Global Health Asia-Pacific May 2022 May 2022 - Page 48

While TKR should only be considered for those with end-stage arthritis , it is not the only solution for end-stage knee arthritis . to take off . And the Home Connect team I work with has been absolutely fantastic in connecting with my patients . My fabulous physiotherapists who visit my patients and are confident enough to take my patient for a walk along the corridor and up a flight of stairs and back . And last but not least is my anaesthetist who is able to consistently wake my patients up after surgery looking and feeling fresh and not having post-operative nausea and vomiting ( PONV ). In the past one of the major deterrents for patients walking immediately after surgery is severe PONV and of course this will derail any plans of sending patients home early .
You talk so much about people and techniques . Do you not use any of the new advances in technology to improve outcomes of surgery ? I am a cautious technophile . It ’ s important to know that tech is industry driven . I didn ’ t buy into computer navigation in the early years after doing a handful of cases because I found the risks outweighed the benefits . At the end of the day , I am responsible for my patients . I did however , adopt patient-specific instruments early and was the first in the country and possibly the region to do it . Similarly with other technologies I weighed the pros and cons and made a decision in the interest of my patients .
I am happy to say that I developed my fastrack surgical protocol using conventional surgery alone . However , I am now excited to have adopted robotic surgery ( in its current form ) in a big way . I can see it improving outcomes significantly . In addition I am able to do a lot of niche partial knee replacements that have been dormant in my armamentarium over the years only
to be resuscitated with robotics .
While TKR should only be considered for those with end-stage arthritis , it is not the only solution for endstage knee arthritis . There are the various partial knee procedures and for those intending to continue to be physically active , there are joint-sparing surgeries even in end-stage arthritis .
Again , there are multiple robotic platforms out there but it ’ s important to choose the right one for my patient .
Do you think robots will allow surgeons to do fastrack TKR ? No . As I said , fastrack TKR is a culmination of surgical techniques from surgical exposure , soft- tissue balancing , pain management , controlling bleeding , wound closure and even little things like dressing materials and methods . None of this is contributed by the robot . However , robots in TKR enhance the outcome of surgery . It is a useful tool in the hands of an experienced TKR surgeon .
Do you think robots are going to be a big addition to the knee replacement armamentarium in the future ? I think they will eventually . I am happy to have been introduced to the robot at the stage of my practice when I have more or less worked out everything else before I resort to using robots . Robots are only useful in making accurate bone cuts . One of the founders of total knee replacement surgery once said ‘ a knee replacement is a soft-tissue surgery with incidental bone cuts ’. This is absolutely true . As a surgeon I could cut the bone accurately but if I can ’ t balance the soft tissue the outcome could be disastrous . n
46 MAY 2022 GlobalHealthAsiaPacific . com