While some surgeons are indifferent or opposed to computers and robotic-assisted surgery, other physicians and practices embrace new technology combined with minimally invasive techniques.
William T. Long, MD, orthopedic surgeon and founder of the Orthopaedic Computer Surgery Institute at Good Samaritan Hospital in Los Angeles, and a leader of MIS and revision surgery of the knee and hip, embraces the use of computers and robotics in the operating room. Dr. Long says one of the main reasons he needs to re-operate on patients is because implants were put in incorrectly during the initial surgery.
"The technology that makes revision surgery less complex for me is the use of computer navigation," says Dr. Long. "What we believe, and what we've seen in the literature, is that if you use the computer, the placement of the implants is more accurate. If you use the computer technology you'll put the parts in with more precision than you would if you don't use it."
Despite the precision that computer-assisted surgery provides, Dr. Long mentions certain surgeons are opposed to the new technology, because of a mixture of cultural views towards technology and due to the financial burden of the technology.
"In general, the younger surgeons understand and embrace the concept of the computer in the operating room. Many older surgeons say, 'they built the pyramids without computers, and they're still standing, so I don't need a computer either,'" says Dr. Long.
However, there are downsides to computer technologies for joint replacement. Dr. Long says the downsides relate more to the physician than the patient. The surgeon must take time off from daily practice to study the new technology and convince the hospital to provide the upfront capital to purchase it.
"In 2005, we weren't using computers and now I use them for nearly every case," says Dr. Long. "The big downside [of the technology] to many surgeons is you have to learn about the technology on your own dime. No one is going to pay the surgeon to learn these new technologies. It is very expensive."
"The [computers] used to cost $1 million, and the hospitals wanted the surgeon to guarantee that the investment would bring in another million dollars worth of profit. This is a business decision, not a patient outcome or a patient care decision," says Dr. Long. "You've got the patient who benefits from the use of the computer, and the surgeon, who has a conflict of interest because of time and money. The hospital would like a guarantee that they'll make the money back, and that consideration has nothing to do with the best interest of the patient."
In addition to hospitals being financially conflicted, Dr. Long also mentions Medicare and many insurance companies will not reimburse the physician for using "unproven technology."
Still, even with the financial conflict of interest associated with computer navigation technology, Dr. Long says the best way to perform effective, accurate surgery, is using computer and robotics-assisted navigation technologies.
"In my practice, we not only use this to help the surgery go well, but it is also a marketing tool. Many patients have come from other hospitals in Los Angeles to our practice and stated clearly, 'we are here because you use the computer.' The patients are now driving it," says Dr. Long.
According to Dr. Long, hips coming out of socket, due to the socket being put in wrong, is the leading reason why hips need to be re-operated on.
"In the United States the average is about 5 percent of hip replacements, and it's devastating," says Dr. Long. "There were two studies, one from Stanford and one from Harvard, where 60 percent of the time each of those centers reported that they put the cup in a position that is not ideal. That is Stanford and Harvard, so imagine what is happening at small community hospitals."
In the United States, the number one reason for a patient to sue their orthopedic surgeon following hip surgery is that the leg length comes out unequal. The use of robotics in the operating room allows the physician to adjust the length by 1mm, about the thickness of two or three hairs. Without the computer, the legal standard is that the legs should be within approximately ½ inch of each other. Anything after that does not result in a good result for patients.
"Joint replacement surgeons should accept that the future of joint replacement will include modern technology like computers and robotic techniques to make the surgery better," says Dr. Long. "In the future, surgeons and patients may have to form a united front to persuade hospitals to invest in things that are in the best interest of patients. Physicians who evolve and include this technology as part of their practice will first and foremost benefit their patients and promote their practices because of the outstanding results."