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WHAT ARE THE BENEFITS OF ROBOTIC SURGERY AND HOW DOES IT IMPACT PATIENT RECOVERY?

Robotic surgery came about, obviously, with technology, with new inventions and leaps forward. Anytime you do a hip surgery or knee surgery, one of the key factors is alignment. When you traditionally started doing alignment, it was just rough, where you estimated the appropriate alignment. As instrumentation improved, you could determine interoperative, during surgery, with basic guides using patient landmarks. Robotics is a step forward. Basically, the purpose of robotics in regard to orthopedic surgery is to allow more reproduceable, precise alignment. In surgery, instead of saying, “Well, this looks pretty well-aligned,” you can say, “OK, I’m going to put this in at 3 degrees or 4 degrees or 5 degrees.” It’s just a lot more precise alignment, and if you have things more precisely aligned initially, then you’re going to have fewer potential complications for malalignment, which, particularly when you talk about partial knee replacements, is one of the factors that led to high numbers of failures. If you have fewer complications, it’s going to give the patient a better opportunity to have a successful recovery.

HOW CAN CONSERVATIVE APPROACHES TO ORTHOPEDICS KEEP YOU ACTIVE?

Many doctors, if you come to them with a knee problem, they’re going to automatically say you need the full knee replacement or you’re going to need this or that. Sometimes, a conservative approach determines that instead of a full knee replacement, maybe the patient needs a partial knee replacement. I try to individualize what I recommend for any patient, so if I recommend a partial knee replacement, that is going to facilitate a much quicker recovery than to have a full knee replacement in the average person.

YOU’RE ON THE CUTTING EDGE OF ORTHOPEDIC SURGERY FOR OUTPATIENT TOTAL KNEE REPLACEMENTS. WHO ARE IDEAL CANDIDATES FOR OUTPATIENT PARTIAL OR TOTAL KNEE SURGERY AND WHAT ARE THE BENEFITS?

We’ve been doing outpatient partial knee replacements for years. We have an older population in this area, so I would say it’s not for everyone. I’ve had a number of patients over the years go home the following day. It really depends on a few factors: a patient has to be very active, they have to have excellent home support, so if they live alone then they’re probably not a good candidate. Usually it’s patients who have minimal past medical history of anything significant. So, you don’t want a patient who has diabetes, high blood pressure, who is overweight. We also have to have a good, supportive team: physical therapy, nursing care.

The outpatient total knee replacement is a program I have been working on about three years. We’re starting to get more patients who request that and, to be honest, it really depends upon that particular person. But we have now assembled appropriate support staff so we can offer outpatient knee replacement, outpatient hip replacement or overnight stay. The average length of stay is only a few days. Most patients go home on the second day; some go home on the day after

Dr. Donald Perry, M.D.

surgery. For select patients that I think it is reasonable after discussing and going over the potential options, if they want to go home the same day, that is an achievable goal.

The biggest benefit is going home the same day. Some people do better at home. We try not to keep people in the hospital any more than necessary, but I think that when patients go home sooner, they tend to be more active because, obviously, if you’re in the hospital, you’re not walking around to go to the refrigerator or doing other tasks or activities that you might do at home. A lot of that depends on the patient’s individual situation. People want to be home in their own surroundings, so that is the primary benefit.

A lot of people put off knee or hip replacement because they don’t want to be in the hospital, so if we can do anything to safely minimize the hospital stay, I think that it’s probably a good thing. Hospital stays are very costly and may not be necessary. With that being said, most of the patients probably would benefit from being in the hospital at least a day or two.

I try to individualize the procedure and the length of stay or outpatient-versusinpatient to the individual patient. It really is on a case-by-case basis.

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