Latest / Becker’s Healthcare Digital Health + Health IT / Dr. David Homesley, Orthopedic Surgeon in Robotics

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Dr. David Homesley, Orthopedic Surgeon in Robotics · Becker’s Healthcare Digital Health + Health IT

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  - This is the Becker's Healthcare Podcast, created
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  Thanks for listening. Now here's the episode.
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  - This is Laura Dedo with the Becker's Healthcare Podcast.
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  I'm thrilled today to be joined by Dr. David Homesley,
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  an orthopedic surgeon at Novant Health.
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  Dr. Homesley, it's a pleasure
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  to have you on the podcast today.
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  - Well, thanks for having me
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  - Now, I'm looking forward to our discussion.
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  I know we'll talk a lot about some
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  of the new technology in the orthopedic space,
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  especially robotics and how the technology's evolving.
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  But before we dive into those questions,
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  can you tell me a little bit more
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  about yourself and your background?
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  - Yeah, I, um, I've been in practice for about 20 years
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  and I trained at the, uh, Rothman Institute, did
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  residency and fellowship there and finished in 2003.
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  And, um, I've been in Charlotte since 2004, um,
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  where I'm, uh, the chair of the orthopedic department
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  of Novant Health, uh, Presbyterian Medical Center, uh,
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  here in Charlotte, North Carolina.
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  And it's a big health system that's a non-for-profit, uh,
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  system that, um, supplies, uh, healthcare
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  and services to communities in Charlotte, Winston,
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  and Wilmington, North Carolina.
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  - Well, that's amazing to hear.
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  And you know, it seems like a huge, uh, department
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  to really be overseeing.
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  Um, from your perspective, could you talk a little bit about
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  how you're using robotics
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  and how that's changed the field of orthopedic surgery?
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  What have you seen as the advantages of using robotics?
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  - Um, I, I think that, you know, it's an evolving field.
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  I, I think that it's, I think
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  that the technology has improved
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  a lot over the last 10 years
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  or so, where it's a lot more efficient and it's giving, uh,
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  or I think it can give surgeons data in the operating room
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  that can make choices
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  or decisions for the patient, um,
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  specifically given their anatomy and,
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  and what their deformity is for, um, in, in particular
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  for like knee replacement planning.
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  - Well, that's fascinating to hear,
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  and certainly as you mentioned, I,
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  I know the technology has really evolved over the, um,
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  the past few years, especially to get to a place
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  where it's very sophisticated
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  and I hear it, you know, it can definitely be more precise
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  even than it was, you know, five, 10 years ago.
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  From your perspective, having all that data
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  and information, how does it change the way you think about
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  patients and, and, um, the level
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  of care you're able to provide?
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  - Well, I think, I think what I like about it is that,
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  you know, when we do a knee replacement
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  and, you know, he is trying to get a good,
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  well-balanced knee, um, that's essentially centered
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  underneath the hip and above the ankle.
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  And I think that we have really good accurate, uh,
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  alignment rods and tension devices to achieve that.
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  But I think what the robotic surgery does is it really helps
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  with the, um, equating that, I guess,
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  idea of feel factor
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  and tension devices to essentially numerical data
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  that then you can kind of translate into not only
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  what you're feeling but what you're seeing on the computer
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  screen in real time, that then you can position
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  the femoral component
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  and the tibial component to kind of match
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  that patient's, um, soft tissue laxity
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  or their knee, uh, motion, um, by not having
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  to potentially take more bone
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  or, um, release more tissue or and accommodate for that
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  before, even before you starting the surgery.
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  - Well, that's fascinating to hear and,
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  and really seems like a cool, um, technology to have,
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  have patients, uh, really appreciated having their,
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  their robot as part of the surgery?
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  Or is that something, you know, um,
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  that some are a little bit nervous about?
