Robotic TKR vs. Standard TKR

Dear CSS Members and Colleagues:

Please find enclosed an article presenting the value of Robotic TKR vs standard approach to TKR and commentary by Dr. Stafano Bini. Finally, something to consider other than the Coronavirus.

Why should we care about this if our interest is the shoulder? There are several reasons:

First, Robotics has gained significant penetration into the joint replacement market and it has been propose that it improves the outcome of TKR. This is, of course, hotly debated. Moreover, I posted previously in this blog on the Economics of Robotics in joint replacement as it may be that Robotics reduces errors by less experienced surgeons. Indeed, Stefano Bini in his commentary makes this point.

Second, TSA and RSA have followed other joints with an approach to virtual planning and then execution of that plan using navigation, PSI, and soon likely to be released Robotics-driven surgery as well as Mixed Reality facilitated Surgery. Robotics is a capital intensive expense and post Corona Virus pandemic there may be significant cost pressures on expensive technologies. We should therefore carefully follow what is happening in the TKR and THR spaces.

Third, it is likely that most studies don’t consider that Value Creation, according to Michael Porter and colleagues happens in three tiers. Tier 1 is the actual outcome. Tier 2 is the process of recovery and it includes complications. Tier 3 is the durability of the outcome. It is likely that Tier 3 is not part of most robotic studies as cyclical loading of misaligned components may not lead to failure and need for revision for some time. More importantly, the value we create for our patients in terms of durability of a joint replacement is captured only by the patient and not by the hospital, the vendor or the surgeon. By this I mean that payment for service is only for a short duration following the surgery, so the remaining value is captured by the patient. This paradoxically creates a lack of alignment between all stakeholders.

I hope this helps you think about new technology evolving in shoulder arthroplasty.

My best wishes for your continued health and that of your families.

JP Warner, MD

Founder, CSS

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