Shelbourne Knee Center: Winter 2024 Newsletter

KNEE TREATMENT NEWS

RESEARCH-BASED INSIGHTS THAT MAXIMIZE PATIENT OUTCOMES

THE BENEFITS OF ROBOTICASSISTED TKA

When Rodney Benner, MD, first started hearing about roboticassisted total knee arthroplasty (TKA), he was skeptical. Over the next few years, the Shelbourne Knee Center orthopedic surgeon learned more and finally decided to try it. Now, after performing about 200 roboticassisted TKAs in 2023, Dr. Benner is an ardent supporter of the procedure for primary TKA.

“The increased data from robotics compared to conventional instrumentation enables me to evaluate and adjust factors in knee replacement that I haven’t been able to fine-tune before,” says Dr. Benner.

Data-Driven Decision-Making

Data-driven insights from ROSA

Knee System, the robotic surgical assistant Dr. Benner uses, inform his decision-making and enable him to focus on achieving the optimal outcome for each patient. Objective intraoperative metrics on soft tissue enable surgeons to accurately assess soft tissue balancing and make intraoperative adjustments to planned limb and component alignment based on the data.

“Robotic-assisted TKA helps us fine-

tune the soft tissue balancing and use the data to align the limb the way we want to,” he says.

Increased Precision and Accuracy

The ability to balance soft tissue was a key factor in Dr. Benner’s decision to try robotic-assisted TKA. Before, Dr. Benner had to try to determine the appropriate soft tissue balance through well-trained feel intraoperatively. With ROSA Knee System, he now has objective measurements of the soft tissue.

Using that objective data and robotic guidance, Dr. Benner has adapted his surgical technique for increased precision and accuracy. Along with soft tissue balancing, robotic-assisted TKA helps him with bone resections, implant selection and accurate positioning of components. Now, Dr. Benner often chooses

different implants and can resect less bone in certain parts of the knee. Robotic-assisted TKA is especially beneficial in complex cases, such as patients with valgus deformity. Achieving appropriate alignment and soft tissue balancing throughout the full range of motion and achieving rotational alignment are much more difficult in these patients, potentially leading to implant failure. Data from the robotic surgical assistant enable Dr. Benner to balance soft tissue and align the limb more precisely in both complex and straightforward cases.

Multiple studies show that robotic-assisted TKA is more accurate than conventional instrumentation. In one cadaveric study, for example, four high-volume arthroplasty surgeons performed 14 robotically assisted TKAs and 20 conventional TKAs. Three of the surgeons had no prior experience in robotics. Researchers

RODNEY BENNER, MD

found statistically more accurate results (p < 0.05) and fewer outliers (p < 0.05) with robotic-assisted TKA than with conventional instrumentation.¹

A Likely Improvement in Patient Outcomes

While it is too early to have data about patient outcomes, satisfaction and implant survivorship of roboticassisted TKA, Dr. Benner does expect to see better outcomes. His observations so far are promising. “Our patients seem to be getting their range of motion back a little quicker and are more stable,” he says.

Some early data suggest improvements in range of motion. One study compared 50 roboticassisted TKAs with 47 TKAs performed with imageless navigation. At the one-year follow-up, robotic-assisted TKA was associated with:

• Higher maximum range of motion (119.4° vs. 107.1°; p < 0.0001)

• Better mean arc of motion improvement by 11.67° (23.02° vs. 11.36°; p < 0.0001).²

Also, Dr. Benner believes that patients will see a functional benefit

More TKA Insights

To hear an interesting discussion of smart technology in TKA, listen to our podcast featuring Dr. Benner, Fred Cushner, MD, a knee surgeon at the Hospital for Special Surgery in New York City, and Scot Bauman, PT, DPT, PhD, research analyst at Shelbourne Knee Center. To listen, scan the QR code below.

To subscribe or view all topics discussed on SKC’s podcast, search for “The Shelbourne Knee Center Podcast” on your favorite podcast app or visit https://bit.ly/SKCpodcast.

due to the ability to balance soft tissue and reduce bone resection in robotic-assisted TKA.

Shelbourne Knee Center has been collecting data on roboticassisted TKA since Dr. Benner started performing the procedure. This is part of the Shelbourne Knee Center Research Program, which includes data on more than 13,000 patients over 40+ years. The research, which is used to continually improve treatments for patients, focuses on patient outcomes and factors related to those outcomes.

Research on robotic-assisted TKA will include a comparison of data from robotic-assisted and conventional TKA performed at Shelbourne Knee Center. With a vast amount of data now available from the robotic surgical system, Dr. Benner and his colleagues will be carefully considering how to focus the research to develop research-backed innovations to optimize patient care.

Increased Operative Efficiency

While most research shows that robotic-assisted TKA takes longer than conventional TKA, Dr. Benner’s experience has been different.

“Robotic-assisted TKA makes the cuts more accurate so I’m less likely to have to go back and redo cuts. The operation is more efficient now that I’m using robotic assistance,” he says.

Also, the surgical workflow is more ergonomic with robotic-assisted TKA, resulting in less physiological stress and postural strain on surgeons compared to conventional instrumentation.

REFERENCES

1. Seidenstein A, Birmingham M, Foran J, Ogden S., Better accuracy and reproducibility of a new robotically assisted system for total knee arthroplasty compared to conventional instrumentation: a cadaveric study. Knee Surg Sports Traumatol Arthrosc. 2020 Mar;29(3):859-866. doi: 10.1007/s00167-02006038-w. Epub 2020 May 24. PMID: 32448945.

