Total Knee Replacement Added to the List of Robotic Orthopaedic Procedures at WMC

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By Melonee Hurt, Williamson Medical Center

With knee replacement patients getting younger and technology getting better, the demand for quality joint replacements is ever-increasing. In fact, according to the National Center for Biotechnology Information, total knee replacement surgeries are projected to increase 673 percent by 2030.

Cory Calendine, M.D., orthopaedic surgeon with Vanderbilt Bone & Joint in Franklin, says the reason this business is growing so fast is two-fold.
“Knee replacement patients are more demanding than ever and they have high expectations,” Cory says. “Today’s knee replacement parts are better than they were ten years ago, so we have more confidence putting them in younger people.”

Historically, Cory says, some total knee replacement patients would eventually develop pain post-operatively that was primarily due to instability of the new joint. With the latest robotic technology being used at Williamson Medical Center (WMC), even that can be fixed.

“The MAKO robotic arm solves the problem of instability,” he says. “Before this technology, surgeons were placing joints manually, which was less precise and could lead to alignment issues and ultimately pain around the knee. We now plan the new joint based on a CT scan, not an X-ray. CTs are 3-D images, not flat, so we have much better information going in.”
Brian Perkinson, M.D., also with Bone & Joint in Franklin said prior to this robotic technology, surgeons also often had to do soft tissue balancing, which meant releasing, or cutting, certain ligaments to create the appropriate balance to the knee.

“This robotic technology allows us to adjust the cuts to the bone within a couple of degrees to create the balance we need,” Brian says. “Because of this we can avoid soft tissue releases. This means less pain for the patient, less scar tissue, a quicker recovery and improved function in the knee.”

Leading the Way

WMC was the first hospital in the state to do a total knee replacement with the MAKO robotic system and was the eighth hospital in the country to perform the surgery.

“What this means is WMC is making a stance to say that we are going to advance orthopaedic care in a responsible way,” Cory says. “We are part of an evolution.”

In addition to surgeons performing these highly technical, and extremely successful surgeries exclusively at WMC, it is also a regional training site that allows surgeons from across the world to scrub in and be educated on these procedures.

“What we are doing is responsible innovation and others are taking notice. You have to be out there to evaluate what’s going on. If you find something you believe in, leading the way is important,” Cory says. “I took my WMC surgical team to New York and did a live demo feed that was broadcast into 200-some sites across the world who tuned in to see the technology used here at WMC.”

Brian added that he sees WMC’s venture in this technology as an investment in the health and well-being of the future of this community.

“This is a prime example of WMC reinvesting in our community, by offering the most sophisticated and modern surgical opportunities for our patients,” he says.

Perfect Balance

Initially, Cory says, there was confusion among patients about a “robot” performing the joint replacement, but his patients trusted him to do their surgery robotically.
“The robot is not doing the surgery,” he says. “The surgeon is doing the surgery, but the robotic arm acts like a GPS, so it allows us to do improved planning pre-operatively and improved execution intra-operatively. We use that improved information to make sure the joint is aligned and balanced perfectly.”

Cory says prior to robotic total knee replacements, 20 percent of total knee patients recorded less than excellent results due to alignment and instability issues in the new joint.

“But if you can put the parts perfectly matched to the bone, it will lead to a better outcome,” he says. “With this kind of precision, you can have greater confidence in offering it to younger patients who have higher demands. We have taken accuracy to another level.”

Brian agreed, saying he believes this total knee technology will be the most utilized of all the robotic technology over time.

“This technology allows us to more accurately place the knee replacement in a better position to allow for more normal knee mechanics, motion, stability and alignment,” he says.

Both Cory Calendine, M.D. and Brian Perkinson M.D., are board-certified orthopaedic surgeons with Vanderbilt Bone & Joint in Franklin and are credentialed physicians with Williamson Medical Center. Their office can be reached by calling 615.790.3290.

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