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  - I think, I think a lot of them like it
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  because they, I think they just feel that it kind
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  of gives you more data
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  and I think they, you know, um,
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  maybe trust the surgery just a little bit more.
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  I mean, I, I I will say that, you know,
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  when we we're doing surgery on patients, a lot of it, a lot
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  of what we do is from the confidence of,
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  of the patient with the surgeon
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  and that they have a more confidence,
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  I feel like they're gonna do better
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  and then they're not questioning as much.
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  So I think if they, they feel like, and I do,
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  and I do feel the,
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  the robotic surgery does give you more information
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  to be able to make better decisions about, like I said,
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  with the balancing of the knee.
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  And I think that if you kind of explain it, explain
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  to the patient that way, they, they feel more comfortable,
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  comfortable about, um, their outcomes.
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  - That makes a lot of sense, you know,
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  and really it seems like it would be, um, a valuable tool
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  to have, as you mentioned in the operating room.
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  Um, from your perspective too, is it now, you know,
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  most surgeons are learning about the technology
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  and learning about robotics
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  when they're going through training.
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  Um, how does that really affect new surgeons coming up now,
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  um, and really being able
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  to use the technology appropriately and,
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  and, um, be able to include
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  that within the care that they're delivering?
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  Do you see this as eventually becoming a standard of care
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  or how do you see robotics, um, moving forward?
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  - That, that's a, a great,
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  and I would say tricky question, uh, to
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  answer in the sense that that, you know, the,
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  the robotic surgery doesn't really do the surgery.
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  I mean, you have to know how to balance a knee
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  because, you know, I, I think that with the, the training
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  that we do through courses, um, through, um,
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  if you're already out in practice and,
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  and you, you do it, I would encourage a, you know,
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  to either, um, definitely, uh, work with a, a lab
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  where you can do it on cadaver
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  and if you have the opportunity to scrub with a, a surgeon
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  that's experienced to definitely do that
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  because what you'll probably find is, is based off
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  of your exposure and your experience.
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  'cause you know, I've, I've been doing 'em for five years
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  and I've done probably, I've done over a thousand of them
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  and every knee's a little bit different.
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  But what I think, what's what I have found is, is that
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  with the robotic surgery,
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  what I have found is very consistent with it, I find is, is
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  that the numbers that I'm seeing in the operating room
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  are probably particular to me in
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  what I do in the operating room.
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  And I think if another surgeon was doing the same robotic
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  system, they looked at those numbers,
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  they may not quite be the same based off of
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  what their exposure is and how they like their knee.
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  Some docs like their knee a little bit tighter
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  or some like a little bit looser based off of
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  where their starting point is.
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  Um, so, so I do find there's
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  definitely a learning curve from there.
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  And so it is definitely something to where
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  I think in the orthopedic training, you definitely gotta
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  have a lot of experience, you know, with the surgeon
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  who doesn't do the robot to understand how
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  to balance the knee because there'll be some nuances
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  that even when you do the robotic surgery, you'll get
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  to the end and you'll still have
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  to do some little tweaking with the balancing.
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  I, I find though, with the robotic surgery,
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  I'm finding I'm doing that less
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  and less with the robotic surgery.
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  So when I get to the end and I'm trialing it, I'm not having
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  to do, um, recutting it
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  or doing soft tissue releases where sometimes
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  with the manual you may have to do that.
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  And, and also what's neat about the robotic surgery,
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  if if you feel like you can't, you're not gonna be able
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  to accommodate it with a soft tissue release
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  or you're not happy with something.
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  What's neat about the robotic surgery is that if you have
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  to go back and recut something, it's, it's, um,
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  even more accurate of recutting than having
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  to put the cutting black, cutting blocks back on the knee
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  to, to refashion the cut.
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  Um, so I think some, there's some advantages to the robot,
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  but it, but it's not the end all be all.
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  I mean, you, you have to understand kind of the mechanics
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  of the way your knee, the way you like your knee replacement
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  and how the numbers that you get on the robotic surgery
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  translate to what you do.
