Robotic-Assisted Surgery Is the Latest in BMC’s Suite of Arthroplasty Techniques

Within the most advanced surgery programs, robotics is making a positive impact on both patients and their care teams. Despite the set-up costs and time required to initiate a robotic-assisted surgery surgery capability, early adopters cite benefits from improved surgical precision, reduced exposure to fluoroscopy, and an enhanced surgeon experience.  

Committed to the latest innovative technologies and ensuring state-of-the-art treatment, the arthroplasty team at Boston Medical Center (BMC) invested in robotic knee replacement surgery in 2023.  

“The way we deliver care is constantly evolving, and Orthopedics is on that cutting edge of innovation because of the technologies we use,” explains Ayesha Abdeen, MD, chief of Hip and Knee Replacement Surgery. “I believe it’s our responsibility to our patients and trainees to incorporate these technologies as time goes on. It’s very exciting to be able to offer innovations such as robotics that can enhance the accuracy of an operation and potentially improve outcomes.”

How exactly does robotic-assisted surgery work?

BMC was the first hospital in Massachusetts to acquire the FDA-approved VELYS Robotic-Assisted Solution for total knee arthroplasty (TKA) and plans to expand its use within the next year to partial knee replacement surgeries. The BMC joint replacement surgeons have also incorporated the VELYS Hip Navigation for use during minimally invasive hip replacement surgery.  

The VELYS knee system uses intra-operative anatomic landmarks to give surgeons  the detailed information they need to perform the most precise knee replacement. 

“Some patients worry that the robot will be doing the surgery, but we explain it’s actually robotic assisted,” Abdeen says. “The surgery is still being done by the surgeon, but we program the robot based on what we need to correct in the patient’s knee and the way we want to balance the knee. It enhances the accuracy of our cuts and the placement of the components.” 

An added benefit of the VELYS is that it doesn’t require additional CT testing preoperatively, which lowers costs and reduces patients’ and providers’ exposure to radiation. 

“Reducing radiation exposure benefits our patients, surgeons, anesthesia team, and nursing staff. Orthopedics is a very male-dominated field, but exposure to radiation is an occupational hazard for expectant mothers on the team, so using less radiation is always favorable,” says Abdeen. 

“VELYS is a fascinating technology that’s allowing us to have improved accuracy, be more efficient in the operating room, and ultimately reduce radiation exposure,” says BMC orthopedic surgeon, David M. Freccero, MD. “As it continues to evolve, I think it’s going to allow us to be even more efficient and achieve even better outcomes.” 

Because it’s such a new technology, long-term outcomes are limited. BMC is currently collecting data to determine long-term outcomes of utilizing robotic technology in surgery. 

“Robot-assisted knee replacement has been shown to enhance the accuracy of the components, and that was something we wished to offer our patients,” explains Abdeen. “Incorporating these technologies early on allows us to measure outcomes as time goes on.”

An experienced team on a mission

Because of the complexity of hip and knee replacement surgery and individuals’ unique anatomy, robotics are best integrated into experienced arthroplasty teams. 

“Our faculty are fellowship-trained in hip and knee replacement surgery, and each have a broad depth of clinical experience,” says Abdeen. “We have specific expertise in complex problems pertaining to hip and knee replacement, whether it’s in primary or complex revision setting.”  

The renowned hip and knee replacement surgery team at BMC falls under the Department of Orthopedic Surgery, led by Paul Tornetta, MD, president of the American Academy of Orthopedic Surgeons. 

For Abdeen, who joined BMC after years as the chief of hip and knee replacement at Beth Israel Deaconess Medical Center, being at the forefront of arthroplasty care is particularly satisfying at BMC. 

“Many of our patients are disadvantaged and have complex social and medical problems. I like being able to offer them not only what is the current standard of care, but also some of the newest innovations that are available, including robotic surgery,” she says.  

She adds that robotic-assisted surgery can be very beneficial to underserved patients like those at BMC who present for a knee replacement in a late stage of disease.  

“We treat a lot of patients with very severe varus [“bow-legged”] or valgus [“knock-kneed]) deformities because of long-standing arthritis, prior infections or fractures, and childhood deformities of the hip and knee,” says Abdeen. “Robotics can be less invasive and may mean the difference between two operations versus one, or a very long operation versus a shorter one.”

A commitment to innovation beyond robotics

The Arthroplasty team at BMC has adopted several other innovative technologies and protocols, including perioperative optimization, augmented-reality hip navigation, and a rapid recovery protocol. These advances have improved outcomes and contributed to BMC’s recognition as a “Blue Distinction Center for Knee and Hip Replacement” by BlueCross BlueShield. These elite centers have demonstrated expertise in knee and hip replacement with lower complication rates, and fewer hospital readmissions.  

Perioperative optimization 

For patients with medical and social complexities, BMC has the infrastructure and teams to be able to help with all facets of their care. The SAFE (Screen, Access, Follow-up, Elective Surgery) program at BMC helps to manage a patients’ medical and social issues that could affect the success of their orthopedic surgery. 

“SAFE is a centralized orthopedic program tailored to the needs of the individual patient, so they are optimized for surgery,” explains Abdeen. SAFE addresses everything from a patient’s diabetes and cardiovascular care needs, to nutrition, smoking cessation, and even housing instability. SAFE has successfully reduced complication rates after surgery and improved satisfaction.  

Augmented reality hip navigation 

The team uses a tool called HipXpert during minimally invasive direct anterior hip replacements. 

“This planning tool helps us accurately position and place the implants, based on a preoperative CT scan of the patient’s individual bony anatomy,” Freccero says. “Anatomic hip replacements are based on replicating the patient’s anatomy, and this technology improves that. In addition, its use of augmented reality can minimize the use of intraoperative thoracoscopy.” 

Rapid recovery protocol 

BMC patients benefit from enhanced recovery after surgery (ERAS), a multidisciplinary rapid recovery protocol involving anesthesia, nursing, and physical therapy. Opioid-sparing pathways and less invasive, regional anesthesia protocols implemented in collaboration with anesthesiologist Seroos Salavati, MD, and physical therapy on day zero are just two of the ERAS components that allow patients to go home on the day of or the day after surgery.

Robotics enhances, does not replace, hands-on training

Being on the cutting edge of care is all about the patients, which Abdeen says means making sure they extend their knowledge further than their department. 

“It’s exciting to teach residents and fellows how to use newer technologies and how to incorporate them into their practice,” she says. “But how they learn to do a knee replacement now is going to be very different from how they do it in practice 15 or 20 years from now. Our role to teach the next generation or orthopedic surgeons the fundamentals of how to do a well-balanced total knee replacement and a well-positioned implant, but also to be able to incorporate new technologies as they evolve.”

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This story originally ran on Doximity.