Narrator: Coming up on Mayo Clinic Q&A, for those who are
suffering from severe arthritis pain in the knee joints, knee
replacement is a viable option to improve a person's quality of
life. Today on Mayo Clinic Q&A, we'll look at augmented reality
and how this new technology is helping patients achieve
long-term success from knee replacement surgery.
Dr. Michael Taunton: The benefits of this augmented
reality system is that we can make more precise and accurate
bony cuts and make the angles more correct to make the limb
more straight. What we want to do is reduce the outliers so we
can more efficiently and more precisely do their knee replacement.
Dr. Halena Gazelka: Welcome, everyone to Mayo Clinic Q&A. I'm
your host, Dr. Halena Gazelka. Osteoarthritis is the most
common form of arthritis affecting millions of people
worldwide, and most commonly affects joints in your hands,
knees, hips and spine, and the symptoms can often be managed
with non-operative treatments, but damage to joints cannot be
reversed, and sometimes joint replacement is necessary.
Orthopedic surgeons now have a fascinating new tool in the OR,
augmented reality knee replacement. And I can't wait to
learn about this with you today. So, we have orthopedic surgeon
Dr. Michael Taunton from Mayo Clinic, here to talk with us.
Welcome, Michael.
Dr. Michael Taunton: It's good to be here. Thank you for having
me.
Dr. Halena Gazelka: I just love the things that I learn doing
this podcast. And so, I'm very excited to ask you what in the
world is augmented reality? And what does it have to do with
knee replacements?
Dr. Michael Taunton: Well, so augmented reality, think of a
fighter pilot in a jet that has a visor over their eyes that's
displaying electronic data that is overlaid over what they're
seeing in the real world. So, don't confuse this with virtual
reality that your kids have at home, that they're playing video
games with their eyes covered. This is typically some sort of
glasses or helmet-based visor that's displaying information in
front of your eyes that's rendered digitally that is being
processed from a computer to give you additional information
or for entertainment purposes, you know, some other display in
front of your eyes.
Dr. Halena Gazelka: So, do you wear goggles?
Dr. Michael Taunton: So, for this particular system that I
use, it is a helmet-based visor that is placed over part of our
vision. So, as a surgeon I definitely want to have an
unobstructed view of what I'm seeing while I'm operating. This
system has a visor in front of my eyes also that's projecting
digital information in front of my eyes outside of the area
where I'm specifically operating.
Dr. Halena Gazelka: So, how does augmented reality help you do
knee replacements, Michael?
Dr. Michael Taunton: So, for a while we've had computer
assisted surgery where we've been able to take data from the
patient's own leg and enter that into a computer and have it
display some of this information displayed for us to help us
understand how best to remove the correct amount of bone in
the right angle to make the knee replacement fit better and have
better alignment of the limb after surgery. The problem with
some of those computer assisted programs is that there is a
screen that we're looking at across the room, or a computer
that we're looking at across the room, so that we're having to
take our eyes off the patient. And also to collect some of that
data, we're having to use instruments or a computer across
the room and cameras across the room, that we're having to take
our eyes off the patient to collect data. In this system all
of that information is being gathered by the helmet-based
system. So, there's actually in addition to a projection from
the helmet-based system, there's also cameras that are recording
information from sensors on the patient's knee, so that all of
the information is being gathered by the helmet-based
system and then displayed to me on the helmet-based system.
Dr. Halena Gazelka: That's truly fascinating. The
anesthesiologist in me, as a resident I remember watching
many, many knee replacements and thinking how incredibly, I was
amazed at how precise you have to be with the angles and the
cuts that you make so that the replacement fits. That sounds
amazing.
Dr. Michael Taunton: Yeah, it's really, you know, the next step,
what we see in in orthopedic surgery is the ability to get
real-time feedback in what we're doing, while keeping our eyes on
the patient, and not having to have, you know, large pieces of
machinery come in and out of the room to help us with our
surgery.
Dr. Halena Gazelka: Does it make it more precise then, Michael?
Dr. Michael Taunton: Well, that's hard to say right now.
So, this technology used in knee surgery has only been around for
the last couple of years. We did the first augmented reality
case with this system this fall here at Mayo that had never been
done before. So, this is, you know, really innovative in that
we don't have data to say long-term this is going to, you
know, change the patient's outcomes. We need more
information.
Dr. Halena Gazelka: So, Michael I imagine this is an area you're
still studying. So, how do you decide if an individual might be
a candidate for an augmented reality knee surgery versus the
more traditional way you've done this?
