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Brinkman JC, Moore ML, Lai C, Tummala SV, Pollock JR, McQuivey KS, Hassebrock JD, Thompson AB, Chhabra A. Patient Interest in Quadriceps Autograft Anterior Cruciate Ligament Reconstruction Is Increasing Over Other Autograft Options: A 12-Year Google Trends Analysis. Arthrosc Sports Med Rehabil 2024; 6:100942. [PMID: 39006776 PMCID: PMC11240022 DOI: 10.1016/j.asmr.2024.100942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 04/02/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose To use Google trends to explore differences in public interest among types of anterior cruciate ligament (ACL) autografts, specifically quadriceps tendon, patellar tendon, and hamstring tendon autografts, between 2008 and 2019. Methods Data were obtained by querying Google Trends for key terms and phrases for online search data ranging from January 2008 to December 2019. Relative search volumes were created based on searches related to ACL reconstruction with comparative analysis generated for search terms related to quadriceps ACL, patellar tendon ACL, and hamstring ACL autografts. Statistical analysis included linear regression analysis, comparison of quarterly search volume trends over time, and comparison of cumulative annual search volumes for 2008 versus 2019. Results Linear models for respective search terms were statistically significant for the quadriceps (P < .001) and patellar (P = .007) tendon autograft groups but not the hamstring group (P = .129). The quadriceps autograft group demonstrated a 12-year search volume trend change of 0.56, which was significantly greater than the hamstring (0.07; P < .001) and patellar tendon (0.168; P < .001) groups. There was no significant difference in the trend change between hamstring and patellar tendon groups (P = .20). Percent change in cumulative relative annual search volumes between 2008 and 2019 was 112% for the quadriceps tendon group, 12.9% for the hamstring group, and 18.6% for the patellar tendon group. Conclusions This study indicates a consistently increasing public interest in quadriceps tendon autograft for ACL reconstruction. The quadriceps autograft group demonstrated a significantly greater 12-year online search volume, greater linear correlation, and larger percent change between 2008 and 2019 compared with patellar tendon or hamstring autograft groups. Clinical Relevance Awareness of patient perceptions has value in informing shared decision-making, aligning patient expectations, and guiding areas of future research. Each of these has an impact on patient care. Being aware of patient interest and expectations is particularly important in areas with controversial or emerging research.
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Affiliation(s)
- Joseph C Brinkman
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | - M Lane Moore
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, U.S.A
| | - Cara Lai
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | - Sailesh V Tummala
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | | | - Kade S McQuivey
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | | | - Adam B Thompson
- The Robert Larner M.D. College of Medicine at The University of Vermont, Burlington, Vermont, U.S.A
| | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
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Pinci MV, Torres-Lugo NJ, Deliz-Jimenez DE, Salem-Hernandez J, Claudio-Marcano A, Ramírez N, Otero-López A. Patient Perception of Robotic-Assisted Total Joint Arthroplasty in a Hispanic Population. Arthroplast Today 2024; 25:101286. [PMID: 38292146 PMCID: PMC10826131 DOI: 10.1016/j.artd.2023.101286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/25/2023] [Accepted: 11/03/2023] [Indexed: 02/01/2024] Open
Abstract
Background Robotic-assisted orthopaedic surgery has become popular and widely available, mainly for total joint arthroplasty. However, there has been a persistent concern regarding access to robotic-assisted surgery and the utilization rate of total joint arthroplasty among minority groups. As an imperative effort to close the gap regarding health inequalities, we assessed the knowledge and perspective of Hispanics regarding robotic-assisted orthopaedic surgery. Methods A 28-item questionnaire was established to evaluate Hispanics' perceptions of robotic-assisted orthopaedic surgery. Participants answered questions about demographic features, knowledge about robotic-assisted orthopaedic surgery, and preferences regarding manual vs robotic-assisted procedures. Results A total of 580 questionnaires were analyzed in our study, with an average age of participants of 49.1 years. Only 44.2% of the participants were familiar with robotic-assisted orthopaedic surgery. Fifty-three percent of the respondents preferred robotic-assisted surgery over conventional procedures, with many participants believing that robotic-assisted surgery leads to better outcomes (54.7%) and faster recovery (53.1%). Conclusions Knowledge about specific factors such as clinical outcomes and costs may influence the perception and preference of Hispanics toward robotic-assisted orthopaedic surgery. Therefore, patient education may play a crucial role in the informed decision-making process in Hispanics when opting between robotic-assisted or traditional orthopaedic surgery.