Benefits of RoboticAssisted TKA

• Improved precision and accuracy

• Faster recovery of range of motion

• Increased operative efficiency

• Less postural strain for surgeons

Research-Based Treatment

The Shelbourne Knee Center Research Program focuses primarily on:

1. ACL reconstruction

2. Robotic-assisted TKA

3. Nonoperative treatment of knee osteoarthritis

4. Knee arthroscopy.

Dr. Benner and K. Donald Shelbourne, MD, an orthopedic surgeon and founder of Shelbourne Knee Center, work with the center’s physical therapists and athletic trainers to develop and conduct research. The research team also includes:

• Research Manager Adam Norris

• Research Manager/Medical Writer Scot Bauman, PT, DPT, PhD

• Two research coordinators: Heather Garrison and Diane Davidson.

Shelbourne Knee Center invites all patients to be part of research, which includes:

• Annual email surveys

• Objective evaluations (for surgical patients) done during free follow-up visits:

- X-rays

- Physical examination

- Physical testing.

The team reviews research results regularly and updates treatments based on results. They share results through:

• International, national and regional presentations

• Articles in medical journals

• The new Shelbourne Knee Center Podcast.

2. Mancino F, Rossi SMP, Sangaletti R, Lucenti L, Terragnoli F, Benazzo F. A new robotically assisted technique can improve outcomes of total knee arthroplasty comparing to an imageless navigation system. Arch Orthop Trauma Surg. Aug 1 2022;doi:10.1007/s00402022-04560-9.

NEW SKC PODCAST DISCUSSES ROBOTICS IN TKA

ORTHOPEDIC SURGEON JAMES C.

BALLARD, MD, has performed about 700 robotic-assisted total knee arthroplasties (TKAs). Like Rodney Benner, MD, an orthopedic surgeon at Shelbourne Knee Center (SKC), Dr. Ballard was at first skeptical about the procedure, thinking it was overhyped. In a recent episode of the Shelbourne Knee Center Podcast, Dr. Benner and Dr. Ballard discussed their experiences with robotics and how that technology has changed their practices.

In the podcast, Dr. Ballard shares that he started using robotic technology for TKA so that he could tell the device manufacturer why he didn’t need robotics. Initially, he performed robotic-assisted TKA one

day and the conventional procedure the next so he could compare the two approaches.

He soon found that he could perform more precise and accurate TKAs with robotic assistance than without it. “The power of robotics is recognizing that knees are more individual than we thought they were,” says Dr. Ballard. “They don’t always follow a particular paradigm.”

Dr. Ballard, who practices at Regenerative Orthopedic Center in Oregon City, Oregon, specializes in primary and revision hip and knee replacements. Dr. Ballard was the first surgeon in the Northwest to perform an outpatient total joint replacement.

A Podcast for Knee Surgeons

Launched in 2023, the Shelbourne Knee Center Podcast is designed to improve patient outcomes by creating healthy discussions among physicians who treat patients with knee pain or knee injuries. “The podcast is an opportunity to get our message and ideas out there in a way where we have ample time for discussion,” says Dr. Benner.

Each week, Dr. Benner and Scot Bauman, PT, DPT, PhD, a medical writer and research analyst at SKC, discuss a different aspect of orthopedic knee care. Some episodes, such as the episode with Dr. Ballard, feature guest experts from around the world. Other episodes focus on data on specific injuries and treatments from both the Shelbourne Knee Center Research Program and studies published by other researchers.

While Dr. Benner and other researchers at SKC still use traditional methods to share their knee treatment research and learnings, the podcast enables them to offer more in-depth discussions of key issues and data. Instead of simply presenting results, the podcast allows researchers time to explain their earlier work and their process, methods and plans.

“Take a listen and give us some feedback,” says Dr. Benner. “We’re open to ideas and would appreciate your input.”

Listen or Subscribe Today

To listen to the podcast with Dr. Ballard, scan the QR code.

To subscribe or view all topics discussed on SKC’s podcast, search for “The Shelbourne Knee Center Podcast” on your favorite podcast app or visit https://bit.ly/SKCpodcast.

FixKnee.com: A Resource for Clinicians

AT SHELBOURNE KNEE CENTER, we’ve been conducting research for 40+ years. More than 13,000 of our patients have participated in follow-up surveys and exams. The result? A trove of clinical information related to treating knee injuries and disorders. We’ve made much of this material available to clinicians via our website, www.FixKnee.com. Visit to find a complete list of our published research (with links) organized by topic. Our website also features two blogs for clinicians, For Colleagues and For Professionals, which you’ll find under News + Resources. That section also hosts a Knee Treatment News page with links to digital flipbook versions of each issue.

Research-Backed Treatment for Rare Knee Injuries

Shelbourne Knee Center’s two orthopedic surgeons, K. Donald Shelbourne, MD, and Rodney Benner, MD, have had their research published in more than 160 medical journals and over 100 book chapters. To discuss a rare knee injury or other case with one of our surgeons, email skckneecare@ecommunity.com or call 888-FIX-KNEE (317-924-8636)

MEET OUR TEAM

ORTHOPEDIC SURGEONS

n K. Donald Shelbourne, MD

n Rodney Benner, MD

CLINICAL TEAM

n Jean Fouts, RN, BSN

n Lee Linenberg, CA

n Emily Guy, PA

PHYSICAL THERAPISTS AND ATHLETIC TRAINERS

n Bill Claussen, MPT

n Emma Sterrett, LAT, ATC

n Darla Baker, PT, DPT, ATC/L

n Sarah Eaton, PT, DPT, ATC, LAT

n Jennifer Christy, PT

n Alana Gillenwater, PT, DPT

n Bryanna McKinstry, PT

n Noah Runyon, PT

RESEARCH TEAM

n Scot Bauman, PT, DPT, PhD

n Diane Davidson, BS, MBA, CCRC

n Adam Norris, ACRP-CP

n Heather Garrison