PAVING THE WAY

V PAVING THE WAYalrico residents Roger and Gloria Chambers loved traveling to archaeological sites around the world—until one of Roger’s ailing knees gave out as they were walking through a long terminal at London Gatwick Airport several years ago and he had to be pushed along in a cart. Before long, Chambers ended up in the office of Dr. Michael Miranda, an orthopedic surgeon at Tampa General Hospital and Florida Orthopaedic Institute. It was more than Miranda’s sterling reputation that drew Roger and Gloria, whose own arthritic knees needed attention as well. Retired educa-

ROBOTIC TOOLS, NEXT-GEN PROSTHESES, AND 3D PRINTING ARE REDEFINING ORTHOPEDIC SURGERY AT TAMPA GENERAL HOSPITAL BY SETH SOFFIAN tors, they’d also read of Miranda’s use of roboticassisted surgery in conjunction with both TGH and the Institute, and they wanted to benefit from the greater precision and improved patient outcomes, including quicker recoveries and less pain.

“This is the only way to go,” said Roger, who underwent a total knee replacement two months after his wife in the fall of 2019. “It really worked well. He is really outstanding.”

TGH is accustomed to superior outcomes. For 2021-22, it ranks as the top hospital in Florida and No. 23 in the nation in orthopedics by U.S. News & World Report. The all-fellowship-

Tampa General Hospital is ranked as the best hospital in Florida and No. 23 in the nation for orthopedics by U.S. News & World Report for 2021-22.

trained surgeons of Florida Orthopaedic Institute, the largest orthopedic group in Florida, lead research into, and the development of, the latest surgical practices and technological advances to help keep TGH at the forefront of world-class care.

“There is not a place in the area that has surgeons who do development and design like we do,” said Miranda, who also serves as an affiliate assistant professor at the USF Health Morsani College of Medicine. “It’s unmatched certainly in the area and maybe even as far as the Southeast.”

Surgical Advancements

Leading technologies at TGH include the use of the MAKO RIO™ Robotic Arm Interactive Orthopedic System in hip replacements and total and partial knee replacements. Controlled by surgeons using tactile, acoustical, and visual feedback, the robotic arm provides greater precision and consistency for bone preparation and customized implant positioning.

“It can cut to less than half a millimeter accuracy—that’s pretty accurate,” said Miranda, who specializes in knees and hips. “The precision is unmatched by the human hand or eye.”

TGH’s continued improvements in preoperative planning in recent years through 3Dprinted modeling is critical to achieving the best possible outcomes, too. Printed based on patient CT (computerized tomography) scans, the models allow surgeons to precisely size, rotate, and position implants customized to a patient’s joint. This can cut down on surgical times and result in greater patient mobility and function, as well as implant longevity.

“The thing I’ve been amazed about is the accuracy,” Miranda emphasized. “The preoperative plan and what you’ve executed match

The results are proven. Patients have less pain and get back to their normal activities more quickly.”

The surgeons of Florida Orthopaedic Institute practicing at Tampa General Hospital are all fellowship trained.

perfectly. Patients are up and moving and out of the hospital quickly and back to their activity level in four to six weeks. You can’t argue with that kind of result.”

Some of the newer, more advanced orthopedic procedures being conducted at TGH include a direct anterior approach to hip replacement, conducted through a small incision at the front of the hip rather than the more traditional posterior approach. The less-invasive direct anterior approach is deemed more technically demanding and is not universally practiced. But it avoids the need for a considerably larger incision, and more importantly reduces the need to cut—and later repair—muscles and tendons to reach the damaged joint, as with most posterior approaches.

“ T h e r e s u l t s a r e p r o v e n , ” s a i d M i r a n d a , a n e a r l y p i o n e e r o f t h e d i r e c t a n t e r i o r a p p r o a c h . “ P a t i e n t s h a v e l e s s p a i n a n d g e t b a c k t o t h e i r n o r m a l a c t i v i t i e s m o r e q u i c k l y . ”

Tampa General also has been at the forefront of major developments in an option that once didn’t exist for people with long-standing ankle arthritis or trauma to the joint: a replacement. Dr. Roy Sanders, chief of Orthopedic Surgery at TGH, chair of Orthopaedic Surgery at the USF Health Morsani College of Medicine, and president of Florida Orthopaedic Institute, helped design the secondgeneration ankle prosthesis and was the third surgeon in the U.S. to perform routine ankle replacement surgery. Third-generation implants now in use have greater longevity, thanks to advances in 3D-printed modeling.

Until the mid-1990s, the only option was to fuse the bones in the ankle. Those include the larger lower leg bone (the tibia) and ankle bone (the talus). “This technology is amazing,” said Sanders, leader of the TGH team that has performed hundreds of ankle replacements— more than any other center in Florida. “A completely custom, mirror image of the anterior tibia and talus can be created to perfectly position the reference wires, which then allow an anatomically correct placement of the implants. This makes it possible for us to make the most precise cuts, and the outcomes are much better.”

Tampa General Hospital’s commitment to innovative technologies is critical to achieving the best possible outcomes.

More to Come

For knee replacement recipients Roger and Gloria Chambers, surgery was so successful that both are scheduled to have their other knees—the left for both—replaced by Miranda. “This all went off a lot smoother than I really thought it might. I was very pleased,” said Gloria, praising the pain management, physical therapy, and overall outcome she experienced. “Friends of mine who came to visit were astonished I was as mobile as I was” about six weeks after surgery, she recalled. “I was far more recovered than they thought I would be at that point.”

As pleased with the outcomes as most patients are, Miranda noted that continued technological advancements in orthopedics at Tampa General will be important in further reducing the rate of the small sample of patients who aren’t satisfied with their results. Those include more advancements in robotics and 3D modeling, as well as developments in the next generation of orthopedic technology, such as augmented reality for training and simulations. “I think that’s the next step after robotics,” Miranda said. “That’s pretty exciting.”

In terms of robotic technology, Miranda is part of a design team working on pressure sensors that can help with the measurement and balancing of ligaments on both sides of the knee, “so the patient doesn’t even feel like they have a knee replacement,” he said. “Robotic technology is not just a cutting tool. It can give the surgeon a lot more information and feedback, such as component sizing and ligament balancing throughout the procedure.”

Industry-wide, studies show as many as 10 percent of orthopedic patients aren’t satisfied with their care. But Miranda believes that continued technological progress can improve outcomes for everyone. “We’re perfectionists,” he said. “We want to make sure that everybody has a good result. That’s why we get on these design teams. That’s part of the drive to get everything right. Always.”

Dr. Roy Sanders