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Affiliation(s)
- Marcantonio V. Pinci
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Norberto J. Torres-Lugo
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - David E. Deliz-Jimenez
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | | | - Alexandra Claudio-Marcano
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Norman Ramírez
- Department of Orthopaedic Surgery, Mayagüez Medical Center, Mayagüez, Puerto Rico
| | - Antonio Otero-López
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
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Berlet M, Fuchtmann J, Krumpholz R, Naceri A, Macari D, Jähne-Schon C, Haddadin S, Friess H, Feussner H, Wilhelm D. Toward telemedical diagnostics-clinical evaluation of a robotic examination system for emergency patients. Digit Health 2024; 10:20552076231225084. [PMID: 38205033 PMCID: PMC10777806 DOI: 10.1177/20552076231225084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
Introduction The SARS-CoV-2 pandemic has affected global public healthcare for several years. Numerous medical professionals have been infected since the outbreak in 2019, resulting in a shortage of healthcare providers. Since traditional personal protective wear was insufficient to eliminate the virus transmission reliably, new strategies to avoid cross-infection were imperative while enabling high-quality medical care. In the project ProteCT, we investigated the potential of robotic-assisted examination in providing medical examination via a telemedical approach. Material and Methods We constructed a fully functional examination cabin equipped with cameras, microphones, screens and robotic arms to evaluate usability and perception. Therefore, we conducted a preliminary study with 10 healthy volunteers and 10 physicians to gain first insights and optimize the setup. In a second step, we performed telemedical examinations of actual patients from the local emergency department to compare the robotic approach with the classical method of measuring vital signs, auscultation, palpation and percussion. Results The preliminary study identified basic requirements, such as the need for force-feedback and telemedical training for physicians. In the main study, acceptance was high and most patients indicated they would use a telemedical system again. Our setup enabled the physician to make the same diagnoses as by classic examination in the emergency department in most cases. Discussion The potential acceptance of a telemedical system such as ProteCT is high. Robotic telemedical approaches could complement future healthcare beyond the Corona pandemic to reach rural areas or even war zones. Moreover, the daily clinical use of robotic telemedicine could improve patients' safety, the quality of perioperative management and the workflow in any medical facility. Conclusion The development of telemedical and telerobotic systems is a multidisciplinary and complex challenge. However, acceptance of the proposed system was high among patients and physicians, indicating the potential use of similar systems for future healthcare.
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Affiliation(s)
- Maximilian Berlet
- Department of Surgery, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
- MITI Research Group, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jonas Fuchtmann
- MITI Research Group, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Roman Krumpholz
- MITI Research Group, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Abdeldjallil Naceri
- Munich Institute of Robotics and Machine Intelligence, Technical University of Munich, Munich, Germany
| | - Daniela Macari
- Franka Emika GmbH, Munich, Germany
- Max Planck Institute for Intelligent Systems, Max Planck ETH Center for Learning Systems, Stuttgart, Germany
| | | | - Sami Haddadin
- Munich Institute of Robotics and Machine Intelligence, Technical University of Munich, Munich, Germany
| | - Helmut Friess
- Department of Surgery, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hubertus Feussner
- Department of Surgery, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
- MITI Research Group, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dirk Wilhelm
- Department of Surgery, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
- MITI Research Group, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
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Yasen Z, Woffenden H, Robinson AP. Robotic-Assisted Knee Arthroplasty: Insights and Implications From Current Literature. Cureus 2023; 15:e50852. [PMID: 38249205 PMCID: PMC10798799 DOI: 10.7759/cureus.50852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Robotic-assisted knee arthroplasty has emerged as a promising development, aiming to enhance surgical precision and patient outcomes. This literature review examines the clinical efficacy, cost implications, environmental impact, and potential of telesurgery in robotic-assisted total knee arthroplasty (RATKA) and robotic-assisted unicompartmental knee arthroplasty (RAUKA) relative to conventional techniques. A thorough literature search was conducted across medical databases. Clinical and radiological outcomes of RATKA and RAUKA were extracted and analyzed. Direct costs, operating time, surgeon learning curve, environmental implications, and the futuristic concept of telesurgery were also considered. Subjective patient assessments such as WOMAC, Oxford Knee Score, and SF-36, alongside objective measures like HSS score and KSS, were commonly used. Radiological parameters like hip-knee-ankle (HKA) and femorotibial angle provided insights into post-operative alignment. Evidence indicated sporadic high-level design studies, often with limited samples. Cost remains a major constraint with robotic systems, though high-volume cases might offset expenses. Environmental assessments revealed robotic surgeries generate a higher carbon footprint. Telesurgery, an evolving field, could transcend geographical boundaries but is not without challenges, including high costs, latency issues, and cyber threats. While robotic-assisted surgeries may hold promise in the future, substantial barriers, including acquisition costs, potential surgeon deskilling, and environmental concerns, need addressing. Greater robot utilization may drive costs down with more competitors entering the market. Continued research, especially multi-center RCTs, is pivotal to solidifying the role of robotic systems in knee arthroplasty.
