Seven Surgeons Tackle a 61-Year-Old Stockbroker’s First Total Knee – Part I

At the last Orthopaedic Summit: Evolving Technologies (OSET), a panel of orthopedic surgeons tackled the case of a 61-year-old stockbroker undergoing her first total knee replacement—knows all the investments and technology. In this panel, moderated by Scott Sporer, M.D., seven different surgeons offered their take on the real answer. Let’s hear from the first four. Can you guess who won? Is it 1) 3D Computer Navigation, or 2) Sensor Balancing, or 3) Navigation Hand-Held Alignment, or 4) a CT Guided Robotic Total Knee?

“3D Computer Navigation Imaging Is the Answer to Get Perfection”

Dr. McAllister: A 61-year-old active female stockbroker who is intelligent and well-read has been investigating what kind of technology she wants for her knee replacement. I’ll give you five reasons why she will choose computer navigation.

First, computer navigation is really the only global, 3D, real-time technology that has been proven over decades to deliver the outcomes we desire.

Unlike some other technologies, with navigation the surgeon is allowed to use familiar instruments. The surgeon can use the technology and still choose implants based on the quality and value of the implants, rather than the technology that’s being used.

How can computer navigation help us with early functional results? When accompanied by the appropriate balancing equipment, not only do we have command of all the important features of a knee replacement—but we’ve enhanced our opportunity to accurately perform minimally invasive surgical techniques, avoid a rod at the femur, and deal with some of the issues in terms of transfusions.

Navigation also impacts the venue, allowing us to become much more capable and austere with our choices of instruments. I do the majority of my joint replacements now in an ASC [ambulatory surgeryl center], where we need to be careful about the number of instruments.

When you’re talking to a patient, what they want to know is: What do you do? What is your experience? Why should I come to you?

I’m going to convey information on my patient-reported outcomes and the impact these technologies have had on my patients. I will emphasize that if this patient qualifies to have her surgery done on an outpatient basis, then that would save her a portion of the cost. I’ll show her how many narcotic pills our patients use, what her rate of recovery will be, and how quickly she’ll be able to get back to her daily activities. So, I will be discussing recovery at two weeks, three weeks, four weeks and Forgotten Joint Scores at three months instead of at two years.

I said I’d give you five reasons why this patient will choose to have navigation for her knee replacement. These are not my reasons, but instead harken back to a 2007 consensus statement from AAOS [American Academy of Orthopaedic Surgeons): navigation is the accepted gold standard for mechanical access, component positioning, ligament balancing, and it’s the perfect adjunct for minimally invasive surgical techniques which are now accepted. In the end, it means she can now more easily have her knee replacement done in the ASC. All my other colleagues are just wrong.