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  - That makes a lot - Of sense. That
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  answered the question .
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  - Yeah. Yeah, no, I appreciate that.
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  Um, and I appreciate you getting into the nu nuances of it
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  because certainly, you know, there's a lot
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  to think about there and um, as you mentioned, being able
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  to understand the procedure, um,
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  in each surgeon's a little bit different in
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  how they prefer things to go.
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  So, um, that, that's really helpful information.
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  Now broadening it out a little bit, when you look at, um,
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  yourself and in, um, the orthopedics department at Novant,
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  how are you thinking about growth
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  and adding value to the organization overall?
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  What do you really see as being areas where you're going
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  to spend most of your time on over the next year or two?
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  - I, I would say I, I think most of it is, is, is just
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  taking care of taking, uh, good care of patients.
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  I, I think that, um, you know, the, the, um, the thing
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  with the robotic surgery, I think is, it's a, it's a,
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  it's a really, um, neat technology
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  and I think that as the, the word gets out
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  and patients, you know, learn about it, you know,
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  I think it is something that that helps, um,
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  with, with the outcomes.
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  And I think it's, it's neat to stay on top of the,
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  the technology
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  but also to explain to patients too that in hip
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  and knee replacements we've got such good technology,
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  it's hard to say what the, the newest stuff
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  that's coming out's gonna be the best for them
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  because we need about 10 years of data to show that
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  what we've been using is, is good and,
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  and is better than what we're currently using now.
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  And I think we're getting, we have enough data now to show
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  that with the robotic surgery, it's definitely the same
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  as the traditional way of doing it.
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  And I think as we kind of move forward,
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  we're probably gonna find that I think it's, you know,
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  it'll be, um, if not equal, better in the sense
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  of consistency, consistency for patients.
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  So I think, I think that part's neat, neat for patients,
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  you know, just trying to stay, staying up
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  with the technology and you know, just kind of explaining
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  to patients what's out there because they do get a lot
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  of information off the internet.
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  And part of our job that's frustrating is it is sometimes
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  'cause of what comes out in the, in the internet is just to
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  explain it to 'em in a, you know, in a, um, in a way
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  that they understand that that's kind of best for them.
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  - I can imagine that there, you know,
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  sometimes it's misinformation
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  and sometimes the marketing hyperbole that gets in there.
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  Um, you know, and it can become tiring to, to continue
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  to explain that to patients.
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  But such an important lesson in, in part
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  of your interactions with them.
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  Um, you know, do you ever get patients coming in asking
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  about robotics or really
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  wanting that to be part of their care?
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  - Yeah, I think they do because they, they, they,
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  they're starting to hear about it more
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  and they just kind of wanna know, um, what's out there
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  as far as the tech technology goes.
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  And I think part of that is a little bit word of mouth.
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  Sometimes it's even, um, you know, um,
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  with the patients, um, being referred for from their, um,
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  doctors and um, you know, kind of just wanting to know kind
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  of what's out there to give them the best possible
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  outcome that they can get.
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  And I think, I think that one
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  of the neat things about working at, um, Novant is,
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  is they kind of all, uh, um, you know, working as a team to,
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  to try to make the best possible results
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  they can for the patient.
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  And you know, that kind of starts from the nurses,
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  the physical therapists, the anesthesiologists,
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  and you know, I think that gives us some really good
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  outcomes to where, you know, we've, we've become, um,
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  a partner with, uh, Carrum Health,
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  which is like a digital health company that kind
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  of looks at the top 10% of providers, you know,
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  based off of their outcomes.
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  And we've been lucky and,
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  and fortunate to be able to partner with them.
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  And so that's gathered more patients too, um, with, for, um,
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  hip and knee placements.
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  - Absolutely. That's great to hear. And you know,
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  you also mentioned some of the misconceptions.
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  Is there one common thing
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  that people come in thinking that just isn't true?