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Affiliation(s)
- Zaid Yasen
- Trauma and Orthopedics, Royal Free Hospital, London, GBR
- Surgery and Cancer, Imperial College London, London, GBR
| | - Hugo Woffenden
- Trauma and Orthopedics, Ministry of Defence, Portsmouth, GBR
| | - Andrew P Robinson
- Trauma and Orthopedics, Lewisham and Greenwich NHS Trust, London, GBR
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Tarwala R, Mercuri JJ, Iorio R, Karkare N. Ethical Considerations in Total Joint Arthroplasty. J Am Acad Orthop Surg 2023; 31:1001-1008. [PMID: 37561941 DOI: 10.5435/jaaos-d-22-00941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 07/03/2023] [Indexed: 08/12/2023] Open
Abstract
Hip and knee arthroplasty surgeries have excellent outcomes and notably improve quality of life. However, ethical issues permeate the practice of adult reconstruction, and as economics and technology evolve, these issues have become increasingly important. This article will review the currently published literature on ethical issues including industry influences, implants and instrumentations, surgical innovation, new technology adoptions, and healthcare policy-relevant issues, including patient cost sharing and bundled care programs. In addition, the direct marketing of implants from the manufacturer to the general public may falsely raise patient expectations concerning the long-term clinical outcome and performance of newer devices in the absence of long-term studies. This article will also focus on relevant contemporary ethical issues that do not necessarily have preexisting published literature or guidelines but, nonetheless, are crucial for adult reconstruction surgeons to address. These issues include access to care and challenges with orthopaedic resident and fellow education. Surgeons must understand the ethical issues that can arise in their clinical practice and how those issues affect patients. Clinicians are tasked with making the best-reasoned judgment possible to optimize their patients' outcomes. Still, the ability to standardize treatment while optimizing individual outcomes for unique patients remains a challenge.
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Affiliation(s)
- Rupesh Tarwala
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY (Tarwala), the Division of Adult Hip and Knee Reconstruction, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Scranton, PA (Mercuri), the Harvard Medical School, Brigham and Women's Hospital, Boston, MA (Iorio), and Lenox Hill Hospital, New York, NY (Karkare)
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Sweet MC, Miladore N, Bovid KM, Kenter K. Technology-Assisted Hip and Knee Arthroplasty in Orthopaedic Residency Training: A National Survey. J Am Acad Orthop Surg 2023; 31:1033-1039. [PMID: 37467400 DOI: 10.5435/jaaos-d-23-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 06/06/2023] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION The adoption of technology-assisted total joint arthroplasty (TA-TJA) is increasing; however, the extent to which TA-TJA is used among orthopaedic trainees is unknown. The purpose of this study was to assess the current use of TA total knee arthroplasty (TKA) and total hip arthroplasty (THA) by orthopaedic residents and to evaluate resident perceptions toward TA-TJA in their surgical training. METHODS In this cross-sectional study, an anonymous electronic survey was sent to all Accreditation Council for Graduate Medical Education-accredited orthopaedic surgery residency program coordinators to distribute to their PGY-2 to PGY-5 residents. The survey consisted of 24 questions, including resident demographics, utilization of TA-TJA in their training, and perceptions regarding TA-TJA. RESULTS A total of 103 orthopaedic residents completed the survey, of whom 68.0% reported using TA-TJA at their institution. Of the residents using TA-TJA, 28.6% used TA for total TKA only, 71.4% used TA for both TKA and THA, and none used TA solely for THA. One-third of residents (33.3%) use TA for more than half of all TKAs conducted, whereas 57.0% use TA for <10% of all THAs conducted. Approximately half of all residents (49.5%) thought that training in TA-TJA should be required during residency, with no significant differences between junior and senior level residents ( P = 0.24). Most (82.0%) thought that trainees should be required to learn conventional TJA before learning TA-TJA. 63.0% thought that technology had a positive effect on their primary TJA training experience; however, 26.0% reported concern that their training conducting conventional TJA may be inadequate. DISCUSSION This study demonstrates that most orthopaedic residents currently conduct TA-TJA and highlights notable differences in TJA training experiences. These results provide a platform for future work aimed at further optimizing TJA training in residency, particularly as technology continues to rapidly evolve and utilization of TA-TJA is projected to grow exponentially. LEVEL OF EVIDENCE N/A, survey-based study.
