Presbyterian adds robotic assistance to knee replacement surgery

Oct. 18—ROSA is offering a helping hand with knee replacement surgeries at Presbyterian Santa Fe Medical Center.

The ROSA Knee System is a robotic assistant for knee replacement surgery, a new concept in play only since the closing years of the 2010s.

ROSA joined the Presbyterian Santa Fe staff in July, just months after the south-side hospital opened its orthopedic care center in February.

"ROSA represents the most state-of-the-art thing we are doing from a surgical perspective," said David Arredondo, regional medical director at the 4-year-old Presbyterian Santa Fe Medical Center.

National studies show knee replacement surgeries result in 20 percent to 25 percent of patients not feeling better off with the new knee, complaining it "doesn't feel natural" and that the new knee can be stiff or not fit ideally.

"The patients appear to be recovering faster from this new technology," said Dr. John Garcia, the orthopedic surgeon who has performed 47 of the roughly 56 robotically assisted knee replacements so far at Presbyterian Santa Fe since ROSA was brought aboard in July.

"Everybody has a different alignment, different tensions," Garcia said. "ROSA customizes the position, orientation and soft-tissue tension for each patient. The whole thing about knee replacement is where you put your cuts."

Robotic-assisted surgery allows surgeons to plan and perform knee replacements with a high degree of accuracy.

The ROSA Knee System is two units on wheels. The sensor device inputs the body landscape to help establish orientation for the cutting guide unit, which precisely aligns cuts of the tibia, femur and tissue for the surgeon.

"This allows you to coordinate all the cuts," Garcia said.

The acquisition of ROSA Knee is a collaboration between Presbyterian and the recently formed Nexus Health, an independent, local, multi-specialty physician group whose orthopedic group operates the Presbyterian orthopedic center. Garcia is one of three Nexus orthopedic surgeons at Presbyterian Santa Fe.

Presbyterian Santa Fe acquired two ROSA Knee System robotic assistants made by Zimmer Biomet. There are only four of these total joint replacement devices in New Mexico; the other two are at New Mexico Surgery Center Orthopedics, on the campus of Presbyterian Kaseman Hospital in Albuquerque.

Zimmer Biomet's ROSA Knee and Stryker's Mako Knee are the industry leaders in the nascent knee replacement robotic assistance field. Mako hit the market in 2017 and ROSA in 2019.

Garcia is a champion of ROSA Knee, which he has been considering for 11/2 years and presented to Presbyterian Santa Fe as an option. Garcia and Arredondo acknowledge all orthopedic surgeons have not yet embraced robotic assistants for knee replacement surgeries.

"You have to have guys interested in this," Garcia said.

"Some don't think they need it," Arredondo added.

New Mexico Surgery Center Orthopedics in Albuquerque installed the first two ROSA Knee Systems in New Mexico.

"You have a higher percent of results in the sweet spot with the robot than without the robot," said Dr. Bill Ritchie, an orthopedic surgeon at New Mexico Surgery Center Orthopedics.

Ritchie said it is slower to do a knee replacement with ROSA than without the robotic assistant, but younger orthopedic surgeons will likely be more adept at adapting to the robot than older surgeons. Will this new technology, just a few years old, become the standard in a few years?

"The future, in part, depends on if it will be reimbursable by insurance," Ritchie said. "Long-term results we don't know yet."

Presbyterian Santa Fe is the only Presbyterian Healthcare Services hospital in New Mexico with the ROSA Knee System that is capable of doing total joint replacements.

"We have the DaVinci surgical robot at Presbyterian Hospital [in Albuquerque] and Presbyterian Rust Medical Center [in Rio Rancho], but they do not have the capability to do total joint replacements," Arredondo said. "This hospital operates autonomously. Presbyterian Santa Fe decided to tap into its capital budget after conducting a financial analysis."

ROSA Knee Systems each cost about $700,000.

"We invest in new technology as it becomes available and reliable evidence shows that it benefits patients," Arredondo said. "We decided on this device because it improves accuracy and because it is available for total joint replacements, a very common orthopedic surgery."

Next on the horizon at Presbyterian Santa Fe Medical Center: a cardiac CT scanner to screen patients for cardiac blockages in a noninvasive manner.

"It's just a question of when, maybe mid- or later 2023," Arredondo said.

For now, he is pleased to have state-of-the-art knee replacement technology in Santa Fe.

"It's exciting that we can have it at a relatively small hospital," he said. "Many larger hospitals don't have it."