South County Hospital orthopedic surgeon using robotic-assisted technology to perform full knee replacements

DR. BOB MARCHAND stands in a South County Hospital operating room with Mako equipment, which is used to assist in hip replacements, and partial and full knee replacements. / COURTESY SOUTH COUNTY HOSPITAL
DR. BOB MARCHAND stands in a South County Hospital operating room with Mako equipment, which is used to assist in hip replacements, and partial and full knee replacements. / COURTESY SOUTH COUNTY HOSPITAL

SOUTH KINGSTOWN – At South County Hospital, Rhode Island’s only independent hospital, Dr. Bob Marchand performs full knee replacement surgeries using a high-tech tool that will not be commercially marketed and released until March 2017, he told Providence Business News.

That tool, the Mako robotic arm-assisted technology, earned approval from the Food and Drug Administration in August 2015, said Marchand, an orthopedic surgeon at South County Hospital and a paid consultant for Stryker, a company that bought Mako in 2014. Earlier, he was a paid consultant for Mako, where he helped with technology development and taught other surgeons how to perform partial knee and hip replacements using Mako equipment.
Marchand, who learned how to do these robotic-assisted surgeries on cadavers, has helped train hundreds of other surgeons for Mako and Stryker. He expects to train his four South County Hospital orthopedic surgery colleagues on the robotic-assisted technology full knee replacement in the next several weeks.

South County Hospital was one of seven hospitals – selected based on surgeons’ experience with robotic equipment for hip and/or partial knee replacements – asked to participate in an empathic study, in which 35 patients at each site would receive full knee replacements with the robotic technology. No other hospitals from New England participated. Marchand added, “Videos [of some number of these surgeries] evaluated how the robotic technology was integrated into the operating room, how the learning curve of the people doing the robotic procedures was and how much time it took to do the surgeries.”

After completing in late July the 35 full knee replacements under the study, he’s continued using the Mako technology and completed another 25 or so such surgeries since then. Once the study’s surgeries were completed, participating surgeons are only eligible to continue using the Mako technology if their hospital purchased it, as South County Hospital had. Marchand reported that South County Hospital is the first facility to complete its empathic studies, and no other empathic study sites have begun using the technology in a commercial application. (Providence Business News contacted several Stryker employees in an attempt to verify those facts to no avail; no one would speak on the record or on background.)

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With some 270 hospitals currently using Mako robotic assistance for hip and/or partial knee replacement, Stryker didn’t want to introduce this new technology for full knee replacement to all facilities at once, given the potentially very high learning curve, Marchand said. Instead, Stryker will analyze all the data gathered from the videotaped surgeries and then prepare a regimented roll out so that all surgeons can be trained consistently.

Marchand, whose practice focuses now on hip and knee surgeries, is fully committed to using robotic-assisted technology, although patients may opt for traditional surgery. Marchand now views such orthopedic surgeries performed without technology as archaic as rotary phones.

“I go on the assumption that accuracy is kind of important and the only way to truly make [such surgery] accurate is to use advanced technologies – nothing can beat it,” he said.
With the pre-op CAT scan of the knee and the equipment’s precision, the technology ensures more accurate cuts, more accurate alignment and more accurate placement, he added. It’s accurate to within a single millimeter – the thickness of a thread. “You can’t do that manually,” said Marchand, who acknowledged that some orthopedic surgeons disavow robotic-assisted technology for a variety of reasons.

The technology isn’t inexpensive. South County Hospital’s three Mako robots have a list price of $1 million each – and each robot has a different attachment (priced separately) specific to each kind of surgery – though South County Hospital representatives declined to disclose the hospital’s costs. Marchand said that when insurers won’t cover the $500-$700 fee associated with the robotic technology, patients likely would be responsible.

Marchand can perform the robotic-assisted surgery in less time than a traditional surgery and a full knee replacement done under robotic-assisted surgery requires two trays of equipment, rather than seven trays with a traditional full knee replacement. This creates operating room efficiencies and cost savings, Marchand added. Patients’ post-operative physical therapy rehabilitation is the same, whether traditional or robotic-assisted surgery, Marchand said.

Given South County Hospital’s proven experience in hip and knee surgeries, Blue Cross & Blue Shield of Rhode Island has recognized the facility as a Blue Distinction Centers+ hospital for hip and knee replacements. Blue Cross has similarly recognized, as of Sept. 1, 2016, these hospitals for their expertise and efficiency in delivering this care: Newport, Rhode Island, The Miriam and Our Lady of Fatima hospitals and Roger Williams Medical Center. Nearby Massachusetts facilities receiving the BDC+ distinction for hip and knee replacements are Saint Anne’s Hospital and Southcoast Hospitals Group-Charlton Memorial, both in Fall River.

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