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Affiliation(s)
- Matthew C Sweet
- From the Department of Orthopaedic Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI
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7
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Abdelaal MS, Wiafe BM, Khan IA, Magnuson JA, Saxena A, Smith EB, Lonner JH, Star AM, Good RP, Sharkey PF. Robotic-Assisted Total Knee Arthroplasty: What are Patients' Perspectives, Understanding and Expectations? J Arthroplasty 2023; 38:1726-1733.e4. [PMID: 36924858 DOI: 10.1016/j.arth.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND The rate of using robotic-assisted total knee arthroplasty (RA-TKA) has increased markedly. Understanding how patients view the role of robotics during total knee arthroplasty (TKA) informs shared decision making and facilitate efforts to appropriately educate patients regarding the risks and benefits of robotic assistance. METHODS A self-administered questionnaire was completed by 440 potential TKA patients at the time of their surgery scheduling. Participants answered 25 questions regarding RA-TKA, socioeconomic factors, and their willingness to pay (WTP) for RA-TKA. Logistic regressions were used to determine if population characteristics and surgeon preferences influenced the patients' perceptions of RA-TKA. RESULTS There were 39.7% of respondents who said that they had no knowledge regarding RA-TKA. Only 40.7% of participants had expressed a desire for RA-TKA to be used. There were 8.7% who were WTP extra for the use of RA-TKA. Participants believed that the main 3 benefits of RA-TKA compared to conventional methods were: more accurate implant placement (56.2%); better results (49.0%); and faster recovery (32.1%). The main 3 patient concerns were harm from malfunction (55.2%), reduced surgeon role in the procedure (48.1%), and lack of supportive research (28.3%). Surgeon preference of RA-TKA was associated with patient's willingness to have RA-TKA (odds ratio 4.60, confidence interval 2.98-7.81, P < .001), and with WTP extra for RA-TKA (odds ratio 2.05, confidence interval: 1.01-4.26, P = .049). CONCLUSION Patient knowledge regarding RA-TKA is limited. Nonpeer-reviewed online information may make prospective TKA candidates vulnerable to misinformation and aggressive advertising. The challenge for orthopaedic surgeons is to re-establish control and reliably educate patients about the proven advantages and disadvantages of this emerging technology.
