact that it eliminated the preoperative imaging by allowing us to input data directly. This represents a savings to the patient that could be probably $1,000 over the previous method while hopefully getting a better result as well.”

Dr. Russ Rauls, a board-certified surgeon with Twin Lakes Orthopaedics & Sports Medicine, said the new system takes a lot of the educated guesswork out of a surgical procedure, even compared to previous robotic systems.

“The traditional way to do this has been using a metal guide that you put inside the bone or reference outside the bone and to try to get information on sizing and orientation,” said Rauls. “(CORI) technology actually does things in real-time in the operating room with the robotic arm helping you do all that.”

Rauls, an Arkansas native who has been practicing in Mountain Home since 2011, said the machine is particularly helpful when dealing with difficult cases, such as when the joint is damaged or malformed or in revision cases where the surgeon is swapping one prosthetic for another.

“With difficult cases, this makes things a little easier,” he said. “That could be a revision case where the typical referencing anatomical points aren’t as obvious. There are also patients who can’t have the MRI or CT scan typically used in placement, and (CORI) helps in those cases. And, in some of the cases where the knee deformity is worse, it helps to nuance some of those decisions as well.”

Board-certified orthopaedic surgeon Dr. Win Moore said the primary benefit of the CORI system is in dealing with what he called “outlier cases” because the surgeon can manipulate the calculations to provide a “what if” before cutting into bone.

“All along, we’ve done these calculations in our head,” he said. “‘What if we do a 2-millimeter cut here, what’s it going to do there?’ With this, the computer does that all for you. You get feedback as to what it’s going to do to all parameters, as far as knee balance is concerned. And, you can run through several scenarios like, ‘What if I change the angle here?’ or ‘What if I add a millimeter cut there? What does that do?’ It gives you some instant feedback.”

Moore, in practice at Baxter Health Bone & Joint Clinic since 2008, said the system is equally valuable to newer surgeons as well as those who have been around the block a few times.

“I think it’s a really big plus for young surgeons that haven’t done a ton of (surgeries) and haven’t figured out the things that you learn with time,” he said. “For the guys who’ve been doing it for a long time, it’s really good for limiting the outliers, the ones you’re going to see one out of 100 where you go, ‘It’s looking good, but that tibia base plate just looks a little crooked to me. It doesn’t look perfect.’”

The latest technology has even progressed enough to win over medical skeptics. Dr. Jason McConnell, a board-certified surgeon with Twin Lakes Orthopaedics and Sports Medicine said he had resisted such technology because he didn’t see an appreciable benefit to the patient, until now.

“I’ve been kind of against it, honestly, because we actually first looked at a robot seven or eight years ago and you couldn’t do as much with them back then. It used to be more of a marketing kind of thing,” he said. “With this one, the more I started digging into it, you hear people talking about a forgotten knee score — people who forget they’ve got a total knee because it feels more normal.

“For a long time, I told patients this is really good for pain relief, this is good for this and that and it lets you do a lot, but it’s not your knee when you were 20. What I’m hopeful of is (CORI) is going to allow us to still have a knee that is good for pain relief and does feel more like your knee did when you were 30 or 40. I have come around to thinking this is going to help us be better at putting knees in people.”

Patients’ perceptions of surgical technology run the gamut. Some people are excited about the use of a robot because they think it eliminates the possibility for human error, while others are uncomfortable thinking there’s no human involved in the operation. In both cases, and for everyone in between, patient education is paramount said Dr. Don Franklin, who’s been in practice with Twin Lakes Orthopaedics & Sports Medicine in Mountain Home for four years.

“It’s good technology; it’s really cool stuff but I tell people, this is not really a robot. It is a computer-guided instrument held in the surgeon’s hands,” he said. “The beginning steps of doing a knee replacement are not any different than they were before, it’s just the way we cut the bottom of the femur and cut the top of the tibia is now going to be different. Instead of saw blades, we are using a computer-navigated Dremel tool that will only allow you to go so deep or so shallow in certain places based on that patient’s native anatomy.”

Franklin said while such tools have proliferated rapidly and definitely help a physician do better, more precise work, patients also need to understand the level of a surgeon’s skill and experience are as important as ever for a successful outcome.

“I think a lot of patients are under the impression that a surgeon kind of stands aside and the robot does the work,” he said. “That could not be farther from the truth.”