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  - I would say as far as a knee replacement goes,
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  they come in thinking that the knee is gonna, you know,
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  fix all their problems
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  and once we put the knee in it is gonna feel like a normal
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  knee and they'll never know it's a knee replacement.
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  And what I try to explain to patients is regardless of
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  how well aligned or how well balanced it is,
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  they'll probably always know it's an artificial knee.
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  'cause it just doesn't move like a normal knee, regardless
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  of the implant that you use.
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  Um, it's, you know, obviously usually better than the
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  arthritic knee, um, where you can, you know,
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  do activities on it, um, that, um, you know,
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  that they can't do on their arthritic knee.
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  Um, and so that's something they've gotta, uh, uh, try to,
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  I try to, uh, explain to the patient
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  where the hip replacement, a lot of patients, you know,
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  they'll forget which hips replace
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  and the rehab's not as hard
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  and other than some maybe numbness over the incision,
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  they'll may forget which hips replaced.
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  But a knee, a knee, the complexity of it's just
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  so much the way it moves, it's so hard to reproduce
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  with a knee replacement that most patients will kind
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  of know it's an artificial knee.
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  - Got it. That, that's really interesting to hear and,
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  and definitely, um, good to know.
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  Now, is there any other technology that you use and,
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  and really feel like is cutting edge
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  or on the forefront of, of, uh, where orthopedics is headed?
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  - I, I, I, I've, I've probably over 10 to 13
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  or 14 years I've been using, um, um, uh,
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  with some knee replacements.
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  I've been using uns cemented knees or pre FITT knees.
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  Um, I've had really good results with those.
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  Um, and those are, you know, when we do a knee replacement,
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  a lot of times we'll cement it to the, um, end of the femur
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  and the, the tibia.
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  Um, but I've been also,
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  but I've been doing a lot of, um,
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  what's called press fitt knees, where there's bone on growth
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  so you don't have to use cement.
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  Um, and I, I like that technology a a lot, um, and it,
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  and it's been good to me
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  and my patients, so I've continued to do those
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  and been doing, um, more
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  and more of those, uh, CrossFit needs.
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  - Well, that's awesome to hear.
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  Thank you for sharing that with us.
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  Now, before we wrap up,
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  I'm wondering are there any other areas where you see it
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  as being really primed for growth
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  and development in orthopedics going forward?
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  - I, I think, I think that, um, you know, I,
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  I think it's just, it's, it's something where, like I said,
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  with the hip and knee replacements,
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  our technology's really good currently where we think,
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  you know, hopefully they're gonna last 20 to 30 years.
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  So it's hard on new technology to come out to,
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  to jump on that bandwagon.
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  And I think that, you know, a lot of surgeons did
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  with the metal and metal
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  technology with the hip replacements.
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  'cause in the lab, you know,
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  it looked like it was gonna do well
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  and then there are patients that didn't do well with those.
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  Um, so I think that, you know, it's being careful
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  but also kind of looking at, um,
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  the outcomes of the patients.
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  And I, I think that, you know, kind of back
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  to the question you just asked me, the other,
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  the other thing I'd find, not necessarily technology,
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  but um, it's more, uh, too of what are the
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  outside modalities that we can utilize
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  to help the patient have a better outcome
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  with their physical therapy and activity level.
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  And so I think that's kind of a team approach
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  and doing things like, um, you know, peripheral nerve blocks
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  and regional anesthesia, um, different types of, um,
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  you know, uh, medications that we use, um, interop
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  and post-op to help the patient be able to kind
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  of do their physical therapy a little bit easier, um,
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  which can improve their outcomes.
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  - Fantastic. Well, Dr.
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  Homesley, thank you so much for joining our podcast today.
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  This has been really a fun and interesting conversation
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  and I look forward to connecting with you again soon.
• 15:53
  - Sure. I appreciate you having me.
• 15:57
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