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Affiliation(s)
- Mohammad S Abdelaal
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Bright M Wiafe
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Irfan A Khan
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Justin A Magnuson
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Arjun Saxena
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Eric B Smith
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jess H Lonner
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Andrew M Star
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Robert P Good
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Peter F Sharkey
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Pagani NR, Puzzitiello RN, Stambough JB, Saxena A. Online Crowdsourcing Survey of United States Population Preferences and Perceptions Regarding Outpatient Hip and Knee Arthroplasty. J Arthroplasty 2022; 37:2323-2332. [PMID: 35738362 DOI: 10.1016/j.arth.2022.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/11/2022] [Accepted: 06/14/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Outpatient total joint arthroplasty (TJA) has been shown to be both safe and cost-effective in appropriately selected patients and continues to expand substantially across the United States. Using online crowdsourcing, we aimed to assess population perceptions regarding outpatient TJA and to determine factors associated with preference for outpatient versus inpatient arthroplasty. METHODS A closed-ended survey consisting of 39 questions was administered to members of a public platform. Study participants responded to questions regarding demographic factors and outpatient TJA. Validated assessments to capture health literacy and engagement were also used. To determine factors associated with preference for outpatient TJA, multivariable logistic regression analyses were performed. RESULTS In total, 900 participants completed the survey. After exclusion of surveys with incomplete data, 725 responses remained for analysis (80.6%). Over half (59.9%) of the survey participants would feel comfortable going home the same day of surgery following TJA. However, two-thirds (64.6%) would prefer to stay in the hospital following TJA. The majority (68.0%) of respondents perceive a hospital setting as the safest location for TJA. The 3 major concerns regarding outpatient TJA were cost, post-operative pain control, and post-operative complication. Among the 111 respondents (15.3%) who would prefer outpatient TJA, 45% would pay more out-of-pocket, 63.1% travel further, and 55.9% would be willing to wait longer to have their surgery performed as an outpatient. On multivariable regressions, those living in a suburban setting (adjusted odds ratios, 95% confidence intervals: 4.2 [1.3-2.7], P = .02) and >60 year old adjusted odds ratios (95% confidence intervals: 8 [2-33.1], P = .004) were more likely to prefer outpatient TJA. CONCLUSION Despite the rise in outpatient TJA, the majority of the public appears to prefer inpatient TJA and the minority would expect to be discharged home the same day. Our data can be used to address specific patient concerns regarding outpatient TJA and set realistic expectations for hospital systems and ambulatory facilities.
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Affiliation(s)
- Nicholas R Pagani
- Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, Massachusetts
| | - Richard N Puzzitiello
- Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, Massachusetts
| | - Jeffrey B Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Arjun Saxena
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Morgan P. What's New in Hip Replacement. J Bone Joint Surg Am 2022; 104:1599-1604. [PMID: 35980042 DOI: 10.2106/jbjs.22.00535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Patrick Morgan
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
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Moore HN, de Paula TR, Keller DS. Needs assessment for patient-centered education and outcome metrics in robotic surgery. Surg Endosc 2022; 37:3968-3973. [PMID: 36002685 PMCID: PMC10156849 DOI: 10.1007/s00464-022-09500-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/23/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND From clinical experience, many patients undergoing robotic assisted surgery (RAS) have a poor understanding of the technology. To ensure informed consent and appropriate expectations, a needs assessment for patient-centered education and outcome metrics in RAS is warranted. Our goal was to perform an assessment of patient understanding, comfort with robotic technology, and ability to obtain critical information from their surgeon when undergoing RAS. METHODS Twenty patients planned for RAS by three surgeons were asked to complete a six-item Likert agreement scale survey prior to signing informed consent. The study coordinator administered surveys, while the surgeon left the room. Indicator statements were crafted to reduce bias and two-way evaluated for consistency. The surgeons were additionally asked their perception of each patient's understanding and comfort with RAS. Frequency statistics and tendencies were analyzed. RESULTS Surgeons strongly agreed all patients appropriately understood how RAS functioned and would ask more questions before signing consent, if needed. Patients were predominately not familiar with RAS and felt surgeons did not explain how RAS worked. There was wide variability on if patients understood how RAS worked for their treatment. Overall, patients were not completely comfortable with RAS for their care, did not understand the risks of RAS compared to other approaches, and did not feel their surgeon understood what they needed to know to make informed decisions. CONCLUSIONS This needs assessment demonstrated critical gaps in patient knowledge about RAS, surgeon communication skills, and the ability of surgeons to know what was important from the patient perspective. The development of RAS patient-centered education and outcome metrics could help address these gaps.
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Affiliation(s)
- Hope Nicole Moore
- Department of Surgery, Davis Medical Center, University of California, 2335, Stockton Blvd, NAOB 6Th Floor, Sacramento, CA, 95817, USA.
