LEFT Dr.
Greg Rennirt is an orthopedic surgeon with KentuckyOne Health Orthopedic Associates specializing in sports medicine and shoulder repairs and is the physician market leader of the West Market (Louisville area) for KentuckyOne Health. RIGHT Dr. Arthur L. Malkani, orthopedic surgeon with Shea Orthopedic Group, part of KentuckyOne Health, started Jewish Hospital’s total joint program in 1997 and now performs total hip and partial knee replacement using the Mako robotic system.
Medicaid bundled payment program. (For more information, see the sidebar Bundling Payments, Improving Outcomes on page 12.) “Probably the biggest difference in what KentuckyOne can offer versus all the other orthopedic surgeons in Kentucky is our total joint program. What we have in our total joint program through our bundled payment program with CMS is really unique,” says Rennirt. “We’ve significantly improved outcomes. We’ve dramatically cut length of stay. We’ve cut the cost of surgery. Patient satisfaction is through the roof. That really is a differentiator.”
Robotic Perfection
Redesigned transitions of care and changing reimbursement models are only part of the equation for KentuckyOne’s total joint program. The addition of robotic hip and partial knee replacement is revolutionizing outcomes and has the potential to exponentially increase the lifespan of implants. While robotic joint surgery has been around for several years, it has been slow to
The Mako robotic system uses pre-operative CT scans along with intraoperative tracking to allow surgeons to place implants perfectly ever time.
come to Kentucky. However, in December 2015, Jewish Hospital was the first in the area to launch a robotic joint replacement program with the MakoPlasty™ Interactive Orthopedic System, a product of Stryker®. For Stryker, the Shea Orthopedic Group, part of KentuckyOne Health, was the fastest launch in company history in terms of the number of patients who had robotic surgery within the first 90 days. Now six months into the robotic program, orthopedic surgeon Arthur L. Malkani, MD, who began Jewish Hospital’s total joint program in 1997 and is with Shea Orthopedic Group, says he and a fellow surgeon have done a total of approximately 65 robotic surgeries, about 50 of which have been hip replacements and 15 of which have been partial knee replacements. Robotic total knee replacements
were recently approved by the FDA, according to Malkani, and he hopes to have that technology at Jewish Hospital by the end of the year. Using a pre-operative CT scan to map the patient’s anatomy, the Mako robotic system provides surgeons real-time information on correct implant size, position, and leg length to allow perfect placement every time. Malkani likens the robot to using GPS navigation in your car. “GPS is telling me where to go, but I’m driving the car,” he says. With the robot, “If I deviate, it just shuts off. It’s so precise. I can’t imagine doing this surgery without the robot now.” One hundred percent of Malkani’s hip and partial knees replacements are now being done with the robot. For hip replacements, his preference is the direct superior approach, but he says the important thing to note is, “The robotic system can do hips from any position you want based on the patient’s needs and best interests.” With traditional partial knee replacement, the procedure is only perfect an average of 70 percent of the time. With the robot, precision jumps to 95 percent. “It takes the stress out of surgery when you have a system that’s extremely accurate in telling you what size you need and where to go,” says Malkani. Very active 74-year-old Paula Hammer had a total knee replacement done by Malkani in 2010 before the Mako robot was available. She returned to Malkani because of pain in her other knee, and he opted to do a robotic partial knee replacement in January 2016. While Hammer admits she babied her first knee after surgery, she was walking the Masters Tournament three months post-op. This time, however, her results were even better. “The other knee I woke up and I was groggy and ISSUE#101| 11