Dr. Michael Taunton: Yeah. So, let me explain a little bit
about how traditional knee replacement is done. People say,
well, okay, you're using this, how was it done before? Well, in
traditional knee surgery, replacing mechanical alignment
jigs on the leg, and then using those to determine the alignment
and the sizes of the implants. So, in augmented reality, and
these computer systems, we're collecting digital data, the
shape of the bone, the alignment of the leg, and then the
computer is assisting us with that information, and then
displaying where we should cut back onto the screen. So, those
mounts and angles are being determined by the computer. So,
right now, for just about any first time knee replacement, any
patient would be a good candidate for augmented reality.
In some more complex situations or revisions where we haven't
been able to test the system on these situations, or there isn't
enough bone to make these measurements that we need to
make, then they wouldn't be a very good candidate.
Dr. Halena Gazelka: Michael, I'm curious, I'm trying to picture
this. And I'm curious if it's inside your helmet and you're
seeing it does movement of your head make a difference when
you're looking at the knee?
Dr. Michael Taunton: Yeah, so the system is really incredible
in that when you move your head it moves with you, and you can
set through the system where you want your information to be
displayed. But it knows when you move your head. So, it's moving
the information to keep it in the same area of your visual
field no matter where you put your head.
Dr. Halena Gazelka: That is absolutely fascinating.
Dr. Michael Taunton: And you can actually move the cursor with
your head so that you can select menu items by moving your head.
It's also really cool because it incorporates voice recognition
through an artificial intelligence algorithm so that
it knows what you're saying. So, I can tell it, go to the next
step, or go back a step, or I'm ready to place the guide. And it
will go, you know, through the menu. I can tell it to turn the
light on because it has additional lights to help
illuminate the field. I can say, turn the light on, and it will
turn on the light.
Dr. Halena Gazelka: Michael, what are the benefits of using
augmented reality for knee replacement or for a patient
undergoing that procedure? And are there any potential
downsides?
Dr. Michael Taunton: So, the benefits of this augmented
reality system is that we can make more precise and accurate
bony cuts and make the angles more correct to make the limb
more straight than we did before. Not that we weren't
before. But what we want to do is reduce the outliers and make
that precision more. So, that's where patients can benefit as we
can more efficiently and more precisely do their knee
replacement. The downsides? Well, it's new technology. But
we actually feel like this is a technology where we can become
more efficient with the surgery and actually it not take us as
much time because we're not having to use all the mechanical
guides. So, we think with time it's actually going to be a time
saver. And then if we can prove later on that the outcomes are
better. Well, if we reduce further surgeries or, you know,
complications with patients, we can, you know, improve their
ability to return to their activities of daily living for a
longer period of time, and then reduce healthcare costs as well.
Dr. Halena Gazelka: Speaking of which, do you see any
differences in length of hospital stay, recovery, or
rehab for people who undergo augmented reality versus
traditional knee replacement?
Dr. Michael Taunton: It's really hard to say at this point, I
would say thanks to our collaboration with our
anesthesiologists, who are wonderful here at Mayo, we've
been able to reduce the length of stay through multiple
different things through our post-operative protocols, pain
management, and the spinal anesthesia, etc. We've been able
to make huge strides. So, we hope that reducing the length of
surgery, and the amount of tissue trauma that we have to
create through using these kinds of systems, that we can further
increase their outcome and reduce their length of stay, and
pain, and rehabilitation.
Dr. Halena Gazelka: Michael, is this technology widely available
at this point?
Dr. Michael Taunton: No, it's not. We are one of the few
centers that is working on this at this point. So, this is a
limited access. At this point, I'm one of the few surgeons in
the world that's doing this.
Dr. Halena Gazelka: Oh, fascinating. And it strikes me
as so many things in medicine, and in surgery in particular,
the more of them that you do the better you are likely to be at
it. So, patients would want to go to a center where someone was
gaining quite a bit of experience?
Dr. Michael Taunton: Yeah, I think practice makes perfect.
And, you know, I focus my entire practice on hip and knee
replacement. That's all I do. And we've been able to show in
our data that we're able to do these types of procedures more
efficiently with a lower complication rate than if you're
not doing as many, or if you haven't done as many.
Dr. Halena Gazelka: Will this be coming to other joint
replacement surgeries as well?
Dr. Michael Taunton: Yeah, so we were focusing on knee today, but
I'm also using it on hip replacement surgery to help more
accurately place those implants and recreate the leg length and
offset in hip replacement, you know, the length of the leg and
the position of the femur relative to the pelvis.
Dr. Halena Gazelka: Wonderful. Thank you for sharing this with
us today, Michael. It's fascinating.
Dr. Michael Taunton: Yes, it is. And thank you for having me.
Dr. Halena Gazelka: Our thanks to Mayo Clinic orthopedic
surgeon, Dr. Michael Taunton, for being here today to talk
about augmented reality used in knee replacement surgery. I hope
that you learned something. I know that I did. And we wish
each of you a wonderful day.
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