| | - Thais Reif de Paula
- Biomedical Sciences Department, University of Houston Medical School, Houston, TX, USA
| | - Deborah S Keller
- Department of Surgery, Davis Medical Center, University of California, 2335, Stockton Blvd, NAOB 6Th Floor, Sacramento, CA, 95817, USA
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Brinkman JC, Christopher ZK, Moore ML, Pollock JR, Haglin JM, Bingham JS. Patient Interest in Robotic Total Joint Arthroplasty Is Exponential: A 10-Year Google Trends Analysis. Arthroplast Today 2022; 15:13-18. [PMID: 35360676 PMCID: PMC8961076 DOI: 10.1016/j.artd.2022.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 12/28/2021] [Accepted: 02/12/2022] [Indexed: 12/11/2022] Open
Abstract
Background The use of robotics in arthroplasty continues to increase. Patient demand, patient expectations, and patient-directed marketing by industry and care providers each likely contributes to its increasing popularity. Trends in patient interest have not been well described. We used the online Google Trends tool to analyze trends in national public interest toward robotic and nonrobotic arthroplasty between 2011 and 2021. Material and methods Google Trends online was queried for search terms related to nonrobotic hip and knee arthroplasty in addition to robotic hip, robotic knee, and general robotic arthroplasty between January 1, 2011, and December 31, 2021. Results Google Trends Data demonstrated a significant linear increase in online searches related to nonrobotic total knee and hip arthroplasty. Online search volume for robotic hip arthroplasty was significant and linear, while that of robotic knee arthroplasty was significant and exponential. When combined, robotic joint arthroplasty demonstrated an exponential trend over the 10-year period. This increase was noted to be statistically significant when compared with nonrobotic arthroplasty search volume. Conclusion Our study demonstrates that public interest in robotic total joint arthroplasty has increased significantly from 2011 through 2020. When compared with online search volume for conventional arthroplasty, this increasing growth is statistically significant. Public interest in robotic arthroplasty is anticipated to continue to increase, and care providers should be aware of this trend that impacts patient perceptions and expectations. Despite significant growth in interest for robotic arthroplasty, there is incomplete evidence supporting its use over nonrobotic arthroplasty. Additional high-quality studies are needed to inform provider decision-making and appropriately guide public interest in robot-assisted arthroplasty.
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Pennington Z, Judy BF, Zakaria HM, Lakomkin N, Mikula AL, Elder BD, Theodore N. Learning curves in robot-assisted spine surgery: a systematic review and proposal of application to residency curricula. Neurosurg Focus 2022; 52:E3. [PMID: 34973673 DOI: 10.3171/2021.10.focus21496] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/22/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Spine robots have seen increased utilization over the past half decade with the introduction of multiple new systems. Market research expects this expansion to continue over the next half decade at an annual rate of 20%. However, because of the novelty of these devices, there is limited literature on their learning curves and how they should be integrated into residency curricula. With the present review, the authors aimed to address these two points. METHODS A systematic review of the published English-language literature on PubMed, Ovid, Scopus, and Web of Science was conducted to identify studies describing the learning curve in spine robotics. Included articles described clinical results in patients using one of the following endpoints: operative time, screw placement time, fluoroscopy usage, and instrumentation accuracy. Systems examined included the Mazor series, the ExcelsiusGPS, and the TiRobot. Learning curves were reported in a qualitative synthesis, given as the mean improvement in the endpoint per case performed or screw placed where possible. All studies were level IV case series with a high risk of reporting bias. RESULTS Of 1579 unique articles, 97 underwent full-text review and 21 met the inclusion and exclusion criteria; 62 articles were excluded for not presenting primary data for one of the above-described endpoints. Of the 21 articles, 18 noted the presence of a learning curve in spine robots, which ranged from 3 to 30 cases or 15 to 62 screws. Only 12 articles performed regressions of one of the endpoints (most commonly operative time) as a function of screws placed or cases performed. Among these, increasing experience was associated with a 0.24- to 4.6-minute decrease in operative time per case performed. All but one series described the experience of attending surgeons, not residents. CONCLUSIONS Most studies of learning curves with spine robots have found them to be present, with the most common threshold being 20 to 30 cases performed. Unfortunately, all available evidence is level IV data, limited to case series. Given the ability of residency to allow trainees to safely perform these cases under the supervision of experienced senior surgeons, it is argued that a curriculum should be developed for senior-level residents specializing in spine comprising a minimum of 30 performed cases.
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Affiliation(s)
- Zach Pennington
- 1Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Brendan F Judy
- 2Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Hesham M Zakaria
- 3Department of Neurosurgery, California Pacific Medical Center, Sutter Health, San Francisco, California
| | - Nikita Lakomkin
- 1Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | | | | | - Nicholas Theodore
- 2Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
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