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More personalized, accurate knee surgery with robotics

Vail-Summit Orthopaedics & Neurosurgery leads cutting edge, robotic assisted total knee replacements

By Kimberly Nicoletti
Brought to you by Vail-Summit Orthopaedics & Neurosurgery
ROSA provides surgeons with scientific data and precision that leads to improved outcomes for patients who undergo total knee replacement. (photo courtesy of Vail Summit Orthopaedics & Neurosurgery)
ROSA provides surgeons with scientific data and precision that leads to improved outcomes for patients who undergo total knee replacement.
Photo courtesy of Vail Summit Orthopaedics & Neurosurgery
About Nathan Cafferky, M.D. FAAOS

As a total joint surgeon who specializes in adult reconstruction, Dr. Cafferky focuses on hip and knee replacements at Vail-Summit Orthopaedics and Neurosurgery. A native of Portland, Ore., Dr. Cafferky attended medical school at Loma Linda University School of Medicine in Southern California and completed his residency and fellowship training in joints and adult reconstruction at the University of Colorado Anschutz Medical Campus. He serves as a U.S. Ski Team physician and a Team Summit Colorado physician.

Vail-Summit Orthopaedics & Neurosurgery has always been a leader in cutting edge surgery, and now it’s providing more personalized and even more accurate total knee replacements with its Zimmer Biomet Robotic Surgical Assistant (ROSA). 

Increased precision and data

Dr. Nathan Cafferky recently published a paper highlighting the benefits of using ROSA in the peer-reviewed journal “Case Reports in Orthopedics.” His study, which included five total knee replacements, showed how ROSA allows surgeons even more precise knee implant positioning by using real-time, scientific data to guide the accuracy of the surgeon’s work. For instance, ROSA lets surgeons know that the tension they place on each of the ligaments is exact and helps them make more pure bone cuts. Before ROSA, surgeons used their medical expertise to determine if ligament tension was appropriate



“Historically, surgeons have relied on their training, and have used a more subjective artistic approach to evaluation the ligamentous tension,” Cafferky said. “ROSA provides the surgeon with real-time objective data on the ligamentous balancing and gives the surgeon scientific confidence that the knee replacement is well balanced and personalized to each individual patient.”

“Conventional and robotic total knee replacement surgeries are very good at restoring alignment, but total knee replacement is functionally a soft tissue balancing surgery, so it comes down to what the surgeon feels is acceptable. Each surgeon’s assessment of a knee may feel different during surgery, but with robotics, we’re putting numbers on that feel,” Cafferky said. “I think that has been the missing link in total knee replacement surgery.”



Better patient outcomes

Prior to surgery, ROSA converts x-rays — rather than an expensive MRI or a high-radiation CT scan — into a three-dimensional representation of the knee. This allows physicians to map out a patient’s exact, and unique, anatomy before operating. 

The robotic data is especially important for patient satisfaction. Though most patients do very well with total knee replacements, nationwide, about 15% to 20% express pain, discomfort, mechanical sensations or stiffness. Granted, only about 10% of VSON patients express such dissatisfaction, but with ROSA, that number is expected to decrease.

Cafferky notes that ROSA helps provide a more scientifically balanced total knee, leading to highly satisfied patients who are able to successfully return to the activities they love, like skiing, hiking and cycling.

“Our patients already do better than national outcomes, but with robotics, we’re looking to do even better,” Cafferky said. “We’re seeing patients recover faster with less soft tissue trauma and not as much bleeding. Patients have a faster get up and go, faster range of motion improvements and less need for post op manipulations. They appear to be performing better than conventional total knee replacements and have a better quality of life, as far as athletics.”

So far, short-term recovery seems faster and patients appear more satisfied long term, but Cafferky will continue to follow up with long-term outcome studies.

“We’ll probably see faster recovery short-term, and more reproducible long-term outcomes, meaning a higher percentage of patients get back to a more satisfying lifestyle. However, prospective studies (are necessary) to see if we have scientific, statistically significance comparing conventional total knee replacement patients to ROSA assisted total knee replacement surgeries, because we are only a year into our study right now,” he said. “I’m actively involved in multi-center studies, looking at our patients’ outcomes.”

Leading the development of innovative surgical technology

Dr. Cafferky has been on the cutting edge of robotic surgical assistant technology; even before the FDA cleared it for use in total knee replacements in January 2019. He is a consultant for Zimmer Biomet and helped Zimmer Biomet evaluate the safety and accuracy of the ROSA total knee replacements through cadaveric studies and evaluations, which ultimately led to FDA approval in January of 2019. 

“ROSA was initially designed to be used in neurosurgery, due to its very small — 0.5 millimeter — margin of error, meaning that it is very safe,” he said. “My job in the early phases of cadaveric evaluation was to try to turn a Neurosurgery Robotic Arm into an Orthopaedic Robotic Arm. With great success, the FDA approved the ROSA in January 2019, and thus our patients at Vail Summit Orthopaedics and Neurosurgery are benefiting from this technology.”

In April 2019, Vail Health purchased the Zimmer Biomet ROSA, making it one of the first in the nation to acquire the technology. By the first week in May 2019, Cafferky had successfully completed his first robot-assisted total knee replacement. 

“I was one of the first users in the country, and world, to adopt this technology and have been seeing our patients benefit since,” Cafferky says. “Other surgeons from around North America, and around the globe are also seeing the benefits, and many visiting surgeons are coming to Vail to learn how we are improving our patient experience with ROSA.”

Cafferky has trained surgeons from across the United States and around the globe as they launch ROSA technology in their communities.

“It’s been a great privilege and experience to get to interact and train surgeons from around the world. Not only do I get to teach others, but these surgeons also get to teach me something as well,” he said.

ROSA, which is comprised of a base unit with a robotic arm, can position cutting guides for the most accurate bony cuts, and provide objective information on the ligamentous balancing at each step, but Cafferky is still doing and performing the surgery. Cafferky likens surgery before and after ROSA to “going from paper maps to GPS.”

“The most exciting aspect is the objective data I get during surgery,” he said. “The experience is much more streamlined, scientific, and more personalized. Now I can tell a patient with confidence that ‘your knee is scientifically balanced and personalized for you’. I have scientific evidence to support that.”


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